Direct Standardization Method Research Articles

Trends of the incidence and clinical outcomes of suicide-related out-of-hospital cardiac arrest in Korea: A 10-year nationwide observational study

BackgroundThe purpose of this study was to evaluate the characteristics and temporal trends of the incidence and survival outcomes of suicide-related out-of-hospital cardiac arrest (OHCA) according to the suicide attempt method during the past decade. MethodsA population-based observational study between 2009 and 2018 was conducted. EMS-treated suicide-related OHCAs were classified according to the suicide method into hanging, jumping, poisoning, asphyxia and drowning, and other trauma. The study outcomes were survival to discharge and good neurological outcome. The temporal trends of crude and age- and sex-standardized incidence per 100,000 person-years and standardized rates for outcomes were calculated using direct standardization methods. Predictors of survival to discharge were investigated using multivariable logistic regression. ResultsFrom 2009 to 2018, the age- and sex-standardized incidence rate of suicide-related OHCA increased from 3.5 to 4.0 cases per 100,000 person-years. Of 21,720 eligible OHCAs, hanging (59.2%) was the most common suicide method, followed by jumping (21.3%), poisoning (14.9%), and asphyxia and drowning (3.5%). Although the standardized rates of survival to hospital discharge improved from 2.9% to 5.1% during the study period, good neurological outcome was not improved (from 0.7% to 1.0%). By suicide method, survival to discharge for the hanging group was increased, and good neurological outcome for the poisoning group showed improvement (both p-for-trend <0.05). Compared with hanging, other suicide methods were negatively associated with survival outcome. ConclusionThe incidence of suicide-related OHCA has increased over the past decade in Korea, and survival outcomes are still very low. New interventions are needed to decrease the incidence and burden of suicide-related OHCAs.

Drug-related losses of the working-age population of Moscow: official levels and real scale

Introduction. Drugs and the resulting health loss are a global problem. At the same time, residents of megalopolises, mainly of working age, fall into the risk group. The purpose is to assess the scale of losses of the working-age population of Moscow due to drug use. Materials and methods. The data of Rosstat on mortality of the population were used. We have calculated standardized mortality rates by causes of death in the selected age groups. We used a direct method of standardization, the European standard for age structure. To characterize the social status of the deceased, we used the data of the RFS-UMIAS of Moscow (the period of data analysis is July-December 2018 − January-June 2019). Results. We analyzed the dynamics of mortality among the working-age population of Moscow from the main causes of drug etiology (accidental drug poisoning and drug poisoning with unspecified intentions, mental disorders caused by drug use) against the background of Russia in the 2010s. It is shown that the dynamics of mortality from these causes was characterized by a sharp change in trends during 2015−2016. There was a sharp increase in mortality in the capital during the same period from cardiovascular diseases, due to unspecified cardiomyopathy. We pointed out that these shifts are synchronous with the dynamics of mortality from symptoms, signs, and ill-defined conditions. Discussion. It is hypothesized that, with a high degree of probability, the abnormal increase in mortality from unspecified cardiomyopathy is a statistical artifact - a consequence of the transfer of drug-related deaths to a latent form. Conclusions. Masking losses from drug addiction in ill-defined conditions and unspecified cardiomyopathy leads to the fact that mortality from drug poisoning in Moscow is not assessed as a serious problem.

Investigation on spectral standardization among multi-channel of an on-line near-infrared spectrometer

To tackle the issue that the multivariate calibration model cannot be shared among channels due to the inter-channel spectral differences in the on-line multi-channel spectrometer, taking the determination of octane number (RON) and aromatic hydrocarbon content (AC) of multiple reformulated gasoline by on-line Fourier transform near-infrared (FT-NIR) spectrometer combined with partial least squares (PLS) as an example, a novel approach for spectral standardization by piecewise cosine spectra (cosSSM) is proposed in this paper. A total of 42 reformulated gasoline samples were collected and their RON and AC were determined using standard methods with their NIR absorption spectra being measured using the three channels of an on-line NIR spectrometer, respectively. To prove the effectiveness of cosSSM, the spectra of each channel were standardized using cosSSM, and the PLS models of RON and AC were established using the cosine spectra in one channel, then the predictions of the cosine spectra in the other channels were made. The results suggested that cosSSM effectively eliminated the adverse effect of inter-channel spectral variation on the applicability of the channel-specific PLS model, and the performance was comparable to that of the well-established piecewise direct standardization (PDS) method. Besides, cosSSM is relatively simple and easy-to-implement in practical application.

