'My pet can't come with me': Pets as a barrier against moving into supported accommodation

OBJECTIVE

To determine the impact of pet ownership on older people's decision to move to supported accommodation.

METHODS

Online survey.

RESULTS

Older Australians who were current or past pet owners were invited to complete an online survey, with 193 participants providing valid data. Almost two-thirds of the respondents who said they did not intend to move in the foreseeable future (n = 85) said their pet was an important reason. When asked to rate which factors would be hardest to come to terms with if they had to move because they needed more assistance in future, three groups emerged: the first group (37%) thought the impact on their pet of moving would not be difficult and the pet was not an important reason for staying in their current home. The second group (36%) were the opposite; they believed there would be a negative impact on their pet if they moved and the pet was an important reason for them to stay. The final group (27%) thought their pet was not an important reason to stay in their current location but if they did have to move, the impact on the pet would be quite difficult. No one fell into the category of identifying that their pet was an important reason to stay but having to move would have no impact on the animal.

CONCLUSIONS

Many older people think about their pets when making a decision to move house, including considering whether a move to supported accommodation will be difficult for their pet. A perceived absence of pet-friendly supported accommodation may be contributing to sub-optimal decision-making by older people.

New Zealand rickettsia-like organism and Tenacibaculum maritimum vaccine efficacy study

A cohort of Chinook salmon juveniles was vaccinated, with an autogenous bivalent vaccine against New Zealand RLOs (NZ-RLO1) and Tenacibaculum maritimum. A proportion of the cohort was not vaccinated to act as controls. At smoltification, the fish were challenged with NZ-RLO1, NZ-RLO2, or T. maritimum. We found that challenge with T. maritimum by immersion in (7.5 × 105  cfu/mL of water) did not yield any pathology. Challenge with RLOs produced clinical signs that were more or less severe depending on the challenge route, dose or vaccination status. Survival was significantly higher for vaccinated fish within the groups challenged with NZ-RLO1 by intraperitoneal injection with a relative percent survival (RPS) of 48.84%. Survival was not significantly different between vaccinated and non-vaccinated fish for groups challenged with NZ-RLO2 by intraperitoneal injection or by NZ-RLO1 by immersion. Yet, anecdotally the clinical disease presentation (manifesting as haemorrhagic, ulcerative skin lesions) was more severe for the non-vaccinated fish. This study demonstrates that autogenous vaccine against NZ-RLO is protective against severe disease and death by NZ-RLO1 challenge which warrants implementation and further evaluation under field conditions. Yet, this study also highlights the importance of the route of administration and dose when evaluating pathogenicity and vaccine efficacy.

Solutions-Based Approach to Urban Cat Management-Case Studies of a One Welfare Approach to Urban Cat Management

Urban free-roaming cats create concern about their impacts on wildlife and human health, leading to the use of trap-adopt-kill methods to manage these populations. This method is ineffective at decreasing the free-roaming cat population and has a negative impact on cat caregivers' well-being. Using semi-structured interviews, this study explored the relationship that semi-owners (people who feed cats but do not perceive ownership) and owners of multiple cats have with the cats they care for, and the social and psychological impacts of an alternative assistive-centered approach to urban cat management. This approach to semi-owned and owned cats provided free sterilization and preventative healthcare. Our findings demonstrate that the caregivers had a strong emotional bond with the cats they cared for. The caregivers also experienced a positive impact on their quality of life, and indicated an improvement in the cats' welfare after having the cats sterilized through this program. Additionally, the cat caregivers indicated that they had a negative view of agencies, such as the municipal council. It is recommended that an assistive-centered approach to urban cat management be prioritized by local councils and welfare agencies to improve caregivers' quality of life and psychological well-being, whilst also improving cat welfare. The implementation of this assistive-centered management approach could improve the relationship between communities and the agencies involved, leading to the continuous reporting of free-roaming cats for sterilization. This assistive-centered approach has the potential to reduce the free-roaming cat population, their effects on wildlife, nuisance complaints, and council impoundments, and is aligned with the One Welfare philosophy.

Scent detection dogs as a novel method for oestrus detection in an endangered species, the Tasmanian devil (Sarcophilus harrisii)

Captive breeding is a critical tool for conservation of endangered species. Identifying the correct time to pair males and females can be a major challenge for captive breeding programmes, with current methods often being invasive or slow. Detection dogs may provide a non-invasive way to determine female receptivity, but this has not been explored in captive wildlife. This exploratory study investigated the use of detection dogs as a novel method of oestrus detection in the endangered Tasmanian devil (Sarcophilus harrisii). Faecal samples were collected from 11 captive female devils during the breeding seasons of 2020 and 2021. Three dogs with prior detection experience were trained and subsequently assessed (n = 188 searches per dog), on their ability to discriminate between oestrus and non-oestrus devil faecal samples, in a one sample set-up. When assessed on training samples, dogs were able to correctly discriminate oestrus from non-oestrus with a mean sensitivity of 69.1% and mean specificity of 65.7%. When assessed on novel samples, their sensitivity to oestrus dropped (mean sensitivity of 48.6%). However, they were still able to correctly identify non-oestrus samples (mean specificity of 68.1%). This study is the first to explore detection dogs' ability to identify oestrus in a captive breeding programme for endangered wildlife, providing a promising tool for non-invasive monitoring of reproductive status in wildlife.

Can Interacting with Animals Improve Executive Functions? A Systematic Review

There has been growing interest in the potential benefits of using human-animal interactions to improve executive functions: cognitive processes that allow individuals to plan, solve problems, and self-regulate behaviour. To date, no comprehensive review has been conducted. The purpose of this study was to evaluate existing literature, adopting broad inclusion criteria. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 16 papers were identified from peer-reviewed literature. Additional papers were identified from grey literature, including 6 dissertations and 1 thesis. A review of these 23 studies found that human-animal interactions and executive functions are investigated in three main ways: (1) exploring the potential benefits of the human-pet relationship, (2) exploring the impact of an animal's presence during administration of executive function tests, and (3) evaluating the efficacy of animal-assisted services (e.g., animal-assisted therapy) on executive functions. Five of the included studies reported a significant improvement across all measured domains of executive functions, but effect sizes were underreported. Comparatively, 9 studies reported mixed findings, d = 0.32-0.55, while 8 studies reported no significant results. The overall rigour of the research was limited, with great heterogeneity between the study methodologies and outcome measures used. It is recommended that future studies utilise high-quality research methodologies through the use of randomisation, pre- and postmeasures, and appropriate control conditions, where possible.

