Anonymised Information Research Articles

COVID-19 risk factors amongst 14,786 care home residents: an observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays and vaccination status in Wales (UK) between 1 September 2020 and 1 May 2021.

BackgroundCOVID-19 vaccinations have been prioritised for high risk individuals.AimDetermine individual-level risk factors for care home residents testing positive for SARS-CoV-2.Study designLongitudinal observational cohort study using individual-level linked data from the Secure Anonymised Information Linkage (SAIL) databank.SettingFourteen thousand seven hundred and eighty-six older care home residents (aged 65+) living in Wales between 1 September 2020 and 1 May 2021. Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes.MethodsWe estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 PCR test. We included time-dependent covariates for the estimated community positive test rate of COVID-19, hospital inpatient status, vaccination status and frailty. Additional covariates were included for age, sex and specialist care home services.ResultsThe multivariable regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year), community positive test rate (OR 1.13 [1.12,1.13] per percent increase), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09], respectively) were associated with a decreased odds.ConclusionsCare providers need to remain vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Minimising potential COVID-19 infection for care home residents when admitted to hospital should be prioritised.

Session-based recommendation with temporal convolutional network to balance numerical gaps

A session-based recommendation system recommends the next possible item for users by learning the click session sequences of anonymous users. Considering the session data used is anonymous and few background information is available, it is very challenging to solve these problems. Recently, although the session-based recommendation systems based on neural network have achieved gratifying results, there are still two problems in the existing methods: (1) The value of each dimension in the embedded layer result is a non-zero mean distribution and the numerical gaps are very large. Such numerical gaps will increase the variance of the gradient, hindering the parameter optimization, and thus leading to the final prediction results inaccurate; (2) The previous models cannot effectively learn the long-term dependency information and capture the dependencies between non-adjacent items in the session sequence. To solve the above problems, we propose a Session-based Recommendation with Temporal Convolutional Network to Balance Numerical Gaps model. Specifically, we first normalize the embedded layer results, then constrain the embedded results in the unit hypersphere to reduce their impact on gradient calculation, and finally use Temporal Convolution Network (TCN) complements the multi-layer self-attention network to learn the session sequence.The TCN can obtain large enough receptive fields to fully learn session representation and the short-range item dependence that is missing due to the distraction of attention distribution by the self-attention mechanism, and the self-attention method capture the one-to-one interaction of each item, and obtain the long-term dependence of the item. We have conducted a large number of experiments on three real-world datasets. The results show that, in most cases, our proposed method outperforms the state-of-the-arts methods.

A population level study into health vulnerabilities of mothers and fathers involved in public law care proceedings in Wales, UK between 2011 and 2019

IntroductionUnder section 31 of the Children Act 1989, public law care proceedings can be issued if there is concern a child is subject to, or at risk of significant harm, which can lead to removal of a child from parents. Appropriate and effective health and social support are required to potentially prevent some of the need for these proceedings. More comprehensive evidence of the health needs and vulnerabilities of parents will enable enhanced response from family courts and integrated other services. ObjectiveTo examine health vulnerabilities of parents involved in care proceedings in the two-year period prior to involvement. MethodsFamily court data provided by Cafcass Cymru were linked to population-based health records held within the Secure Anonymised Information Linkage Databank. Linked data were available for 8,821 parents of children involved in care proceedings between 2011 and 2019. Findings were benchmarked with reference to a comparison group of parents matched on sex, age, and deprivation (n = 32,006), not subject to care proceedings. Demographic characteristics, overall health service use, and health profiles of parents were examined. Descriptive and statistical tests of independence were used. ResultsNearly half of cohort parents (47.6%) resided in the most deprived quintile. They had higher levels of healthcare use compared to the comparison group across multiple healthcare settings, with the most pronounced differences for emergency department attendances (59.3% vs 37.0%). Health conditions with the largest variation between groups were related to mental health (43.6% vs 16.0%), substance use (19.4% vs 1.6%) and injuries (41.5% vs 23.6%). ConclusionThis study highlights the heightened socioeconomic and health vulnerabilities of parents who experience care proceedings concerning a child. Better understanding of the needs and vulnerabilities of this population may provide opportunities to improve a range of support and preventative interventions that respond to crises in the community.