Breast Cancer Incidence Trends in Isfahan Province Compared with those in England over the Period 2001-2013.

Background:Figures from Iranian cancer registries indicate that Isfahan ranks first in female breast cancer incidence. Although few previous studies have examined whether the breast cancer incidence trend in Isfahan province has increased over a given period of time, this study employed a joint point regression analysis to answer the same question. Moreover, it compared the data of Isfahan province, from a developing country, with those of England, as a representative of developed countries, and tried to explain the causes of the differences observed between the trends.Methods:This repeated cross-sectional study was conducted on the data of 6057 women in Isfahan province and of 141,011 women in England with breast cancer over the years 2001–2013. The incidence rates were calculated using direct standardization method and based on the 2013 standard European population. For an analysis of the trends in breast cancer incidence rates, Joint Point Regression program, version 4.3.1.0, released in April 2016, was employed.Results:The mean age-standardized incidence rate (ASR) was calculated to be 34.7 per100,000 population over the years 2001 to 2013, which indicated an increase from 22 to 68 in Isfahan province. The corresponding mean ASR for England has also risen from 147.5 to 170.1 per 100,000 women during the same time period. The average annual percentage changes (AAPCs) for Isfahan and England were also calculated to be 9.6 and 1.1, respectively. This indicated an increasing trend in breast cancer incidence rates for Isfahan province over the period in question.Conclusions:The drastic discrepancy in breast cancer incidence rates between these two regions may be attributed to differences in an improved cancer registry system in Iran and women's developing awareness of the cancer over time.

Evaluation of a handheld ultra-compact NIR spectrometer for rapid and non-destructive determination of apple fruit quality

• Performances of the MicroNIR spectrometer were evaluated on apples for first time. • The handheld MicroNIR offered equal performance to classical benchtop spectrometer. • Quality parameters were better predicted by Least Squares Support Vector Machines. • The Direct Standardization was used to do calibration transfer between instruments. Benchtop and portable devices based on near infrared (NIR) spectroscopy are increasingly used to evaluate the quality parameters of fruits. This study aims to compare the analytical performance of a benchtop spectrometer (XDS) and a handheld ultra-compact spectrometer (MicroNIR) and to investigate calibration transfer between these devices for quality parameters of apples (soluble solids content, titratable acidity, pulp firmness, and starch-iodine index). Regression analyses were performed on a subset of apples measured with both spectrometers. The coefficient of determination (R²) and the root mean square error of cross-validation (RMSECV) values ​​obtained with Partial Least Squares (PLS) models were similar, which suggests that MicroNIR offers similar performance to the XDS device. For example, for soluble solids content, it was observed a R² = 0.89 with a RMSECV = 0.62 and a R² = 0.91 with a RMSECV = 0.57 for XDS and MicroNIR respectively. For the transfer, calibration models were built using XDS spectra and different regression methods. The best performances were obtained with Least Squares Support Vector Machines (LS-SVM). The Direct Standardization method was applied to achieve calibration transfer. Only two transfer samples were enough to significantly reduce the root mean square error of prediction (RMSEP) values with a relative reduction varying from 74 % to 93 % for PLS and Multiple Linear Regression (MLR) models respectively. It showed the potential of a simple calibration transfer method to allow the use of historical database registered with benchtop instrument.