Executive Functions as Measured by the Dog Executive Function Scale (DEFS) over the Lifespan of Dogs

Executive Functions (EFs) are needed for effortful self-regulation of behaviour and are known to change over the lifespan in humans. In domestic dogs, EFs can be assessed through behavioural rating scales, such as the Dog Executive Function Scale (DEFS). The primary aim of this study was to investigate whether the DEFS, developed initially using a sample of adult dogs, can be used in juvenile (<1 year) and senior (>8 years) dogs. Confirmatory factor analysis of a juvenile and senior dog sample led to good model fit indices, indicating that juvenile and senior dogs' EF structure follows the same functional organisation as found in the DEFS. The secondary aim was to analyse the lifespan development of EFs. Analysis of subscale scores revealed multifaceted relationships with age for four subscales. Working Memory and Attention Towards Owner showed the u-shaped curve traditionally associated with the lifespan development of EFs. Forms of inhibition showed complex associations with age, i.e., Delay Inhibition declined in aging and Motor Regulation increased during aging. Training history and Working Status influenced performance independent of age. More highly trained dogs and working dogs exhibited higher EF skills. Training history appeared more important for EF in non-working dogs than working dogs, perhaps because all working dogs receive a high level of training.

Pet management practices of frog and turtle owners in Victoria, Australia

BACKGROUND

Available empirical evidence suggests that pet animals do not always experience an optimal welfare state. However, most pet welfare research has focused on dogs and cats, with less research investigating amphibians and reptiles. The aim of this study was to characterise how owners of pet frogs and turtles in Victoria, Australia, attempted to meet their pets' welfare needs.

METHODS

Pet frog owners (n = 128) and turtle owners (n = 60) completed an online survey, comprising questions about how they managed their pets' environmental, behavioural, social, nutritional and physical health needs.

RESULTS

For both frogs and turtles, positive and negative welfare indicators were found. Owners described pet enclosures as waterproof and escape-proof. However, fewer than 20% of owners of either pet type had an enclosure size that met the minimum standards described in the relevant Code of Practice.

LIMITATIONS

Because this study relied on self-reporting, future research should directly observe animals under household care to provide a more objective measure of welfare.

CONCLUSION

Pet frogs and turtles in Victoria, Australia, may not always be experiencing an optimal welfare state, despite their owners' stated desire to care for them as well as possible.

The Effect of Dog Presence on the Therapeutic Alliance: A Systematic Review

The development of a therapeutic alliance represents one of the most important processes that occurs in psychological therapy and is one of the strongest predictors of treatment outcome. To ensure the effective delivery of psychological interventions, it is important to explore factors which may improve the therapeutic alliance. There are well-documented effects of human-animal interactions in social settings, and researchers have also considered the effect of dog presence on the therapeutic alliance. A systematic review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. Database searches included CINAHL, Cochrane, Embase, MEDLINE, PsycINFO, and Scopus. The inclusion criteria were studies that assessed the effect of dog presence on the therapeutic alliance and provided a quantitative outcome measure. Six studies met the inclusion criteria and were included in the systematic review. Three of the included studies observed no significant effect of dog presence on the therapeutic alliance; three studies did observe a positive effect, with effect sizes ranging from d = 0.10 to d = 0.58. All six studies took place in either research or clinical settings. Studies differed in terms of help-seeking versus non-help-seeking populations, where help-seeking populations were genuinely pursuing a psychological intervention. Heterogeneity was observed regarding study procedure and outcome measures used. Current data is limited, and initial evidence suggests that the effect of dog presence on the therapeutic alliance remains unclear, illustrated by inconsistent outcomes across the included studies. Further research is warranted before introducing dogs into therapeutic settings for this purpose.

Defining Terms Used for Animals Working in Support Roles for People with Support Needs

Simple Summary

Although animals are being employed for a growing number of roles to support people, the terms used to describe those animals (e.g., “therapy animal” and “emotional support animal”) can be confusing. The same term may be used to describe different types of work, or the same role can be described with different terms. This paper presents the results of a collaboration between over 100 researchers, practitioners, and end users of animal-based supports from all over the world. We created working definitions for the following nine terms: “assistance animal”, “companion animal”, “educational/school support animal”, “emotional support animal”, “facility animal”, “service animal”, “skilled companion animal”, “therapy animal”, and “visiting/visitation animal”. In this paper, we describe the defining characteristics of each animal type and how it is different from the other types. We recommend phasing out the terms “skilled companion animal” and “service animal”, because they are similar to other terms. We discuss how our definitions may be received in different parts of the world.

Abstract

The nomenclature used to describe animals working in roles supporting people can be confusing. The same term may be used to describe different roles, or two terms may mean the same thing. This confusion is evident among researchers, practitioners, and end users. Because certain animal roles are provided with legal protections and/or government-funding support in some jurisdictions, it is necessary to clearly define the existing terms to avoid confusion. The aim of this paper is to provide operationalized definitions for nine terms, which would be useful in many world regions: “assistance animal”, “companion animal”, “educational/school support animal”, “emotional support animal”, “facility animal”, “service animal”, “skilled companion animal”, “therapy animal”, and “visiting/visitation animal”. At the International Society for Anthrozoology (ISAZ) conferences in 2018 and 2020, over 100 delegates participated in workshops to define these terms, many of whom co-authored this paper. Through an iterative process, we have defined the nine terms and explained how they differ from each other. We recommend phasing out two terms (i.e., “skilled companion animal” and “service animal”) due to overlap with other terms that could potentially exacerbate confusion. The implications for several regions of the world are discussed.

O-252 Next generation sequencing analysis of the seminal microbiome in male partners of women with idiopathic recurrent pregnancy loss: results of a prospective cohort study

Study question

Is there an association between the semen microbiome, seminal reactive oxygen species (ROS) and DNA fragmentation in men with recurrent pregnancy loss (RPL)?

Summary answer

This pilot study outlines the subtle role that microbiota play in influencing ROS and sperm DNA damage for male partners of women with RPL

What is known already

RPL is defined as the loss of two or more consecutive pregnancies. This devastating condition impacts approximately 1% of couples. Paternal causes are not routinely screened for and an underlying cause is not found in up to 50% of cases. Recent studies have reported an association between elevated seminal ROS and sperm DNA fragmentation in the male partner, and RPL. We hypothesised that seminal microbiota contribute to increased ROS and sperm DNA damage. To test this, we investigated the relationship between seminal bacterial composition and ROS levels in men with proven fertility versus men with a history of RPL.

Study design, size, duration

We conducted a prospective, case-control study and recruited participants between November 2018 and March 2020 at Imperial College Healthcare NHS Trust. A total of 109 men participated in the study; 46 men with RPL and 63 men with proven fertility and no history of RPL. Each participant attended for a single study visit which consisted of a full medical history, assessment of testicular volume, height, weight, blood samples and production of a semen sample.

Participants/materials, setting, methods

Routine semen analysis (WHO) and endocrine and lipid profiles were performed for all patients. Semen ROS and DNA fragmentation were performed (luminol and TUNEL methodologies, respectively). ROS were classified as high (&gt;3.77 RLU/s) or low (&lt;3.77 RLU/s). Metataxonomic profiling of samples was performed using Illumina Miseq-based sequencing of the V1-V2 hypervariable regions of bacterial 16S rRNA gene amplicons. Multivariate and univariate modelling was performed to explore associations between metataxonomic profiles, ROS levels and clinical metadata.