Management of Poisoned Patients: Implementing a Blended Toxicology Curriculum for Emergency Medicine Residents.

Management of Poisoned Patients: Implementing a Blended Toxicology Curriculum for Emergency Medicine Residents.

An Applied N C Differentiation Interpolation technique for improved random Anomalous values in Data Mining

In data mining, the word “interpolation” refers to interpolating some anonymous information from a given set of known information. The method of interpolation is extensively used as a valuable tool in science and engineering. The predicament is a classical one and dates back to the time of Newton, who needed to solve such a problem in analyzing data on the numerical computations. Numerical applications of interpolation include derivation of computational techniques for numerical differentiation, numerical integration and numerical solutions of differential equations. In this paper a closest fit Application of the formula to numerical data for recovering haphazard Anomalous values in Data Mining has been shown in the case of representing the data on the dataset global carbon dioxide emissions from fossil fuel burning by Fuel Type corresponding as a method of time. The formula is suitable in the situation where the values of the argument are at equal interval.

Epidemiology of pre-existing multimorbidity in pregnant women in the UK in 2018: a population-based cross-sectional study

BackgroundAlthough maternal death is rare in the United Kingdom, 90% of these women had multiple health/social problems. This study aims to estimate the prevalence of pre-existing multimorbidity (two or more long-term physical or mental health conditions) in pregnant women in the United Kingdom (England, Northern Ireland, Wales and Scotland).Study designPregnant women aged 15–49 years with a conception date 1/1/2018 to 31/12/2018 were included in this population-based cross-sectional study, using routine healthcare datasets from primary care: Clinical Practice Research Datalink (CPRD, United Kingdom, n = 37,641) and Secure Anonymized Information Linkage databank (SAIL, Wales, n = 27,782), and secondary care: Scottish Morbidity Records with linked community prescribing data (SMR, Tayside and Fife, n = 6099). Pre-existing multimorbidity preconception was defined from 79 long-term health conditions prioritised through a workshop with patient representatives and clinicians.ResultsThe prevalence of multimorbidity was 44.2% (95% CI 43.7–44.7%), 46.2% (45.6–46.8%) and 19.8% (18.8–20.8%) in CPRD, SAIL and SMR respectively. When limited to health conditions that were active in the year before pregnancy, the prevalence of multimorbidity was still high (24.2% [23.8–24.6%], 23.5% [23.0–24.0%] and 17.0% [16.0 to 17.9%] in the respective datasets). Mental health conditions were highly prevalent and involved 70% of multimorbidity CPRD: multimorbidity with ≥one mental health condition/s 31.3% [30.8–31.8%]).After adjusting for age, ethnicity, gravidity, index of multiple deprivation, body mass index and smoking, logistic regression showed that pregnant women with multimorbidity were more likely to be older (CPRD England, adjusted OR 1.81 [95% CI 1.04–3.17] 45–49 years vs 15–19 years), multigravid (1.68 [1.50–1.89] gravidity ≥ five vs one), have raised body mass index (1.59 [1.44–1.76], body mass index 30+ vs body mass index 18.5–24.9) and smoked preconception (1.61 [1.46–1.77) vs non-smoker).ConclusionMultimorbidity is prevalent in pregnant women in the United Kingdom, they are more likely to be older, multigravid, have raised body mass index and smoked preconception. Secondary care and community prescribing dataset may only capture the severe spectrum of health conditions. Research is needed urgently to quantify the consequences of maternal multimorbidity for both mothers and children.