Calibration transfer for bioprocess Raman monitoring using Kennard Stone piecewise direct standardization and multivariate algorithms

AbstractIn the biopharmaceutical industry, Raman spectroscopy is now a proven PAT tool that enables in‐line simultaneous monitoring of several CPPs and CQAs in real‐time. However, as Raman monitoring requires multivariate modeling, variabilities unknown by models can impact the monitoring prediction accuracy. With the widespread use of Raman PAT tools, it is necessary to fix instrumental variability impacts, encountered for instance during a device replacement. In this work, we investigated the impact of instrumental variability between probes inside a multi‐channel analyzer and between two analyzers, and explored solutions to correct them on model prediction errors in cell cultures. It is shown that the Kennard Stone piecewise direct standardization (KS PDS) method enables to lower model prediction errors between probes of a multi‐channel analyzer from 20% to 10% on the cell densities (TCD/VCD). Considering the integration of a new device or the replacement of a previous one, it has been determined that a first cell culture monitoring can be directly performed with the new analyzer calibrated by the KS PDS method based on the dataset from the previous analyzer, with an accuracy better than 10% on the main components of the culture like glucose, lactate, and the cell densities. Then, the new data obtained by the new analyzer can be inserted in a global calibration dataset to integrate instrumental variability in the chemometric model: it is shown that only one batch with the new device in a consistent and equilibrated calibration dataset was sufficient to correct the prediction gap induced by instrumental variability, allowing to exploit the data from previous analyzers considering optimized methods. This methodology provides good multivariate calibration model prediction errors throughout the instrumental changes which is a requirement for model maintenance.

Mortality trends for all causes of cancer in Mato Grosso State, Brazil

Abstract Background Cancer is the second leading cause of death in Brazil, being the most common breast, lung, colorectal, cervix and pancreas among women and lung, prostate, colorectal, stomach and esophagus among men. The mortality trends for all causes of cancer in Brazil have been increased, with variations between sexes and regions. The objective was to analyze standardized mortality trend rates for all causes of cancer in Mato Grosso State, Brazil, from 2000 to 2015. Methods This is a descriptive, ecological, time-series study using data from the Mortality Information System, made available by the Department of Health of the Mato Grosso State. Deaths from cancer of all ages were selected, whose basic cause was identified by the letter “C” from the 10th revision of International Classification of Diseases. The direct method of standardization was performed with the 1960 world population and expected deaths were estimated. To estimate the trend, the annual percentage variation (APV) was calculated using the ratio regression coefficient/2000 mortality rate, for the state and its five macroregions. Results From 2000 to 2015, 28.525 deaths from cancer occurred in the state residents. There was an increasing trend in the mortality rates for all causes of cancer, with APV of 0.81% (p = 0.001). Considering the macroregions, the south (APV = 1.12%; p = 0.01), north (APV = 1.51%; p = 0.01) and east (APV = 1.82%; p = 0.01) had an increasing trend and the west (APV = 0.51%; p = 0.44) and the center-north (APV = 0.46%; p = 0.12) had a stable trend. Conclusions Mato Grosso follows the Brazilian cancer mortality increased trend. Variation in mortality rates found among different macroregions of the state and no decreased rates reveal regional disparities and the importance of cancer control and prevention in the state. Key messages Mortality rate for all causes of cancer increased in Mato Grosso State, Brazil, from 2000 to 2015. Variation in mortality trends by macroregions of the Mato Grosso State reveals regional disparities and the importance of cancer control and prevention in the state.

Comparison of Mortality by Gender and Regions in Tanzania using Direct Standardized Death Rates (DSDR) Method

Background: Comparison of mortality is very useful in assessing population health. Crude rates can easily be computed from the mortality but they are not good for comparison across groups of the population. The aim of this paper was to compare mortality in Tanzania by region and gender using the 2012 Tanzania Population and Housing Census.&#x0D; Methods: Age-specific death rates for regions, Tanzania Mainland, Tanzania Zanzibar and entire Tanzania were obtained from Mortality and Health monograph data downloadable from the National Bureau of Statistics website. The direct standardization method was used to compare the mortality for male and female populations across all regions of Tanzania Mainland and Zanzibar.&#x0D; Results: Findings show that the mortality is low in Arusha, Manyara, and Kilimanjaro compared to other regions in Tanzania mainland implying that health status for both male and female population in those regions is better than the other regions while it is the worst in Njombe, Iringa, and Kagera implying the poor health status for those regions as compared to the rest regions in Tanzania Mainland. In Tanzania Zanzibar, high mortality was observed in Kusini Unguja and the lowest in Kaskazini Unguja for both male and female populations. By national wise and for almost all regions, the mortality for the male population is higher than that for the female population.&#x0D; Conclusion: Direct standardization methods can save as the best way for comparing mortality because it takes into consideration both the population at risk and the age structure. However, in estimating mortality, crude death rates should be used to give the magnitude while direct standardized death rates should be used for comparison purposes.