Main results and the role of chance

Men with RPL had higher mean semen volume (p = 0.02) and increased prevalence of high ROS (p = 0.02, Fisher's exact) compared with controls; but other clinical characteristics were similar between groups. A total of 3,700,136 high quality sequence reads were generated for the dataset with an average of 33,946 reads/sample. Hierarchical clustering of bacterial genera relative abundances identified 4 distinct microbial signatures characterised by high relative abundance of 1. Streptococcus, 2. Lactobacillus and Gardnerella, 3. polymicrobial (including Prevotella), and 4. Corynebacterium and Finegoldia. Prevalences of these groups were similar in control and RPL groups (p = 0.11). Additionally, no association between the bacterial genera groups and elevated ROS, DNA fragmentation, or clinical factors such as age, ethnicity, or semen volume were observed (chi-square tests). At species taxonomy level relative abundance of L. crispatus was higher in controls compared to RPL, but did not withstand false discovery rate correction for multiple testing (p = 0.006, q = 0.67). Higher relative abundance of Microbacterium was detected in semen samples with high DNA fragmentation (p = 8.7E-4, q = 0.08). This relationship was even stronger within the RPL cohort (p = 2.8E-5, q = 0.002). No significant enrichment of specific taxa was observed between high or low ROS samples however, low ROS was associated with Corynebacterium relative abundance &gt;20%.

Limitations, reasons for caution

More patients are required to enhance statistical power. Duplicate sample collection may establish the robustness of seminal compositions observed. Time since last sexual intercourse samples may affect the analysis. Concomitant analysis of the vaginal microbiome of female partners may improve our understanding of how partners may affect each other’s fertility.

Wider implications of the findings

Our data suggests interactions between microbiota composition, ROS and sperm DNA damage which may be implicated in the pathogenesis of recurrent miscarriage. Further studies are needed to determine if seminal microbiota play causal roles in RPL, and whether interventions modifying the seminal microbiome may modify pregnancy outcomes in affected couples

Trial registration number

not applicable

Predictors of Professional Quality of Life in Veterinary Professionals

Working in the veterinary profession can be both stressful and rewarding. High workloads, long work hours, emotionally charged interactions with clients, and exposure to animal suffering and participation in euthanasia place many at risk of compassion fatigue, which then threatens their professional quality of life (ProQOL). Despite this risk, many veterinary professionals choose to stay within the profession. This study explores personal and organizational factors predicting compassion satisfaction (CS), burnout, and secondary traumatic stress (STS) in veterinary professionals, and the extent to which these aspects of ProQOL are linked with intentions to leave the profession. Regression results show that personal factors accounted for 31.1% of the variance in CS, 45.3% in burnout, and 33.8% in STS. Organizational factors significantly accounted for 33.3% of the variance in CS, 47.9% in burnout, and 32.7% in STS. Together, ProQOL accounted for 28.9% and 16.0% of the variance in intentions to leave one's current role and to leave the profession altogether, respectively. These results suggest that both personal and organizational factors play a role in veterinary professionals' ProQOL and highlight the importance of promoting CS and managing burnout and STS for the purpose of fostering veterinary staff well-being and retention.

Development of the dog executive function scale (DEFS) for adult dogs

Executive functions (EFs) are cognitive processes that are used to effortfully self-regulate behaviour and might be important for dogs’ success in working and pet roles. Currently, studies are assessing dogs’ EF skills through often laborious cognitive measures, leading to small sample sizes and lacking measures of reliability. A complementary method is needed. The aim of this study was to develop a dog executive function scale (DEFS) for adult dogs. Focus groups were held with people working with dogs professionally to refine a pool of items describing dog behaviours related to EF. A survey was distributed online to a convenience sample of N = 714 owners of adult dogs. Exploratory and confirmatory factor analysis identified six distinguishable factors named behavioural flexibility, motor inhibition, attention towards owner, instruction following, delay inhibition and working memory. These factors appear similar to factors identified in human EF scales. Working dogs exhibit higher EF scores on the DEFS than non-working dogs. Dogs sourced from breeders exhibited higher DEFS scores than dogs sourced from shelters, and the amount of training received positively correlated with dogs’ DEFS scores. The DEFS requires further validation with cognitive measures. The DEFS could then be used by researchers to complement assessment of dogs’ EF skills through cognitive measures or assess dogs’ EF skills in large samples.

Effect of initiating biologics compared to intensifying conventional DMARDs on clinical and MRI outcomes in established rheumatoid arthritis patients in clinical remission: Secondary analyses of the IMAGINE-RA trial

Objectives: To compare the effect of treat-to-target-based escalations in conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics on clinical disease activity and magnetic resonance imaging (MRI) inflammation in a rheumatoid arthritis (RA) cohort in clinical remission.Method: One-hundred patients with established RA, Disease Activity Score based on 28-joint count-C-reactive protein (DAS28-CRP) < 3.2, and no swollen joints (hereafter referred to as 'in clinical remission') who received csDMARDs underwent clinical evaluation and MRI of the wrist and second to fifth metacarpophalangeal joints every 4 months. They followed a 2 year MRI treatment strategy targeting DAS28-CRP ≤ 3.2, no swollen joints, and absence of MRI osteitis, with predefined algorithmic treatment escalation: first: increase in csDMARDs; second: adding a biologic; third: switch biologic. MRI osteitis and Health Assessment Questionnaire (HAQ) (co-primary outcomes) and MRI combined inflammation and Simplified Disease Activity Index (SDAI) (key secondary outcomes) were assessed 4 months after treatment change and expressed as estimates of group differences. Statistical analyses were based on the intention-to-treat population analysed using repeated-measures mixed models.Escalation to first biologic compared to csDMARD escalation more effectively reduced MRI osteitis (difference between least squares means 1.8, 95% confidence interval 1.0-2.6), HAQ score (0.08, 0.03-0.1), MRI combined inflammation (2.5, 0.9-4.1), and SDAI scores (2.7, 1.9-3.5).Treat-to-target-based treatment escalations to biologics compared to escalation in csDMARDs more effectively improved MRI inflammation, physical function, and clinical disease activity in patients with established RA in clinical remission. Treatment escalation in RA patients in clinical remission reduces clinical and MRI-assessed disease activity.Trial registration: Clinicaltrials.gov identifier: NCT01656278.

P–385 The relationship between systemic oestradiol and vaginal microbiota composition in miscarriage and normal pregnancy

Study question

Is there an association between serum oestradiol, vaginal microbial composition and pregnancy outcome in the early first trimester?

Summary answer

In women with a vaginal microbiome deplete of Lactobacillus species at the time of Pregnancy of Uncertain Viability (IPUV), higher serum oestradiol associates with livebirth.

What is known already

During pregnancy, oestradiol mediates vaginal mucosal properties and increases glycogen deposition in epithelial cells which is thought to support colonisation of Lactobacillus species. Low levels of Lactobacillus associates with adverse outcomes such as miscarriage and preterm birth. The direct relationship between systemic oestradiol and the vaginal microbiome has never been studied in pregnancy. However studies have shown a positive correlation between serum oestrone, vaginal glycogen and Lactobacillus abundance in menopausal women.

