Geographic Location Of Residence Research Articles

DISPARITIES IN ACCESS TO REPRODUCTIVE GENETIC SERVICES ASSOCIATED WITH GEOGRAPHIC LOCATION OF RESIDENCE AND MATERNAL ETHNICITY

To describe the association between geographic location of residence and use of aneuploidy screening or prenatal genetic counseling, and how it is modified by maternal race and ethnicity. Retrospective cohort of individuals at a tertiary-care center between 2017-19. County of residence was classified as rural or metropolitan based on US Office of Management and Budget 2019 definitions. Maternal race and ethnicity were self-identified. Our composite outcome was defined as use of aneuploidy screening or genetic counseling visit. The composite outcome was compared by geographic location and ethnicity. Logistic regression was used to model the relationship between geographic location and the composite outcome. 8774 pregnancies were included. 4770 (54%) had genetic screening and 3,781 (43%) had at least one genetic-counseling (GC) visit. Rural patients were significantly less likely to have the composite outcome compared to metropolitan peers (37.1% vs. 47.2%, p<0.001). In addition, we identified differences in the composite outcome between White rural patients and LatinX rural patients (37.7% vs. 35.6%, p<0.001), and between Asian rural patients and LatinX and Black rural patients (41.0% vs. 35.6%, p<0.001; 41.0% vs. 36.8%, p<0.001). Logistic regression demonstrated rural patients were significantly less likely to have the composite outcome compared to metropolitan peers, after adjusting for LatinX ethnicity and gestational age at first prenatal visit (OR 0.72, [0.55, 0.95], p=0.002. Rural, minority patients were significantly less likely to receive reproductive genetic services compared to metropolitan peers extending our knowledge of disparities in maternity care.

Abstract PO5-17-05: Recommendations of a panel of experts from the Brazilian Society of Mastology on breast and axilla clipping: when, how and for whom?

Abstract Background: The precise location of the tumor site is essential for obtaining free margins and success of surgical treatment, reducing the rates of reoperation and local recurrences. Neoadjuvant chemotherapy (NAC) is a challenge for preoperative tumor localization, due to the different patterns of locoregional response, limitations related to imaging methods, and the possibility of a pathological complete response (pCR). In addition, there are several divergent approaches regarding preoperative axillary evaluation, lymph node marking methods and approaches when facing cN1. Thus, the knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology (SBM) regarding breast and axilla marking were evaluated and a consensus regarding management and treatment was reached. Methods: This is an online survey conducted between June and December 2022. All 1.742 active mastologists affiliated to SBM were anonymously invited to participate in the study. The online form contained 28 objective questions, of which 22 were formulated on a Likert scale. These questions addressed several relevant aspects related to breast and axilla marking in the neoadjuvant setting. Responses that reached 70% agreement were considered consensual. Statistical analysis was performed using the SPSS program. Post hoc analysis was performed when appropriate and, in all analyses, the significance level of p &amp;lt; 0.05 was adopted. Results: A total of 468 mastologists answered the questionnaire (26.8%), with a predominance of professionals aged between 40-49 years (32.1%), male (50.4%), and residents of state capitals (63.9%). Most professionals were board-certified (84,8%), 87.7% for more than five years. The indication of tumor marking in the breast prior to NAC was consensual (96.4%) and the metal clip was the preferred method (69.7%). If available, the US-visible clip is preferred (86.5%). With respect to the marking of the breast and axilla prior to NAC, 93.3% of the mastologists considered relevant issues related to the techniques and materials. There was no consensus regarding the indication of pre-NAC histologically positive lymph node marking (49.8% disagree and 42.8% agree), however there was consensus that the clinical and imaging evaluation is insufficient for staging the axilla as N1 (71.6 %). The contraindication of breast and node marking in T4b tumors (71.2%) was consensual. There was consensus on the indication of sentinel lymph node biopsy (SLNB) for initially cN1 (92.3%) or cN2 (72.7%) tumors that became cN0 after NAC, with 67.5% opting for dual staining with technetium and patent blue. There was also consensus on the indication of axillary lymphadenectomy (89%) after NAC when double marking with technetium and patent blue for SLNB is not available. In addition, 41.0% of mastologists perform axillary lymphadenectomy when less than three lymph nodes are found in the SLNB. Among the 28 questions, consensus was reached on only 11 (39.3%); with some consensus variations according to age group, sex, geographic location of residence, place of professional activity (public or private), and professional experience. Conclusion: The indication of pre-NAC breast marking is consensual among Brazilian mastologists, although axillary nodal marking is not. There is a great divergence of attitudes among Brazilian surgeons in relation to the many issues related to pre-NAC breast and axilla marking, indicating the need to establish continuing education programs on the subject. Citation Format: Henrique Couto, Augusto Hassan, Dalton Steinmacher, Eduardo Pessoa, Eduardo Millen, Felipe Zerwes, Francisco Pimentel Cavalcante, Giuliano Tosello, Gustavo Badan, José Francisco, Leonardo Soares, Lucas Budel, Luciano Chala, Raquel Fernandes, Ruffo Freitas-Junior, Vilmar Oliveira, Vinicius Budel, Andre Mattar. Recommendations of a panel of experts from the Brazilian Society of Mastology on breast and axilla clipping: when, how and for whom? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-17-05.