Constructing inverse probability weights for institutional comparisons in healthcare.

In comparing quality of care between hospitals, disease-specific quality indicators measure structural, process, or outcome elements related to the care of a particular condition. Such comparisons can be framed in terms of causal contrasts, answering the question of whether a patient (or a population of patients on average) would receive different care if treated at the care level of a different hospital. Fair comparisons have to be adjusted for patient case-mix, which is equivalent to controlling for confounding by the patient-level factors, including demographic factors, comorbidities, and disease progression. The methodological choice for such comparisons is usually between direct and indirect standardization methods. In this article, we discuss the alternative of inverse probability weighting as a tool for standardization in hospital comparisons. This involves fitting multinomial logistic hospital assignment models and using these to construct the inverse probability weights. The challenge in the present context is the presence of large number of hospitals being compared, many of which have a small patient volume. We propose methods to include small categories in the weighted analysis, as well as metrics and visualizations for checking the positivity/overlap and covariate balance in constructing such weights. The methods are illustrated in a running example using linked administrative data on surgical treatment of kidney cancer patients in Ontario.

Social, demographic, health care and co-morbidity predictors of tuberculosis mortality in Amazonas, Brazil: a multiple cause of death approach.

ObjectivesEstimate TB mortality rates, catalogue multiple causes on death certificates in which TB was reported and identify predictors of TB from reporting on death certificates in the State of Amazonas, Brazil, based on a multiple cause of death approach.MethodsThe death records of residents in the Amazonas state between 2006–2014 were analyzed and separated into three categories: TB not reported on the death certificate (TBNoR), TB reported as the underlying cause of death (TBUC) and TB reported as an associated cause of death (TBAC). Age standardized annual mortality rates for TBUC, TBAC and with TB reported (TBUC plus TBAC) were estimated for the State of Amazonas using the direct standardization method and World Health Organization 2000–2025 standard population. Mortality odds ratios (OR) for reporting of TBUC and TBAC were estimated using multinomial logistic regression.ResultsAge standardized annual TBUC and TBAC mortality rates ranged between 5.9–7.8/105 and 2.7–4.0/105, respectively. TBUC was associated with being a resident in the State capital (OR = 0.66), of female gender (OR = 0.87), having an education level of 8 to 11, or 12 or more school years (OR = 0.67 and 0.50 respectively), non-white race/skin color (OR = 1.38) and place of death reported as in the State capital (OR = 1.69). TBAC was related to the triennium in which death occurred (OR = 1.21 and 1.22 for the years 2009–2011 and 2012–2014 respectively), age (OR = 36.1 and 16.5 for ages 15–39 and 40–64 years respectively) and when death occurred in the State capital (OR = 5.8).ConclusionsTBUC was predominantly associated with predictors of unfavorable socioeconomic conditions and health care access constraints, whereas TBAC was mainly related to ages which were typical of high HIV disease incidence.

Increasing Cervical Cancer Incidence in Rural Eastern Cape Province of South Africa From 1998 to 2012: A Population-Based Cancer Registry Study.

PURPOSEIn this study, we aimed to investigate trends in the age-standardized and age-specific incidence rates in two distinct regions (the northern and southern areas) of South Africa covered by a population-based cancer registry. In addition, trends in coverage of the cervical cancer screening program were assessed using routine health service data.METHODSOccurrences (topography C53.0-C53.9) for the period 1998-2012 were extracted from a cancer registry database from which basic descriptive statistics and frequencies were analyzed for all variables using CanReg4. Trends over time were estimated using a direct standardization method and world standard population as a reference. Screening coverage annualized figures for women age ≥ 30 years by sub–health district were extracted from the District Health Information System.RESULTSIn the northern area, annual age-standardized incidence rates per 100,000 women increased from 24.0 (95% CI, 21.1 to 27.0) in 1998-2002 to 39.0 (95% CI, 35.6 to 42.5) in 2008-2012, with a screening coverage rate of 15% by 2012. In contrast, no increase was observed in incidence in the southern area, with rates of 20.0 (95% CI, 18.5 to 21.4) in 1998-2002 and 18.8 (95% CI, 16.2 to 21.4) in 2008-2012, and the southern area had a higher screening coverage of 41% in 2012. Overall, the percentage distribution of stage at diagnosis showed that 28.5% of occurrences were diagnosed at disease stages I and II and 35%, at III and IV; 36% had with missing stage information (2003-2012). In 77% of occurrences, a histologically verified diagnosis was made, compared with only 12.3% by cytology.CONCLUSIONThis study has demonstrated an almost two-fold increase in the incidence rate in the northern area but little change in the southern area of the cancer registry.