Study design, size, duration

This was a prospective cohort study where one-hundred women were recruited in early pregnancy at the time of IPUV and donated paired blood and vaginal samples. 40 women had an eventual miscarriage, 58 had a livebirth and two pregnancies were terminated. All 100 women donated one paired serum and vaginal sample at this time point, and 22 women with Lactobacillus depletion at the time of IPUV donated further longitudinal vaginal samples.

Participants/materials, setting, methods

Participants were recruited from an Early Pregnancy Unit and underwent transvaginal ultrasound assessment of their pregnancy. Serum samples were analysed with an immunoassay on a ROCHE COBAS E411 analyser for Oestradiol (pg/ml) and Progesterone (ng/ml). Bacterial DNA was extracted from paired vaginal swabs and sequenced using Illumina MiSeq sequencing of 16S rRNA gene amplicons.

Main results and the role of chance

Lactobacillus dominance of the vagina was associated with higher serum levels of E2 and progesterone compared to depletion (E2=398pg/ml vs 302pg/ml(p = 0.02), P4=23.1ng/ml vs 17ng/ml(p = 0.02)). E2 and P4 were positively correlated (r = 0.6, p &lt; 0.05). At species level, L. crispatus dominance associated with significantly higher levels of E2 compared to high-diversity communities (468pg/ml vs 302pg/ml(p = 0.03) but no such relationship was observed for P4. Both E2 and P4 levels were lower in women who eventually miscarried. However there was no significant difference in the vaginal bacterial composition at genera or species level at this early gestational age (P = 0.08) regardless of per vaginal bleeding. However in women with Lactobacillus depleted microbiota, livebirth was associated with significantly higher E2 levels compared to women suffering miscarriage (212pg/ml in miscarriage vs 395pg/ml in livebirth, p = 0.003) (OR = 22.4 P = 0.004). In 22 women who had Lactobacillus depletion at the time of IPUV (7 with an eventual outcome of miscarriage, and 15 with an eventual outcome of livebirth), longitudinal vaginal bacterial DNA sequencing was performed. In 7/15 women with livebirth, and higher E2 levels, the microbial composition changed to become more Lactobacillus dominant during pregnancy, whereas in those with miscarriage, only 1/7 changed to become Lactobacillus dominant.

Limitations, reasons for caution

In this study, serum oestradiol levels were compared to the local vaginal bacterial environment. The ideal would be to study local vaginal oestradiol, glycogen and the bacterial composition.

Wider implications of the findings: In contrast to previous studies in menopause where low oestrogen levels associate with the vaginal microbial composition, this study uses the high oestradiol environment of early pregnancy to study the mechanistic relationship between oestradiol and vaginal Lactobacillus abundance.

Trial registration number

NA

O-129 Lactobacillus deplete vaginal microbial composition is associated with chromosomally normal miscarriage and local inflammation

Study question

To investigate the vaginal microbial composition and the local immune response in chromosomally normal and abnormal miscarriages and compare this to uncomplicated pregnancies delivering at term.

Summary answer

We show that euploid miscarriage is associated with a significantly higher prevalence of Lactobacillus spp. deplete vaginal microbial communities compared to aneuploid miscarriage.

What is known already

Emerging evidence supports the role of the vaginal microbiota in adverse pregnancy outcome, but the underlying mechanisms are poorly understood. A dominance of Lactobacillus spp. in pregnancy provides protection against pathogenic bacteria by producing lactic acid and antimicrobial compounds. A depletion in Lactobacillus spp. is often linked to adverse pregnancy outcomes.Current work also implicates the reproductive tract microbiota as a key modulator of local inflammatory and immune pathways. We have previously shown that miscarriage is associated with vaginal dysbiosis but without knowledge of the cytogenetic status of those miscarriages or the local immune profile.

Study design, size, duration

This study was a prospective observational cohort study based at Queen Charlotte’s & Chelsea Hospital, Early Pregnancy Unit, London between March 2014-February 2019. Vaginal swabs were collected from the posterior vaginal fornix of 167 patients.

Participants/materials, setting, methods

We used 16S rRNA gene based metataxonomics to interrogate the vaginal microbiota in a cohort of 167 women, 93 miscarriage patients (54 euploid and 39 aneuploid using molecular cytogenetics) and 74 women who delivered at term and correlate this with the aneuploidy status of the miscarriages. We also measured the concentrations of IL-2, IL-4, IL-6, IL-8, TNF-α, IFN-γ, IL-1β, IL-18 and IL-10 in cervical vaginal fluid using Human Magnetic Luminex Screening Assay (8-plex).

Main results and the role of chance

We show that euploid miscarriage is associated with a significantly higher prevalence of Lactobacillus spp. deplete vaginal microbial communities compared to aneuploid miscarriage (P=0.008). In women having Lactobacillus spp. deplete vaginal microbial communities, euploid miscarriage associates with higher concentrations of pro-inflammatory cytokines IL-1β, IL-8, IL-6 (P&lt;0.001, P=0.01 and P&lt;0.001 respectively) and lower concentrations of anti-inflammatory cytokines IL10 (P&lt;0.001) when compared to viable term pregnancy. We identified Prevotella bivia and Streptococcus as particularly common in euploid miscarriage and as drivers of pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α). Co-occurrence network analyses revealed low levels of co-occurrence between Lactobacillus crispatus and other organisms and strong co-occurrence between Streptococcal species. Our data show a combination of both an adverse vaginal microbiota and a cytokine response to it influences early pregnancy outcome. Although this may be a reflection of intrinsic maternal immune response, it appears that the cytokine response is largely driven by the bacterial taxa present in the vagina, which presents an opportunity for specific, directed intervention. The negative co-occurrence between L.crispatus and all other organisms suggests a possible therapeutic role for probiotics containing this organism. The influence of Streptococci also suggests a potential benefit of targeted antibiotics with probiotics for some patients.

Limitations, reasons for caution

There were no longitudinal samples in this cohort and our results are based on the assumption that the vaginal microbial composition is stable throughout the first trimester.Future longitudinal studies with larger sample sizes are needed to corroborate these findings and provide insights to the mechanisms that trigger the inflammatory response.

Wider implications of the findings

These findings support the hypothesis that the vaginal microbiota plays an important aetiological role in euploid miscarriage and may represent a target to modify the risk of pregnancy loss.

Trial registration number

n/a

Morbidity after local excision of the transformation zone for cervical intra-epithelial neoplasia and early cervical cancer

The awareness that cervical intra-epithelial neoplasia (CIN) treatment increases the risk of preterm birth has led to major changes in clinical practice. Women with CIN have a higher baseline risk of prematurity but local treatment further increases this risk. The risk further increases with increasing cone length and multiplies for repeat excisions; it is unclear whether small cones confer any additional risk to CIN alone. There is no evidence to suggest that fertility is affected by local treatment, although this increases the risk of mid-trimester loss. Caution should prevail when deciding to treat women with CIN of reproductive age. If treatment is offered, this should be conducted effectively to optimise the clearance of disease and minimise the risk of recurrence. Colposcopists should alert women undergoing treatment that this may increase the risk of preterm birth and that they may be offered interventions when pregnant. The cone length should be clearly documented and used as a risk stratifier.