Decolonization of health care in Tanzania

Geographical location of residence and socioeconomic status are two primary factors determining one&amp;rsquo;s access to health care, which often derail the common goal of affording equal accessibility of health-care resources to all individuals. The authors, comprising three physicians from Tanzania and two from the United Kingdom (UK), share a common commitment to understanding and addressing the consequences of colonization on health-care provision. Drawing on extensive experience in both clinical and academic capacities in East Africa, we define decolonization from the perspective of building sustainable and independent clinical and academic services in Tanzania, supported by experienced UK clinicians. In this opinion piece, we describe and discuss workforce and political issues that have shaped the historical and present influences of the UK in Tanzanian health care. In addition, we highlight certain successful initiatives that are already improving outcomes in Africa and offer further examples of practices that might improve clinical and academic outcomes for marginalized populations in the future.

Prevalence of dementia among people experiencing homelessness in Ontario, Canada: a population-based comparative analysis

Cognitive decline in people experiencing homelessness is an increasingly recognised issue. We compared the prevalence of dementia among people experiencing homelessness to housed individuals in the general population and those living in low-income neighbourhoods. We conducted a population-based, cross-sectional, comparative analysis using linked health-care administrative data from Ontario, Canada. We included individuals aged 45 years or older on Jan 1, 2019, who visited hospital-based ambulatory care (eg, emergency department), were hospitalised, or visited a community health centre in 2019; and identified people experiencing homelessness if they had one or more health-care records with an indication of homelessness or unstable housing. Prevalence of dementia was ascertained as of Dec 31, 2019, using a validated case definition for Alzheimer's disease and related dementia that was modified to include diagnoses made at a community health centre. Poisson models were used to generate estimates of prevalence. Estimates were compared with Ontarians that accessed any of the same health-care services over the same time, overall (general population group), and among those who were in the lowest quintile of area-based neighbourhood income (low-income group). 12 863 people experiencing homelessness, 475 544 people in the low-income comparator group, and 2 273 068 people in the general population comparator group were included in the study. Dementia prevalence was 68·7 per 1000 population among people experiencing homelessness, 62·6 per 1000 population in the low-income group, and 51·0 per 1000 population in the general population group. Descriptively, prevalence ratios between people experiencing homelessness and the comparator groups were highest within the ages of 55-64 years and 65-74 years in both sexes, ranging from 2·98 to 5·00. After adjusting for age, sex, geographical location of residence (urban vs rural), and health conditions associated with dementia, the prevalence ratio of dementia among people experiencing homelessness was 1·71 (95% CI 1·60-1·82) compared with the low-income group and 1·90 (1·79-2·03) compared with the general population group. People experiencing homelessness experience a high burden of dementia compared with housed populations in Ontario. Findings suggest that people experiencing homelessness might experience dementia at younger ages and could benefit from the development of proactive screening and housing interventions. The Public Health Agency of Canada.