COVID-19 vaccine uptake and effectiveness in adults aged 50 years and older in Wales UK: a 1.2m population data-linkage cohort approach

ABSTRACT Vaccination programs against COVID-19 vary globally with estimates of vaccine effectiveness (VE) affected by vaccine type, schedule, strain, outcome, and recipient characteristics. This study assessed VE of BNT162b2 and ChAdOx1 vaccines against PCR positive SARS-CoV-2 infection, hospital admission, and death among adults aged 50 years and older in Wales, UK during the period 7 December 2020 to 18 July 2021, when Alpha, followed by Delta, were the predominant variants. We used individual-level linked routinely collected data within the Secure Anonymized Information Linkage (SAIL) Databank. Data were available for 1,262,689 adults aged 50 years and over; coverage of one dose of any COVID-19 vaccine in this population was 92.6%, with coverage of two doses 90.4%. VE against PCR positive infection at 28-days or more post first dose of any COVID-19 vaccine was 16.0% (95%CI 9.6–22.0), and 42.0% (95%CI 36.5–47.1) seven or more days after a second dose. VE against hospital admission was higher at 72.9% (95%CI 63.6–79.8) 28 days or more post vaccination with one dose of any vaccine type, and 84.9% (95%CI 78.2–89.5) at 7 or more days post two doses. VE for one dose against death was estimated to be 80.9% (95%CI 72.1–86.9). VE against PCR positive infection and hospital admission was higher for BNT162b2 compared to ChAdOx1. In conclusion, vaccine uptake has been high among adults in Wales and VE estimates are encouraging, with two doses providing considerable protection against severe outcomes. Continued roll-out of the vaccination programme within Wales, and globally, is crucial in our fight against COVID-19.

Real-world etiologies and treatments of pediatric short bowel syndrome in Japan.

Short bowel syndrome (SBS) is a rare disease that can result in intestinal failure (IF). Short bowel syndrome intestinal failure leads to stunted growth and development and high mortality rates. The primary goal of treatment is to enhance intestinal adaptation and nutrient absorption. Parenteral nutrition (PN) is used to support this process until enteral autonomy can be restored. Some patients experience prolonged partial or complete dependency on PN and face an increased risk of life-threatening catheter-related bloodstream infections and intestinal failure-associated liver disease. This study aimed to provide real-world insights into the patient characteristics and treatment dynamics of PN-dependent children with SBS-IF in Japan. This retrospective observational study used anonymized information from a large hospital-based medical insurance database to identify pediatric patients who received PN for ≥6 months between April 2008 and January 2020. The primary endpoint was weaning from PN. Secondary endpoints included duration and complications of PN. Forty-eight children (mean age, 2.9 years) were eligible for inclusion. The most common causes of SBS-IF were mechanical bowel obstruction, functional bowel disorders, and Hirschsprung's disease. Twenty-two patients (45.8%) were weaned from PN during the study. The mean time to first weaning was 464.2 days and five patients (22.7%) restarted PN. The mean total duration of PN was 692.6 days in weaned patients and 1,170.9 days in unweaned patients. The most frequent complications were sepsis, catheter infections (both 79.2%), and liver dysfunction (64.6%). Pediatric patients with SBS-IF faced difficulties when weaning off PN and rates of life-threatening complications were high.

Radiologist opinions regarding reporting incidental coronary and cardiac calcification on thoracic CT.

Objectives:Coronary and cardiac calcification are frequent incidental findings on non-gated thoracic computed tomography (CT). However, radiologist opinions and practices regarding the reporting of incidental calcification are poorly understood.Methods:UK radiologists were invited to complete this online survey, organised by the British Society of Cardiovascular Imaging (BSCI). Questions included anonymous information on subspecialty, level of training and reporting practices for incidental coronary artery, aortic valve, mitral and thoracic aorta calcification.Results:The survey was completed by 200 respondents: 10% trainees and 90% consultants. Calcification was not reported by 11% for the coronary arteries, 22% for the aortic valve, 35% for the mitral valve and 37% for the thoracic aorta. Those who did not subspecialise in cardiac imaging were less likely to report coronary artery calcification (p = 0.005), aortic valve calcification (p = 0.001) or mitral valve calcification (p = 0.008), but there was no difference in the reporting of thoracic aorta calcification. Those who did not subspecialise in cardiac imaging were also less likely to provide management recommendations for coronary artery calcification (p < 0.001) or recommend echocardiography for aortic valve calcification (p < 0.001), but there was no difference for mitral valve or thoracic aorta recommendations.Conclusion:Incidental coronary artery, valvular and aorta calcification are frequently not reported on thoracic CT and there are differences in reporting practices based on subspeciality.Advances in knowledge:On routine thoracic CT, 11% of radiologists do not report coronary artery calcification. Radiologist reporting practices vary depending on subspeciality but not level of training.