Environmental influences on development of executive functions in dogs

Executive functions (EFs) are a set of cognitive processes used for effortful self-regulation of behaviour. They include inhibition, working memory, cognitive flexibility and, in some models, attention. In humans, socioeconomic factors and life experiences shape development of EFs. Domestic dogs (Canis familiaris) must often regulate their behaviour in the human environment (e.g. no jumping up on humans or chasing cats), and life experiences also probably influence the development of EFs in dogs. Research into dog cognition and behaviour has been thriving, and some methods used to explore these concepts (e.g. object-choice task, questionnaires measuring traits like distraction and aggression) are likely to be sensitive to differences in EFs, even if that is not their stated aim. Here we examine relevant studies to identify experiential factors which may influence the development of EFs in dogs living in human care. These are early experience, training, housing and stress. We conclude that the development of dogs' EFs may be negatively affected by hardships, and positively by surmountable challenges, early in life. Training methods appear important, with punishment-based methods leading to poorer dog EFs. Kennel environments seem to affect dog EFs negatively. While mild stressors might enhance the development of EFs, too much stress seems to have negative effects. Regulation of behaviour, a key outcome of EFs, is crucial for dogs' integration into human society. We should, therefore, strive to better understand how the environment shapes dogs' EFs.

Co-Sleeping between Adolescents and Their Pets May Not Impact Sleep Quality

Pet–owner co-sleeping is increasingly common in some parts of the world. Adult owners often subjectively report benefits of co-sleeping with pets, although objective actigraphy reports conversely indicate sleep disruptions due to the pet. Because limited research is available regarding pet–owner co-sleeping in non-adult samples, the aim of this two-part study was to explore whether co-sleeping improves sleep quality in adolescents, an age group in which poor sleep patterns are well documented. In Study One, an online survey with 265 pet-owning 13-to-17-year-old participants found that over 78% co-slept with their pet. Average sleep quality scores for co-sleepers and non-co-sleepers indicated generally poor sleep, with no differences in sleep quality depending on age, gender, or co-sleeping status. Study Two consisted of two preliminary case studies, using actigraphy on dog–adolescent co-sleepers. In both cases, high sleep concordance was observed, but owners again experienced generally poor sleep quality. Future actigraphy research is needed, including larger sample sizes and a control group of non-co-sleepers, to validate the preliminary findings from this study, but our limited evidence suggests that co-sleeping with a pet may not impact sleep quality in adolescents.

Do Behaviour Assessments in a Shelter Predict the Behaviour of Dogs Post-Adoption?

Simple Summary

In shelters it is usual to conduct standardised behaviour assessments on all incoming dogs. The information gathered from the assessment is used to identify dogs that are suitable for adoption and assist in matching dogs with suitable adopters. We investigated the predictive value of the standardised behaviour assessment protocol currently used in an Australian shelter for dog behaviour post-adoption. A total of 123 dogs, aged 1–10 years and housed in an animal care shelter, were assessed before they were adopted. The new owners of the dogs took part in a post-adoption survey conducted 1 month after adoption, which explored the behaviour of their dog in its new home. Regression analyses identified that friendly/social, fear and anxiousness identified in the shelter assessment significantly predicted corresponding behaviours post-adoption. However, behaviour problems, such as aggression, food guarding and separation-related behaviours, were not reliably predicted by the standardised behaviour assessment. We recommend that dog behaviour assessments in shelters are used only in conjunction with other monitoring tools to assess behaviour over the whole shelter stay, thus facilitating increased safety/welfare standards for dogs, shelters and the wider community.

Abstract

In shelters it is usual to conduct standardised behaviour assessments on admitted dogs. The information gathered from the assessment is used to identify dogs that are suitable for adoption and assist in matching the dog with suitable adopters. These assessments are also used to guide behaviour modification programs for dogs that display some unwanted behaviours. For some dogs, the results may indicate that they are unsuitable either for re-training or for adoption. In these circumstances the dogs may be euthanised. We investigated the predictive value of a standardised behaviour assessment protocol currently used in an Australian shelter for dog behaviour post-adoption. A total of 123 dogs, aged 1–10 years and housed in an animal care shelter, were assessed before they were adopted. The new owners of the dogs took part in a post-adoption survey conducted 1 month after adoption, which explored the behaviour of their dog after adoption. Ordinal regression analyses identified that friendly/social, fear and anxiousness identified in the shelter assessment significantly predicted corresponding behaviours post-adoption. However, behaviour problems, such as aggression, food guarding and separation-related behaviours, were not reliably predicted by the standardised behaviour assessment. The results suggest that further research is required to improve the predictability of behaviour assessment protocols for more specific behaviour problems, including different categories of aggression and separation-related problems. We recommend that dog behaviour assessments in shelters are used only in conjunction with other monitoring tools to assess behaviour over the whole shelter stay, thus facilitating increased safety/welfare standards for dogs, shelters and the wider community.

AB0209 PREDICTORS OF ACHIEVING STRINGENT REMISSION IN PATIENTS WITH ESTABLISHED RHEUMATOID ARTHRITIS IN CLINICAL REMISSION FOLLOWING A TREAT-TO-TARGET STRATEGY

Background:

Achieving remission according to stringent criteria such as Simplified Disease Activity Index (SDAI) and ACR/EULAR Boolean remission is associated with a better long-term outcome in patients with RA1. Possible predictors of achieving stringent remission in patients in clinical remission, following targeted treatment strategies, have not been investigated.

Objectives:

To investigate the predictive value of clinical, radiographic and MRI variables on achieving more stringent remission in RA patients in clinical remission, following MRI and conventional treat-to-target (T2T) strategies.

Methods:

In this post-hoc study, data were used from 171 RA patients in clinical remission (DAS28-CRP< 3.2 and no swollen joints) on conventional synthetic DMARDs, included in the IMAGINE-RA randomized clinical trial2, where they followed an MRI T2T strategy (targeting absence of osteitis) combined with clinical remission (DAS28-CRP≤3.2 and no swollen joints) or a conventional T2T strategy (targeting clinical remission only). Baseline contrast-enhanced MRIs of the dominant wrist and 2nd-5thMCP joints and radiographs of hands and feet were evaluated according to the OMERACT RAMRIS scoring system and Sharp/van der Heijde method, respectively, by two experienced readers. Potential clinical, radiographic and MRI baseline predictors of remission were first tested in univariate logistic regression analyses with achievement of Clinical Disease Activity Index (CDAI), SDAI, and ACR/EULAR Boolean remission at 24 months as dependent variables. Variables with p<0.25 were subsequently tested in multivariate logistic regression analyses with backward selection, adjusted for age, gender and strategy group. Missing values of covariates were imputed using chained equations.

Results:

Based on the univariate analyses, tender joint count, patient VAS global, VAS pain, VAS fatigue, physician VAS global, HAQ, MRI osteitis, radiographic and MRI erosion and joint space narrowing scores were included in multivariate analyses (Table).

Following the MRI T2T strategy was a positive predictor and high patient VAS global a negative predictor of achieving all definitions of remission. Furthermore, high patient VAS pain was negatively associated with achieving SDAI and ACR/EULAR Boolean remission and high tender joint count negatively associated with achieving CDAI and SDAI remission.