Model Maintenance of RC-PLSR for Moisture Content Measurement of Dried Scallop

HighlightsThe RC-PLSR model for Haiwan scallop can be transferred to Xiayi scallop.The direct standardization method is suggested for model maintenance.The VSWS-PDS method can be further improved in precision.Abstract. A prediction model for evaluating the moisture content in dried Haiwan scallops was established using hyperspectral imaging (HSI) technology in a previously published study. The accuracy of such models is usually affected by differences in sample species, different environmental conditions such as temperature or humidity, and aging of instruments. In this study, the prediction ability of the RC-PLSR model is improved by correcting the spectra of the tested species of dried scallop (i.e., Xiayi) to solve the problem of model failure caused by sample differences. The results of model maintenance by direct standardization (DS) are compared with those of variety sensitive wavelength selection - piecewise direct standardization (VSWS-PDS). The results showed that after using VSWS-PDS to modify the spectral data of the dried scallop samples, the correlation coefficient of prediction (Rp) of the updated model increased from 0.0890 to 0.9190. However, the root mean square error of prediction (RMSEP) also increased, indicating a need for improved precision. The RC-PLSR model based on DS correction showed Rp of 0.790 and RMSEP of 9.7481%. Model maintenance using the DS method is suggested because DS generally outperformed VSWS-PDS, even with a lower correlation coefficient. Future work on error reduction and sample input is suggested for VSWS-PDS optimization. Keywords: Direct standardization, Hyperspectral images, Model maintenance, Scallop, VSWS-PDS.

The Incidence and Prevalence of Anxiety, Depression, and Post-traumatic Stress Disorder in a National Cohort of US Veterans With Inflammatory Bowel Disease.

Patients with inflammatory bowel disease (IBD) are more susceptible to mental health problems than the general population; however, temporal trends in psychiatric diagnoses' incidence or prevalence in the United States are lacking. We sought to identify these trends among patients with IBD using national Veterans Heath Administration data. We ascertained the presence of anxiety, depression, or posttraumatic stress disorder among veterans with IBD (ulcerative colitis or Crohn's disease) during fiscal years 2000-2015. Patients with prior anxiety, depression, or posttraumatic stress disorder before their first Veterans Health Administration IBD encounter were excluded to form the study cohort. We calculated annual prevalence, incidence rates, and age standardized and stratified by gender using a direct standardization method. We identified 60,086 IBD patients (93.9% male). The prevalence of anxiety, depression, and/or posttraumatic stress disorder increased from 10.8 per 100 with IBD in 2001 to 38 per 100 with IBD in 2015; 19,595 (32.6%) patients had a new anxiety, depression, and/or posttraumatic stress disorder diagnosis during the study period. The annual incidence rates of these mental health problems went from 6.1 per 100 with IBD in 2001 to 3.6 per 100 in 2015. This trend was largely driven by decline in depression. The prevalence of anxiety, depression, and posttraumatic stress disorder is high among US veterans with IBD and increasing, given the chronicity of IBD and psychological diagnoses. Incidence, particularly depression, appears to be declining. Confirmation and reasons for this encouraging trend are needed.