Analysis and Response Strategy of Cross-Community Rumors Using Mixed Multilayer Method for Enterprise Cyber Warriors

In the age of information explosion, it is easy for people to receive many messages, and it is difficult to verify the authenticity of each message. Therefore, people often quickly and forward the acquired information and share anonymous information, rather than absorbing it after verification. The study questions current Artificial Intelligence (AI) detection methods, arguing that a simple dichotomy cannot distinguish between true and false information. This study proposes a mixed method to analyze events based on the dissemination and interaction of false information in online enterprise communities from the perspective of an observer. The event explores multiple features based on various characteristics, such as motivation, purpose, intention, and behavior. Experimental results show that the proposed method can effectively identify false information with high risk. Additionally, this study discusses the effectiveness and response strategies of the enterprise cyber warrior based on the mixed multi-layer analysis. This study provides a preliminary study of mixed cognitive warfare identification and immediate response behavior for corporate Internet rumors.

The right to information as the basis of media activity in Ukraine

The article identifies some approaches to identifying the concepts of media and legal information. Some classifications of mass media and their immanent elements are considered. The concept of information and its qualifying legal features are defined. The main Laws of Ukraine concerning information are highlighted. Separate normative-legal laws of Ukraine on information and various forms of information are singled out. Categories of legal, public information and misinformation are considered. The key Law of Ukraine on information dated October 2, 1992 № 2657-XII has been determined. It is investigated, that the main source of legal information is the Constitution of Ukraine in accordance to the Law of Ukraine "On Information". It is proved, that information can exist in an ideal and material form and be the object of commodity relations. Attention is drawn to the Law of Ukraine "On Electronic Documents and Electronic Document Management". It is proved, that in the era of using information and communication technologies, the implementation of e-government makes it possible to operate in an information society. Sources for media information have been identified - state, confidential and anonymous. Attention is drawn to the access of the media to confidential information, to data that are not disclosed or published only by court decision. An example is given of the possibility of disseminating public or private information about a person. Attention is drawn to the need to verify anonymous information. In conclusion, it is emphasized, that the media in Ukraine are trying to follow in the footsteps of the latest information and communication technologies. The use of constitutional and legal acts is a vital necessary condition for building civil society, guaranteeing the constitutionality of democracy, freedom of access of the media to primary sources of information.

Data Privacy in Wearable IoT Devices: Anonymization and Deanonymization

With the development of IoT devices, wearable devices are being used to record various types of information. Wearable IoT devices are attached to the user and can collect and transmit user data at all times along with a smartphone. In particular, sensitive information such as location information has an essential value in terms of privacy, and therefore some IoT devices implement data protection by introducing methods such as masking. However, masking can only protect privacy to a certain extent in logs having large numbers of recorded data. However, the effectiveness may decrease if we are linked with other information collected from within the device. Herein, a scenario-based case study on deanonymizing anonymized location information based on logs stored in wearable devices is described. As a result, we combined contextual and direct evidence from the collected information. It was possible to obtain the result in which the user could effectively identify the actual location. Through this study, not only can a deanonymized user location be identified but we can also confirm that cross-validation is possible even when dealing with modified GPS coordinates.

Hospitalisation events in people with chronic kidney disease as a component of multimorbidity: parallel cohort studies in research and routine care settings