Multivariate logistic regression analyses with backward selection, final modelsDependent variables, remission at 24 monthsCDAISDAIACR/EULAR BooleanOR95% CIp-valueOR95% CIp-valueOR95% CIp-valueCovariatesMRI T2T strategy group2.941.25-7.520.0132.461.03-6.350.0435.472.33-14.11<0.001Female0.900.36-2.250.820.800.31-2.050.640.800.32-1.970.63Age1.020.98-1.070.321.020.98-1.070.331.030.99-1.070.15Tender joint count (0-28)0.330.12-0.860.0230.290.10-0.780.013Patient VAS global0.910.88-0.94<0.0010.930.88-0.97<0.0010.930.88-0.980.003Patient VAS pain0.950.91-1.000.0490.920.87-0.980.004

Conclusion:

In RA patients in clinical remission, poor patient reported outcomes and tender joint count were associated with decreased chance of achieving stringent remission, while following an MRI T2T strategy predicted stringent remission across all definitions thereof.

References:

[1]Smolen et al. Ann Rheum Dis 2017

[2]Møller-Bisgaard et al. JAMA 2019

Disclosure of Interests:

Signe Møller-Bisgaard Grant/research support from: AbbVie, Consultant of: BMS, Speakers bureau: BMS, Celgene, Pfizer, Stylianos Georgiadis Grant/research support from: Novartis, Kim Hørslev-Petersen: None declared, Bo Ejbjerg: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, Lykke Ørnbjerg: None declared, Daniel Glinatsi: None declared, Jakob Møllenbach Møller: None declared, Mikael Boesen Consultant of: AbbVie, AstraZeneca, Eli Lilly, Esaote, Glenmark, Novartis, Pfizer, UCB, Paid instructor for: IAG, Image Analysis Group, AbbVie, Eli Lilly, AstraZeneca, esaote, Glenmark, Novartis, Pfizer, UCB (scientific advisor)., Speakers bureau: Eli Lilly, Esaote, Novartis, Pfizer, UCB, Kristian Stengaard-Pedersen: None declared, Ole Rintek Madsen: None declared, Bente Jensen: None declared, Jan Villadsen: None declared, Ellen Margrethe Hauge: None declared, Philip Bennett: None declared, Oliver Hendricks: None declared, Karsten Asmussen: None declared, Marcin Kowalski: None declared, Hanne Merete Lindegaard: None declared, Henning Bliddal Grant/research support from: received research grant fra NOVO Nordic, Consultant of: consultant fee fra NOVO Nordic, Niels Steen Krogh: None declared, Torkell Ellingsen: None declared, Agnete Nielsen: None declared, Lone Balding: None declared, Anne Grethe Jurik: None declared, Henrik Thomsen: None declared, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB

FRI0019 MRI INFLAMMATION, DISEASE ACTIVITY AND FUNCTIONAL IMPAIRMENT ARE MORE EFFECTIVELY REDUCED BY ESCALATION TO BIOLOGICS COMPARED TO CSDMARD-ESCALATION IN RHEUMATOID ARTHRITIS PATIENTS IN CLINICAL REMISSION FOLLOWING A TREAT-TO-TARGET STRATEGY: SECONDARY ANALYSES OF THE IMAGINE-RA TRIAL

Background:

The effect of different treatment escalations on MRI inflammation in rheumatoid arthritis (RA) patients following an MRI treat-to-target (T2T) strategy has not previously been investigated.

Objectives:

To compare the effect of different treatment escalations on MRI inflammation, physical function and disease activity in RA patients in clinical remission, following an MRI T2T strategy.

Methods:

One hundred RA patients in clinical remission (DAS28-CRP<3.2 and no swollen joints), on conventional synthetic (cs) DMARDs following an MRI T2T strategy targeting DAS28-CRP≤3.2, no swollen joints plus absence of MRI osteitis, were followed for 2 years with clinical and MRI (wrist and 2nd-5thMCP joints) evaluation every 4 months1. If target was not met, a predefined treatment escalation algorithm dictated: First: increase in csDMARDs (A), second: adding a TNF inhibitor (TNFi) (B), third and onwards: switch between biologics (C). If target was met, no change in baseline csDMARDs was done (D). Outcomes were assessed 4 months after treatment change. MRIs were evaluated with known chronology by one experienced reader. Repeated measures mixed linear models were used to express estimates of group differences on predefined co-primary outcomes (MRI osteitis, HAQ) and key secondary outcomes (MRI combined inflammation, Simplified Disease Activity Index (SDAI)).

Results:

Escalation to first TNFi (B) or to 2ndor later biologic (C) compared to csDMARDs (A) was consistently more effective on all outcomes (e.g. in group B osteitis was reduced with 1.8 units more than A) (Table). Unchanged (D) compared to escalation in csDMARD (A) treatment did not differ, except for HAQ-score. Escalation to a 2ndor later biologics (C) compared to the first TNFi (B) was more effective suppressing MRI inflammation. Escalation to TNFi treatment (B) or to 2ndor later biologic (C) compared to unchanged treatment (D) was more effective on all outcomes except from HAQ-score (no difference between groups).

Comparisons of treatment escalations1A: Increment in csDMARD mono/combination therapy (n=73)); B: Switch from csDMARD combination therapy to TNFi (n=39); C: Switch from TNFi to 2ndbiologic/switch between biologics (n=21); D: No change in csDMARDs from baseline (n=58)A vs BA vs CA vs DB vs CB vs DC vs DOutcomesPrimaryMRIOsteitis1.8 (1.0; 2.6) p<.00013.6 (2.3; 4.8) p<.00010.3 (−0.3; 1.0)p=.321.8 (0.8; 2.9) p=.0006−1.4 (−2.4; −0.5) p=.0045−3.3 (−4.6; −1.9) p<.0001HAQ0.081(0.033; 0.13) p=.00110.091(0.031; 0.15) p=.00320.054(0.014; 0.095) p=.00910.0092(−0.051; 0.070) p=.77−0.027(−0.082; 0.028) p=.33−0.037(−0.10; 0.031) p=.29Key secondaryMRI combined inflammationa2.5 (0.9; 4.1) p=.00185.4 (3.1; 7.7) p<.00010.4 (−0.9; 1.8)p=.522.9 (0.8; 4.9) p=.0064−2.1 (−4.0; −0.2) p=.032−5.0 (−7.5; −2.4) p=.0002SDAI2.7 (1.9; 3.5) p<.00012.4 (1.4; 3.4) p<.00010.5 (−0.2; 1.2)p=.14−0.3 (−1.3; 0.7)p=.60−2.2 (−3.1; −1.3) p<.0001−1.9 (−3.0; 0.8) p=.0006

1Estimates of group differences (least squares means (95% CI)).

aSum score of synovitis, osteitis and tenosynovitis

Conclusion:

T2T-based treatment escalations to biologics compared to csDMARD-escalations more effectively improved MRI inflammation, physical function and disease activity. Further optimization of the treatment in RA patients in clinical remission may improve long-term outcomes.