Prevalence of multiple sclerosis in the South of Italy based on healthcare administrative data

Abstract Background Multiple sclerosis (MS) is an heterogenous disease whose prevalence varies in Europe. Hereby, we aimed to estimate prevalence of MS in the Campania Region of Italy. Methods To identify individuals with MS living in the Campania Region of Italy, we extracted data from the following healthcare administrative databases: hospital discharge records, regional drug registry, and specialist outpatient visits from Jan-2015 to 3Dec-2017. Individuals alive on the 1-Jan-2018 were included to capture prevalence on this date. Age-sex standardised prevalence rates were calculated using the direct standardisation method; the European population in 2018 was considered as reference population. To assess differences in the prevalence ratios across the five provinces of the region, standardised morbility ratios (SMR) were calculated. To calculate 95% confidence intervals (95%CI) for the standardised rates, the Byar’s approximation method based on the Poisson distribution was used. Results We identified 5,361 individuals with MS (females 64.5%, age 45.6±12.7 years). Standardised prevalence rate per 100,000 people was 90.0 cases (95%CI=87.60, 92.40) (112.07 for females [95%CI=108.36, 115.88] and 66.20 for males [95%CI=63.26, 69.25]). The SMR in the province of Naples, the most densely populated, was 0.90 (95%CI=0.86, 0.96), whereas the highest SMR was found in the province of Salerno (SMR=1.30; 95%CI=1.23, 1.38), and the lowest in the province of Caserta (SMR=0.89; 95%CI=0.82-0.96). Conclusions Prevalence of MS in the Campania Region is lower than previous estimates from smaller areas in the North of Italy, suggesting a longitudinal gradient. Differences within the Region could be explained by genetic/environmental background and healthcare organization (e.g., missing diagnoses). In the future, healthcare administrative databases could be used to monitor MS prevalence/incidence and to plan healthcare resource utilization. Key messages Prevalence of MS in the Campania Region is 90 cases per 100,000 people. It is lower than previous estimates from smaller areas in the North of Italy, suggesting a longitudinal gradient. Differences within the Region could be explained by genetic/environmental background and healthcare organization (e.g., missing diagnoses).

Mortality Among Veterans with Major Mental Illnesses Seen in Primary Care: Results of a National Study of Veteran Deaths.

Premature mortality observed among the mentally ill is largely attributable to chronic illnesses. Veterans seen within Veterans Affairs (VA) have a higher prevalence of mental illness than the general population but there is limited investigation into the common causes of death of Veterans with mental illnesses. To characterize the life expectancy of mentally ill Veterans seen in VA primary care, and to determine the most death rates of combinations of mental illnesses. Retrospective cohort study of decedents. Veterans seen in VA primary care clinics between 2000 and 2011 were included. Records from the VA Corporate Data Warehouse (CDW) were merged with death information from the National Death Index. Mental illnesses were determined using ICD9 codes. Direct standardization methods were used to calculate age-adjusted gender and cause-specific death rates per 1000 deaths for patients with and without depression, anxiety, post-traumatic stress disorder (PTSD), substance use disorder (SUD), serious mental illness (SMI), and combinations of those diagnoses. Of the 1,763,982 death records for Veterans with 1 + primary care visit, 556,489 had at least one mental illness. Heart disease and cancer were the two leading causes of death among Veterans with or without a mental illness, accounting for approximately 1 in 4 deaths. Those with SUD (n = 204,950) had the lowest mean age at time of death (64 ± 12 years). Among men, the death rates were as follows: SUD (55.9/1000); anxiety (49.1/1000); depression (45.1/1000); SMI (40.3/1000); and PTSD (26.2/1000). Among women, death rates were as follows: SUD (55.8/1000); anxiety (36.7/1000); depression (45.1/1000); SMI (32.6/1000); and PTSD (23.1/1000 deaths). Compared to men (10.8/1000) and women (8.7/1000) without a mental illness, these rates were multiple-fold higher in men and in women with a mental illness. A greater number of mental illness diagnoses was associated with higher death rates among men and women (p < 0.0001). Veterans with mental illnesses, particularly those with SUD, and those with multiple diagnoses, had shorter life expectancy than those without a mental illness. Future studies should examine both patient and systemic sources of disparities in providing chronic illness care to Veterans with a mental illness.