BackgroundChronic kidney disease (CKD) typically co-exists with multimorbidity (presence of 2 or more long-term conditions: LTCs). The associations between CKD, multimorbidity and hospitalisation rates are not known. The aim of this study was to examine hospitalisation rates in people with multimorbidity with and without CKD. Amongst people with CKD, the aim was to identify risk factors for hospitalisation.MethodsTwo cohorts were studied in parallel: UK Biobank (a prospective research study: 2006-2020) and Secure Anonymised Information Linkage Databank (SAIL: a routine care database, Wales, UK: 2011-2018). Adults were included if their kidney function was measured at baseline. Nine categories of participants were used: zero LTCs; one, two, three and four or more LTCs excluding CKD; and one, two, three and four or more LTCs including CKD. Emergency hospitalisation events were obtained from linked hospital records.ResultsAmongst 469,339 UK Biobank participants, those without CKD had a median of 1 LTC and those with CKD had a median of 3 LTCs. Amongst 1,620,490 SAIL participants, those without CKD had a median of 1 LTC and those with CKD had a median of 5 LTCs. Compared to those with zero LTCs, participants with four or more LTCs (excluding CKD) had high event rates (rate ratios UK Biobank 4.95 (95% confidence interval 4.82–5.08)/SAIL 3.77 (3.71–3.82)) with higher rates if CKD was one of the LTCs (rate ratios UK Biobank 7.83 (7.42–8.25)/SAIL 9.92 (9.75–10.09)). Amongst people with CKD, risk factors for hospitalisation were advanced CKD, age over 60, multiple cardiometabolic LTCs, combined physical and mental LTCs and complex patterns of multimorbidity (LTCs in three or more body systems).ConclusionsPeople with multimorbidity have high rates of hospitalisation. Importantly, the rates are two to three times higher when CKD is one of the multimorbid conditions. Further research is needed into the mechanism underpinning this to inform strategies to prevent hospitalisation in this very high-risk group.

Impact of the COVID-19 pandemic on health-care usage and mental health of clinically extremely vulnerable individuals in Wales: a population-scale data linkage study

BackgroundThe public health response to the COVID-19 pandemic in the UK included advising those identified as clinically extremely vulnerable (CEV) to self-isolate within their homes. We compared the health-care usage and mental health of the CEV population with that of the general population during the pandemic. MethodsIn this retrospective population-scale data linkage study in Wales, we used person-level linked, routinely collected, data sources available within the Secure Anonymous Information Linkage Databank. Age-standardised rates of monthly planned and emergency care attendances between Jan 1, 2020, and Dec 31, 2020, were examined. We used a Cox model to explore risk factors for depression or anxiety (identified from primary care diagnosis, symptoms, and prescription Read codes). FindingsThe CEV cohort included 127 787 patients and was older than the general population (52·4% (66 963) CEV were aged ≥65 years, vs 21·0% (662 376) of the general population, p<0·0001). Average monthly trends showed that the decline in planned care was greater among the CEV than the general population from March–August, 2020 (elective admissions: –7·2% for CEV vs –0·6 for general population; outpatient attendances: –3·8% vs –1·3%), with a slower recovery into December, 2020 for CEV (elective: CEV –1.4% vs general population 3·9%; outpatient: 1·7% vs 4·1%). There were increases in both ED attendances and emergency admissions from March–August, 2020, which were greater among the general population (7·0% vs 3·1%, respectively) compared with the CEV (4·3% vs 0·5%). Being CEV (hazard ratio 1·2 [95% CI 1·2–1·3]) and historical poor mental health (3·7 [3·5–3·9]) were associated with an increased risk of anxiety or depression. InterpretationDeclines in planned care were not unexpected given the impact of COVID-19 on the National Health Service, and suggest considerable unmet need. Declines in secondary care activity amongst the CEV could reflect reluctance to attend hospital, not reduced clinical need. Reliance on an algorithm to identify CEV might have led to overestimation of the heterogeneous CEV population. FundingThe Health Foundation as part of the Networked Data Labs.

Impact of Antidepressants on Cardiac Events and All-Cause Mortality in Parkinson's Disease: A National Data-Linkage Study.