References:

[1]Møller-Bisgaard et al. JAMA 2019

Disclosure of Interests:

Signe Møller-Bisgaard Grant/research support from: AbbVie, Consultant of: BMS, Speakers bureau: BMS, Celgene, Pfizer, Kim Hørslev-Petersen: None declared, Bo Ejbjerg: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, Robin Christensen: None declared, Lykke Ørnbjerg: None declared, Daniel Glinatsi: None declared, Jakob Møllenbach Møller: None declared, Mikael Boesen Consultant of: AbbVie, AstraZeneca, Eli Lilly, Esaote, Glenmark, Novartis, Pfizer, UCB, Paid instructor for: IAG, Image Analysis Group, AbbVie, Eli Lilly, AstraZeneca, esaote, Glenmark, Novartis, Pfizer, UCB (scientific advisor)., Speakers bureau: Eli Lilly, Esaote, Novartis, Pfizer, UCB, Kristian Stengaard-Pedersen: None declared, Ole Rintek Madsen: None declared, Bente Jensen: None declared, Jan Villadsen: None declared, Ellen Margrethe Hauge: None declared, Philip Bennett: None declared, Oliver Hendricks: None declared, Karsten Asmussen: None declared, Marcin Kowalski: None declared, Hanne Merete Lindegaard: None declared, Henning Bliddal Grant/research support from: received research grant fra NOVO Nordic, Consultant of: consultant fee fra NOVO Nordic, Niels Steen Krogh: None declared, Torkell Ellingsen: None declared, Agnete Nielsen: None declared, Anne Grethe Jurik: None declared, Lone Balding: None declared, Henrik Thomsen: None declared, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB

First-trimester intrauterine hematoma and pregnancy complications

OBJECTIVE

To assess whether sonographic diagnosis of intrauterine hematoma (IUH) in the first trimester of pregnancy is associated with first-trimester miscarriage and antenatal, delivery and neonatal complications.

METHODS

This was a prospective observational cohort study of women with an intrauterine singleton pregnancy between 5 and 14 weeks' gestation recruited at Queen Charlotte's and Chelsea Hospital, London, UK, between March 2014 and March 2016. Participants underwent serial ultrasound examinations in the first trimester, and the presence, location, size and persistence of any IUH was evaluated. First-trimester miscarriage was defined as pregnancy loss before 14 weeks' gestation. Clinical symptoms, including pelvic pain and vaginal bleeding, were recorded at each visit using validated symptom scores. Antenatal, delivery and neonatal outcomes were obtained from hospital records. Logistic regression analysis and the chi-square test were used to assess the association between the presence and features of IUH and the incidence of adverse pregnancy outcome. Odds ratios (OR) were first adjusted for maternal age (aOR) and then further adjusted for the presence of vaginal bleeding or pelvic pain in the first trimester.

RESULTS

Of 1003 women recruited to the study, 946 were included in the final analysis and of these, 268 (28.3%) were diagnosed with an IUH in the first trimester. The presence of IUH was associated with the incidence of preterm birth (aOR, 1.94 (95% CI, 1.07-3.52)), but no other individual or overall antenatal, delivery or neonatal complications. No association was found between the presence of IUH in the first trimester and first-trimester miscarriage (aOR, 0.81 (95% CI, 0.44-1.50)). These findings were independent of the absolute size of the hematoma and the presence of vaginal bleeding or pelvic pain in the first trimester. When IUH was present in the first trimester, there was no association between its size, content or position in relation to the gestational sac and overall antenatal, delivery and neonatal complications. Diagnosis of a retroplacental IUH was associated with an increased risk of overall antenatal complications (P = 0.04).

CONCLUSIONS

Our findings demonstrate that there is no association between the presence of IUH in the first trimester and first-trimester miscarriage. However, an association with preterm birth, independently of the presence of symptoms of pelvic pain and/or vaginal bleeding, is evident. Women diagnosed with IUH in the first trimester should be counseled about their increased risk of preterm birth and possibly be offered increased surveillance during the course of their pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Incidence and mortality from cervical cancer and other malignancies after treatment of cervical intraepithelial neoplasia: a systematic review and meta-analysis of the literature

BACKGROUND

Although local treatments for cervical intraepithelial neoplasia (CIN) are highly effective, it has been reported that treated women remain at increased risk of cervical and other cancers. Our aim is to explore the risk of developing or dying from cervical cancer and other human papillomavirus (HPV)- and non-HPV-related malignancies after CIN treatment and infer its magnitude compared with the general population.

MATERIALS AND METHODS

Design: Systematic review and meta-analysis. Eligibility criteria: Studies with registry-based follow-up reporting cancer incidence or mortality after CIN treatment.

DATA SYNTHESIS

Summary effects were estimated using random-effects models.

OUTCOMES

Incidence rate of cervical cancer among women treated for CIN (per 100 000 woman-years). Relative risk (RR) of cervical cancer, other HPV-related anogenital tract cancer (vagina, vulva, anus), any cancer, and mortality, for women treated for CIN versus the general population.

RESULTS

Twenty-seven studies were eligible. The incidence rate for cervical cancer after CIN treatment was 39 per 100 000 woman-years (95% confidence interval 22-69). The RR of cervical cancer was elevated compared with the general population (3.30, 2.57-4.24; P < 0.001). The RR was higher for women more than 50 years old and remained elevated for at least 20 years after treatment. The RR of vaginal (10.84, 5.58-21.10; P < 0.001), vulvar (3.34, 2.39-4.67; P < 0.001), and anal cancer (5.11, 2.73-9.55; P < 0.001) was also higher. Mortality from cervical/vaginal cancer was elevated, but our estimate was more uncertain (RR 5.04, 0.69-36.94; P = 0.073).

CONCLUSIONS

Women treated for CIN have a considerably higher risk to be later diagnosed with cervical and other HPV-related cancers compared with the general population. The higher risk of cervical cancer lasts for at least 20 years after treatment and is higher for women more than 50 years of age. Prolonged follow-up beyond the last screening round may be warranted for previously treated women.

Early-pregnancy events and subsequent antenatal, delivery and neonatal outcomes: prospective cohort study

OBJECTIVE

To assess prospectively the association between pelvic pain, vaginal bleeding, and nausea and vomiting occurring in the first trimester of pregnancy and the incidence of later adverse pregnancy outcomes.

METHODS

This was a prospective observational cohort study of consecutive women with confirmed intrauterine singleton pregnancy between 5 and 14 weeks' gestation recruited at Queen Charlotte's & Chelsea Hospital, London, UK, from March 2014 to March 2016. Serial ultrasound scans were performed in the first trimester. Participants completed validated symptom scores for vaginal bleeding, pelvic pain, and nausea and vomiting. The key symptom of interest was any pelvic pain and/or vaginal bleeding during the first trimester. Pregnancies were followed up until the final outcome was known. Antenatal, delivery and neonatal outcomes were obtained from hospital records. Logistic regression analysis was used to assess the association between first-trimester symptoms and pregnancy complications by calculating adjusted odds ratios (aOR) with correction for maternal age.