1835. High Burden of Invasive Staphylococcus aureus Disease Among Native Americans on the White Mountain Apache Tribal Lands

BackgroundNative Americans in the southwestern United States (US) have a higher risk of many infectious diseases than the general US population. The objective of this study was to determine the burden of invasive Staphylococcus aureus disease among Native Americans on the White Mountain Apache (WMA) Tribal lands.MethodsProspective population and laboratory-based surveillance for invasive S. aureus infections was conducted from May 2016 through April 2018. A case was defined as a Native American individual living on or around the WMA Tribal lands with S. aureus isolated from a normally sterile site. Incidence rates were calculated using the Indian Health Service User Population as the denominator. Age-standardized incidence rates were calculated by direct standardization methods using US Census data from 2015 as the reference.ResultsFifty-three cases were identified (Year 1: 24; Year 2: 29). Most cases were adults (90.6%; median age: 47.4 years) and had ≥1 underlying medical condition (86.8%), of which the most common were obesity (50.0%) and diabetes (50.0%). 26.4% of cases were categorized as community acquired. Most infections were methicillin-resistant (MRSA; 75.5%). 88.7% of cases were hospitalized, 7.5% required amputation, and 7.7% died within 30 days of the initial culture. The overall incidence of invasive S. aureus was 156.3 per 100,000 persons (95% confidence interval [CI]: 119.4, 204.5) with no significant difference in the incidence by year (Year 1: 141.5; Year 2: 171.1; incidence rate ratio: 1.21; 95% CI: 0.70, 2.08). The overall incidence of invasive MRSA was 118.0 per 100,000 persons (95% CI: 86.5, 160.8) with no significant difference by year (Year 1: 106.1; Year 2: 129.8; incidence rate ratio: 1.22; 95% CI: 0.66, 2.28). The incidence of invasive S. aureus and MRSA increased with age and was highest among individuals 50–64 years of age. The overall age-adjusted incidence of invasive MRSA was 138.2 per 100,000 persons (Year 1: 125.2; Year 2: 150.9, for comparison US 2015 general population: 18.8 per 100,000 persons).ConclusionThe WMA community has one of the highest reported incidence rates globally of invasive MRSA. Interventions are urgently needed in this community to reduce the morbidity and mortality associated with these infections.Disclosures All Authors: No reported Disclosures.

Chemometrics-assisted calibration transfer strategy for determination of three agrochemicals in environmental samples: Solving signal variation and maintaining second-order advantage

This manuscript proposes a chemometrics-assisted calibration transfer strategy to determine three agrochemicals (indole-3-acetic acid, 1-naphthylacetic acid and thiabendazole) in environmental samples by excitation-emission matrix (EEM) fluorescence detection. The fluorescence landscapes of target compounds are heavily overlapped with each other and also with the extracts of real samples, making it impractical to be quantified by conventional spectroscopy methods. The second-order calibration methods based on “mathematical separation” are carried out to handle these headaches as its potential capacity to get successful resolution and quantification even in the presence of overlapped peaks and unknown interferences, known as the famous “second-order advantage”. Piecewise direct standardization (PDS) method, one calibration transfer strategy, is applied for updating chemometric multivariate calibration model to compensate for the signal instability and variation in responses recorded on different instruments, which avoids overhead of a full recalibration usually involves considerable effort, cost, and time. Both root-mean-square error of prediction (RMSEP) and average recoveries calculated from simulated and experimental data are analyzed to validate the feasibility and applicability of this strategy. Result reveals that the number of calibration standard used was reduced from 10 to 3 for later determinations while producing comparable analytical results in terms of RMSEPs and recovery values to those obtained by a full recalibration strategy. The developed strategy takes advantage of less experimental effort and cost, which can be an alternative one for fast screening of agrochemicals and long-term process analysis in environmental samples or related food matrices.