PurposeThis study investigated the 1-year risk of ischemic heart disease (IHD), all cardiovascular events, and all-cause mortality among newly diagnosed Parkinson’s disease (PD) patients who used antidepressants compared to those who did not.Patients and MethodsPatients with PD aged 40 years or older were identified using data from 2000 through 2016 held within the Welsh Secure Anonymized Information Linkage (SAIL) databank. Antidepressant users were propensity-score matched 1:1 with non-users, adjusting for patients’ demographics, socioeconomic status, and multiple comorbidities. Cox proportional hazard regression analyses were performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between the antidepressants and the study outcomes. The follow-up period was 1 year after the initial prescription of antidepressants.ResultsThe study group comprised a total of 3364 participants, with numbers split equally between the antidepressant-user and non-user groups, based on the propensity score-matching process. Overall, the propensity score-adjusted model showed that antidepressant usage in PD patients was not significantly associated with the risk of IHD (HR = 1.05; 95% CI 0.63–1.75) or all cardiovascular events (HR = 1.01; 95% CI 0.71–1.45) compared to non-users. The propensity score-adjusted model also showed that the use of any antidepressant, regardless of its category, was not statistically significantly associated with all-cause mortality (HR = 0.81; 95% CI 0.65–1.02). However, this association reached statistical significance in the multivariate adjusted model (HR = 0.67; 95% CI 0.54–0.84).ConclusionThere was no evidence that antidepressant use was associated with an increased risk of IHD or all cardiovascular events in newly diagnosed PD patients who suffered from depression. Furthermore, antidepressant use might reduce the mortality rate in PD patients during the first year after initiation.

Abstract LB084: High cardiovascular disease mortality after central nervous system tumor diagnosis: Evidence from UK and USA population-based study

Abstract Background Accumulating data show cardiovascular disease (CVD) is a major cause of death in many cancer patients supporting cardio-oncology epidemiology and clinical studies. Although rare, patients diagnosed with brain and central nervous system (CNS) tumours have significant morbidity and mortality. Whether CVD is a major cause of death and if this differs by malignancy has not been comprehensively assessed. Methods We aimed to examine the risk of CVD mortality in patients diagnosed with malignant and non-malignant CNS tumours using cancer registry data in the UK and US. Analyses were conducted using Wales Cancer Registry, UK (Secure Anonymised Information Linkage, SAIL) for 8,743 patients diagnosed from 2000-2015 (54.9% of which died); and the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) for 188,526 patients diagnosed from 2005-2015 (40.0% of which died). Standardized mortality ratios (SMRs) and 95% confidence intervals (CI) were calculated for CVD cause of death (heart disease, cerebrovascular disease, hypertension, atherosclerosis, and aortic aneurysm/dissection) and adjusted for age, sex and calendar year compared to all Welsh and US residents. SMRs were stratified by tumour types (malignant and non-malignant tumours) and main histologic types (glioma and meningioma). Results CVD is the second major cause of death for CNS tumour patients in SAIL and SEER (9.5% &amp; 12.1%, respectively). Patients with malignant and non-malignant CNS tumours had excess CVD mortality compared with the general population (SAIL SMR=2.64, 95% CI=2.39-2.90, SEER SMR=1.38, 95% CI=1.35-1.42). Patients were more likely to die of CVD compared to the general population regardless of whether they were diagnosed with non-malignant meningiomas subtypes (SAIL SMR=3.13, 95%CI=2.73-3.57; SEER SMR=1.36, 95%CI=1.32-1.40) or malignant gliomas (SAIL SMR=2.08, 95%CI=1.46-2.88; SEER SMR=2.21, 95%CI=2.05-2.38). Patients diagnosed younger than 50 years of age had excess risk from CVD mortality compared to general population than those diagnosed at older ages (SAIL SMR=4.58, 95%CI=2.38-7.84, SEER SMR 2.03-95%CI=1.79-2.03). Patients had greater risk of CVD mortality within the first year after CNS tumour diagnosis in both SAIL and SEER (SMR=2.98, 95% CI=2.39-3.66 &amp; SMR=2.14 95%CI=2.03-2.25, respectively). Conclusion CVD mortality is high among patients diagnosed with CNS tumours compared to general population. Cross national datasets for different histologic types of CNS tumours could help define high risk groups that may be targeted for future prevention and clinical studies to clarify the aetiology of CVD among CNS cancer patients. Citation Format: KAI JIN, Paul Brennan, Michael Poon, Cathie Sudlow, Jonine FIGUEROA. High cardiovascular disease mortality after central nervous system tumor diagnosis: Evidence from UK and USA population-based study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB084.

Trend of recognizing depression symptoms and antidepressants use in newly diagnosed Parkinson's disease: Population-based study.