RESULTS

Of 1003 women recruited, 847 pregnancies were included in the final analysis following exclusion of cases due to first-trimester miscarriage (n = 99), termination of pregnancy (n = 20), loss to follow-up (n = 32) or withdrawal from the study (n = 5). Adverse antenatal complications were observed in 166/645 (26%) women with pelvic pain and/or vaginal bleeding in the first trimester (aOR = 1.79; 95% CI, 1.17-2.76) and in 30/181 (17%) women with no symptoms. Neonatal complications were observed in 66/634 (10%) women with and 11/176 (6%) without pelvic pain and/or vaginal bleeding (aOR = 1.73; 95% CI, 0.89-3.36). Delivery complications were observed in 402/615 (65%) women with and 110/174 (63%) without pelvic pain and/or vaginal bleeding during the first trimester (aOR = 1.16; 95% CI, 0.81-1.65). For 18 of 20 individual antenatal complications evaluated, incidence was higher among women with pelvic pain and/or vaginal bleeding, despite the overall incidences being low. Nausea and vomiting in pregnancy showed little association with adverse pregnancy outcomes.

CONCLUSIONS

Our study suggests that there is an increased incidence of antenatal complications in women experiencing pelvic pain and/or vaginal bleeding in the first trimester. This should be considered when advising women attending early-pregnancy units. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

The experience of acquiring an assistance dog: examination of the transition process for first-time handlers

PURPOSE

As the popularity of using dogs to assist individuals with disability grows, there is a need for increased understanding of assistance dog handlers' experiences of living and working with their dog. This is particularly pertinent to first-time handlers and during the initial placement period, where the handler and assistance dog, and the relationship forming between them, may be extremely vulnerable. The aim of this study was to better understand first-time assistance dog handlers' experience of the placement period, especially any challenges that they experience.

MATERIALS AND METHODS

Semi-structured interviews were conducted with two youth and five adult handlers, and one parent of a young handler, recruited from three Australian assistance dog organizations. Interviews were conducted 1 month following the initial acquisition of an assistance dog. Meleis' transitions theory was used to develop a better understanding of the transition process for first-time handlers.

RESULTS

Inductive content analysis identified various challenges that first-time handlers experience throughout the transition period. These included: the initial response to living with the assistance dog; renegotiating relationships and social interactions; and, adjusting expectations regarding the assistance dog's behavior and capabilities.

CONCLUSION

First-time handler experiences indicate a need for assistance dog organizations to develop initiatives to further assist their handlers through a smooth transition into assistance dog ownership. Implications for rehabilitation Integrating an assistance dog into a first-time handler's life is a long process full of challenges. Provider organizations and other support members markedly impact the ease of transitioning an assistance dog into a handler's life. Organizations should be aware of the role they have and employ strategies to create as smooth a transition as possible. Support from other support members is crucial to ease the challenges experienced.

Balancing Effort and Rewards at University: Implications for Physical Health, Mental Health, and Academic Outcomes

BACKGROUND

The effort-reward imbalance model suggests that, when the efforts required within the workplace are disproportionately large in comparison to the rewards resulting from those efforts, there is an increased risk of stress-related health issues. The model posits that higher levels of "overcommitment," in addition to a high effort-reward imbalance ratio, magnifies this risk of ill-health. While work has been conducted to assess the validity of this model within the school setting, research in the higher education sector is limited.

OBJECTIVES

This study explored the validity of the effort-reward imbalance model for explaining burnout, poor health, and academic productivity among university students.

DESIGN AND METHODS

This study utilized a cross-sectional survey of Australian university students (n = 395) from a range of universities.

RESULTS

An imbalance of effort and reward was associated with poorer physical health, increased burnout, and reduced productivity. Effort-reward imbalance mediated a relationship between overcommitment and burnout; those high in overcommitment were more likely to experience an imbalance of effort and reward at university.

CONCLUSION

The relationships between effort-reward imbalance, health, burnout, and academic productivity support the generalizability of this model to the university setting. In addition, the personal characteristic of overcommitment also appears to have an important relationship with burnout.

Beyond the Benefits of Assistance Dogs: Exploring Challenges Experienced by First-Time Handlers

Simple Summary

People with disabilities employ many forms of assistive technology, including assistance dogs (AD), to assist them with managing their disability. Most previous research has focused on the benefits of ADs for their handlers with disability; little is known about the challenges they face. The aim of this study was to explore the experiences of first-time handlers when working with an AD. It was found that handlers experienced many benefits from their dog, as would be expected. However, they also reported experiencing many challenges which hindered or delayed these benefits. These challenges arose from the handler’s medical conditions, cognitive ability and social environment, as well as from dog-related factors. They are important for potential handlers and AD organizations to consider prior to placing an AD, since this will assist individuals and organizations to better determine if an AD is the right form of assistive technology for a particular individual, and, if so, how best to prepare to integrate the dog into the person’s life.

Abstract

The purpose of this study was to explore first time handlers’ experiences when working with an assistance dog (AD). Interviewees included seven first time AD handlers and 14 other individuals close to these handlers, including family members, carers and AD instructors. Semi-structured interviews were conducted six months and one year after each handler received their AD. Interview questions were informed by the Thriving Through Relationships theory of social support and previous interviews with the participants. Inductive content analysis corroborated previous findings regarding the benefits that ADs provide. In addition, four factors were revealed to substantially influence the challenges handlers experienced when learning to utilize their dog. These included the handlers’ medical conditions, cognitive ability and social environment, and dog-related factors. Organizations would benefit from considering these factors in their operational processes.

Ten-year follow-up of two cohorts with an increased risk of variant CJD: donors to individuals who later developed variant CJD and other recipients of these at-risk donors

BACKGROUND

Transmission of variant Creutzfeldt-Jakob disease (vCJD) through blood transfusion is implicated in three deaths and one asymptomatic infection. Based on this evidence, individuals assessed to be at increased risk of vCJD through donating blood transfused to individuals who later developed vCJD, or through being other recipients of such donors, are followed up to further understand the risks of vCJD transmission through blood.

OBJECTIVES

To provide a ten-year follow-up of these at-risk cohorts.

METHODS

Blood donors to patients who later died from vCJD were identified by the Transfusion Medicine Epidemiological Review (TMER) study. A reverse risk probability assessment quantified the risk of blood transfusion or exposure through diet as the source of vCJD in the recipients. Donors to these recipients, and these donors' other recipients, with a probability risk above 1%, are classified as at increased risk of vCJD for public health purposes. These cohorts are monitored for any vCJD occurrences.

RESULTS

A total of 112 donors and 33 other recipients of their donated blood have been classified as at increased risk. After 2397 and 492 vCJD-free years of follow-up, respectively, no deaths in either at-risk cohort were of vCJD-related causes.

CONCLUSIONS

The at-risk cohorts have survived disease-free far longer than the estimated incubation time for dietary-acquired vCJD (donors) and transfusion-acquired disease (other recipients). However, due to our still limited understanding of, and a lack of a reliable test for, asymptomatic vCJD infection, public health follow-up is necessary for continued monitoring of at-risk cohorts.