Increasing Cervical Cancer Incidence in Rural Eastern Cape Province of South Africa, 1998-2012 - A Population-Based Cancer Registry Study

Background: South Africa introduced free cytology-based screening for cervical cancer in 1999. A high cervical cancer incidence has been observed in rural Eastern Cape Province, an area with a high prevalence of Human Immunodeficiency Virus and extensive provision of highly active anti-retroviral therapy. Cervical cancer incidence trends from the population-based Eastern Cape Cancer Registry are further examined by distinct geographic areas; northern and southern. Methods: Cases (topography C53.0-C53.9) for the period 1998-2012 were extracted from a cancer registry database from which basic descriptive statistics and frequencies were analysed for all variables using CanReg4.Trends over time were estimated using a direct standardization method and world standard population as a reference. Screening coverage annualized figures for women 30 years and older by sub-health district were extracted from the District Health Information System. Findings: In the northern area, annual age-standardized incidence rates per 100 000 women increased from 24.0 (95% CI: 21.1-27.0) in 1998-2002 to 39.0 (95% CI: 35.6-42.5) in 2008-2012, with a screening coverage rate of 15% by 2012. In contrast, no increase was observed in incidence in the southern area, with rates of 20.0 (95% CI: 18.5-21.4) in 1998-2002 and 18.8 (95% CI: 16.2-21.4) in 2008-2012, and a higher screening coverage of 41% in 2012. Overall, the percentage distribution of stage at diagnosis showed that 28.5% of cases were diagnosed at disease stages I and II, 35% III and IV, and 36% with missing stage information (2003-2012). In 77% of cases, a histologically verified diagnosis was made, compared with only 12.3% by cytology. Interpretation: The significant increase in the incidence in the northern area does not appear to be directly related to the screening programme but may portend increases associated with the widespread provision of highly active ante-retroviral therapy. Funding Statement: South African Medical Research Council. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: This study was approved by the South African Medical Research Council.

1589-P: Trends in Prediabetes Prevalence and Incidence among Immigrants in Ontario, Canada, 2011-2015: A Population-Based Study

The burden of prediabetes appears to be increasing worldwide. We aimed to examine temporal trends in prediabetes prevalence and incidence among immigrants to Ontario, Canada between 2011 and 2015 using linked administrative health and immigration databases. Comprehensive laboratory data were used to identify individuals without prior diabetes who underwent diabetes screening (N=511,357 in 2011 and 557,081 in 2015). We used logistics multivariate regression and direct age and sex standardization methods with 2011 Canadian census data to calculate prediabetes prevalence and incidence. Using World Health Organization criteria to define prediabetes (fasting plasma glucose (PG) 110-125 mg/dl, 2-hour PG 140-199 mg/dl on a 75 gm OGTT, HbA1c6.0-6.4%), the age- and sex-adjusted prevalence of prediabetes decreased from 15.8% to 12.2% over the 5-year period (p&amp;lt;0.001). These patterns were consistent across all ethnic groups, except immigrants from Sub-Saharan African and the Caribbean, where a rise in prevalence from 14.1 to 15.3% was observed. The largest declines were observed among South Asians and Latin Americans (20.1% to 15.3% and 16.1% to 9.4%, respectively in 2011 vs. 2015, p&amp;lt;0.001). Age- and sex-adjusted prediabetes incidence exhibited similar trends, declining from 11.1 to 9.6 per 100 person-years, with similar patterns by ethnic group as observed for prevalence. These patterns were generally consistent across age groups. In summary, the prevalence and incidence of prediabetes in Canadian immigrants appears to be declining, which may relate to changes in the underlying risk of diabetes in these populations or in screening and prevention practices. Disclosure G. Fazli: None. R. Moineddin: None. B.R. Shah: None. C.F. Wu: None. G. Booth: None.

Urbanicity and risk of first-episode psychosis: incidence study in Brazil.

We estimated the incidence of first-episode psychosis over a 3-year period in a Brazilian catchment area comprising the region's main city, Ribeirão Preto (1 425 306 persons-years at risk), and 25 other municipalities with a total of 1 646 556 persons-years at risk. The incidence rates were estimated and adjusted by gender and age, using the direct standardisation method to the world population as reference. The incidence of psychosis was higher in the younger groups, men, and among Black and minority ethnic Brazilians. Psychosis incidence was lower in Ribeirão Preto (16.69/100 000 person-years at risk; 95% CI 15.68-17.70) compared with the average incidence in the remaining municipalities (21.25/100 000 person-years at risk; 95% CI 20.20-22.31), which have lower population density, suggesting a distinct role for urbanicity in the incidence of first-episode psychosis in low- and middle-income countries.