ObjectivesAlthough depression symptoms are common among patients with Parkinson's disease (PD), the medical literature still reports underrecognition of depression in patients with PD. Our main objective is to examine the trend of depression recognition during the first year of PD diagnosis using large population data.MethodsWe conducted a population‐based study of residents in Wales, using the Secure Anonymized Information Linkage (SAIL) Databank. We included newly diagnosed patients with PD aged 40 years or older with a first PD diagnosis between 2000 and 2015. Depression and antidepressants related data were extracted from SAIL. A series of multilevel logistic regressions were run to determine the factors affecting depression recognition. The results were presented using odds ratios (ORs) with 95% confidence intervals (CI).ResultsThe study included 6596 patients with PD. About 38% of patients had a recorded code of antidepressants, depression diagnosis, or both within the first year of PD diagnosis. There was a significant association of depression diagnosis, antidepressant use, or both with the year of PD diagnosis (OR 0.972, 95% CI 0.962–0.983). We also found that patients who used monoamine oxidase inhibitors (MAO‐B inhibitors) were associated with a lower depression diagnosis, use antidepressants, or both, compared to those who did not use MAO‐B inhibitors (OR 0.769, 95% CI 0.627–0.943).ConclusionThere is a slight decrease in depression recognition in PD patients between 2000 and 2015, which could be due to an increase in depression recognition during the prodromal phase of PD.

Trends and Contributing Factors for Prescribing Antipsychotics in Newly Diagnosed Parkinson's Disease Patients: A Population-Based Study.

PurposePsychosis is very common in later stages of Parkinson’s disease (PD) patients, but its prevalence in newly diagnosed patients is not rare. The use of antipsychotics in PD patients is complex given their association with worsening Parkinsonian motor symptoms and increased mortality rate. This study aims to examine factors that affect the use of antipsychotics in newly diagnosed PD patients and to identify changes in prescribing over time.Patients and MethodsThe Secure Anonymized Information Linkage (SAIL) databank was used to identify a cohort of newly diagnosed PD patients aged 40 years and older in Wales. The cohort was longitudinally examined over 17 years to determine the incidence of new antipsychotic use. Logistic regression models were used to analyze the data and were adjusted for several potential confounding variables.ResultsA total of 9142 PD patients were identified after applying inclusion and exclusion criteria, of whom 58.6% were male. During the first year of PD diagnosis, 12% of the patients developed psychosis and were prescribed antipsychotics. Quetiapine was the most commonly prescribed (49%), followed by risperidone (10.7%). The use of antipsychotics in newly diagnosed PD patients was significantly lower in the years 2009–2016 compared to 2000–2008 (OR 0.37, 95% CI 0.32–0.43). Other significant prescribing factors included patient’s age and history of dementia.ConclusionA dramatic decline in antipsychotic use was identified across years, showing adherence to warnings against use of antipsychotics for PD patients. Given that psychosis is prevalent in PD patients, the continuous assessment of the safety risks of antipsychotics is a matter of priority.

MO488HOSPITALISATION EVENTS IN PEOPLE WITH CHRONIC KIDNEY DISEASE AND MULTIPLE LONG-TERM CONDITIONS

Abstract Background and Aims: Chronic Kidney Disease (CKD) typically co-exists with multiple long-term conditions (LTCs). The impact of CKD combined with multiple LTCs on hospitalisation rates is not known. We hypothesised that hospitalisation rates would be high in people with multiple LTCs, particularly in those with CKD. We also hypothesised that the association between multiple LTCs and hospitalisation would be greatest in subgroups and with certain patterns of LTCs. Method: Two cohorts were studied in parallel: UK Biobank (2006-2019) and Secure Anonymised Information Linkage Databank (SAIL: 2011-2018, Wales, UK). UK Biobank is a prospective research cohort. SAIL is a routine care database. Participants were included if their kidney function was measured at baseline. LTCs were obtained from self-report (UK Biobank) and primary care read codes (SAIL). Participants were categorised into zero, one, two, three and four or more LTCs with and without CKD. CKD was defined as estimated glomerular filtration rate less than 60 ml/min/1.73m2 (single blood test for UK Biobank, two blood tests three months apart for SAIL). Hospitalisation events were obtained from linked hospital records. Results: Among 469,344 of 502,503 UK Biobank participants, those without CKD had a median age of 58 and a median of 1 LTC. Those with CKD had a median age of 64 and a median of 2 LTCs. Among 1,620,490 of 2,768,862 SAIL participants, those without CKD had a median age of 50 and a median of 1 LTC. Those with CKD had a median age of 79 and a median of 4 LTCs. Participants with four or more LTCs had high event rates (Rate Ratios (RRs) 5.35 (95% CI 5.20-5.51)/3.77 (95% CI 3.71-3.82)) with higher rates in CKD (RRs 8.99 (95% CI 8.47-9.54)/9.92 (95% CI 9.75-10.09)). Amongst those with CKD, the association between each increase in LTC count and hospitalisation was greatest in those under the age of 50 (RRs 1.93 (95% CI 1.73-2.16)/1.35(95% CI 1.29-1.41)). Event rates were highest in those with eGFR&amp;lt;30ml/min/1.73m2, but the impact of multiple LTCs was weaker in these participants compared to those with higher eGFRs. Event rates were high in certain patterns of LTCs: cardiometabolic LTCs (RRs 4.45 (95% CI 4.02-4.92)/2.81 (95% CI 2.71-2.91)), complex patterns (RRs 3.60 (95% CI 3.26-3.96)/2.91 (95% CI 2.81-3.01)) and physical/mental LTCs (RRs 3.30 (95% CI 2.86-3.80)/3.18 (95% CI 3.06-3.30)). Conclusion: People with multiple LTCs have high rates of hospitalisation and the rates are augmented in those with CKD. The impact of multiple LTCs is greatest in younger patients and in those with certain patterns of LTCs. Strategies should be developed to prevent hospitalisations in these high-risk groups. Hospitalisation Events by Chronic Kidney Disease (CKD) status and number of Long-term conditions (LTCs) in UK Biobank Hospitalisation Events by Chronic Kidney Disease (CKD) status and number of Long-term conditions (LTCs) in SAIL

Clinical relevance of comprehensive genomic profiling for advanced cancers in India.

e18718 Background: Comprehensive genomic profiling (CGP) assay, a next-generation sequencing (NGS) based technique generates a large amount of genomic information about a cancer. While CGP is increasingly used in low-middle income countries (LMIC), little is known about the extent to which these benefits patients. Here we describe the proportion of patients with advanced cancer in India who eventually receive targeted therapy for an actionable genetic alteration identified on CGP assays. Methods: This was a multicenter, retrospective cohort study in adult patients with advanced non-hematological malignancies who underwent a CGP test. We excluded patients who were identified to have a genetic alteration that has a well-validated targeted standard-of-care therapy (e.g.; EGFR exon 18, 19, 21 mutations for lung cancer, HER2 amplification for breast cancer). Participating oncologists provided anonymized information of consecutive CGP test reports through an online data capture form. Descriptive statistics were used to describe the proportion of patients with subsequent targeted therapy. Results: During 2019-20, 12 medical oncologists provided CGP reports for 297 patients; 235 met the inclusion criteria. Fourteen different testing panels were used by the oncologists. Among the study cohort, 45% were male. Eighty nine percent underwent tumor tissue biopsy and 11% had liquid biopsy. The most common cancers were lung (19%), breast (18%), pancreatobiliary (9%) and colorectal (6%). Patients received a median of 2 lines (range: 0-5) of prior systemic therapy. Based on the CGP assay, 35 patients (15%) received targeted therapy. Among them, 29% was for HER2 amplification (non-breast cancer), 26% for PIK3CA mutation, 11% for HER2 or EGFR exon 20 insertion mutation (lung cancer), 5% each for BRAF mutation (non-melanoma), EGFR mutation (non-lung cancer) and MET mutation. Conclusions: In a LMIC setting, 15% patients received a targeted therapy based on CGP assay. This is comparable to reports from high income countries. Considering the limited access to new drugs and clinical trials, this finding requires further analysis.