The digital health divide: Understanding telehealth adoption across racial lines in rural Illinois

Due to long-standing barriers to healthcare access in rural areas, telehealth has been promoted as an effective means of delivering healthcare services. However, there is a general absence of quantitative data showing how geographic residence and race affect telehealth adoption. This study examines variations in telehealth adoption based on race and geographic residence in Southern Illinois using a mail survey. It finds that residents of urban Carbondale, compared to those in rural Cairo, have better access to broadband and are more likely to use telehealth. Respondents significantly differ from each other based on their geographic location of residence and race when it came to using telehealth to save money on travel and to save money on childcare. A significant barrier to telehealth adoption identified across all groups is privacy protection concern. The findings highlight the crucial role of broadband infrastructure in healthcare access and the need for trust in telehealth systems to ensure data privacy.

Geographical distribution of dental caries in children in the southern region of Brazil

The objective was to investigate the experience and severity of dental caries, from the medical records of children who visited the Children's Dental Clinic of a Faculty of southern Brazil, for four years. A cross-sectional study was carried out by analyzing 262 medical records containing information sociodemographic, as well as clinical oral data, to investigate dental caries. Amongst all children included in study, 226 (86.3%) had some teeth with experience of dental caries and 161 (61.5%) had three or more dental caries. The mean dental caries in children aged between 6-8 years was 5.3 ± 3.1, and the average in children aged between 9-12 years was 2.0 ± 1.9. There was association between the severity of dental caries (more than three teeth) and not using dental floss, as well as with the geographical location of residence. Older children were considered to be protected from dental caries. In this study, the experience of dental caries was high, especially in primary teeth, and variables such as the geographical location of residence, absence of flossing were related to the greater severity of dental caries.

Characteristics and health service utilization of children most at risk for prolonged temporary tube feeding.

This study aimed to describe children at risk of prolonged temporary tube feeding and evaluate associations between tube feeding duration and child and health service variables. A prospective medical hospital records audit was conducted between November 1, 2018, and November 30, 2019. Children at risk of prolonged temporary tube feeding were identified as having a tube feeding duration of >5 days. Information was collected on patient characteristics (eg, age) and service delivery provision (eg, tube exit plans). Data were collected from the pretube decision-making phase until tube removal (if applicable) or until 4 months after tube insertion. Descriptively, 211 at-risk children (median, 3.7 years; interquartile range [IQR], 0.4-7.7) differed from 283 not-at-risk children (median age, 0.9 years; IQR, 0.4-1.8) in terms of age, geographical location of residence, and tube exit planning. Medical diagnoses of neoplasms, congenital abnormalities, perinatal problems, and digestive system diseases in the at-risk group were individually associated with longer than average tube feeding duration, as were the primary reasons for tube feeding of nonorganic growth faltering and inadequate oral intake related to neoplasms. Yet, variables independently associated with greater odds of lengthier tube feeding durations were consultations with a dietitian, speech pathologist, or interdisciplinary feeding team. Children at risk of prolonged temporary tube feeding access interdisciplinary management because of their complexity. Identified descriptive differences between at-risk and not-at-risk children may be useful when selecting patients for tube exit planning and developing tube feeding management education programs for health professionals.

Clinical and serological association of plasma 25-hydroxyvitamin D (25(OH)D) levels in lupus and the short-term effects of oral vitamin D supplementation

Background and objectivesData on the association of vitamin D levels and clinical phenotype and disease activity in systemic lupus erythematosus (SLE) is controversial. Further, the optimal dose of oral vitamin D supplementation in SLE is not clear. Thus, the present study was designed to determine the association of plasma vitamin D levels with clinical phenotype, disease variables and serology in a large, cohort of SLE from South Asia and to evaluate the short-term effect of two different dosage regimens of oral vitamin D supplementation on disease flares and plasma vitamin D levels.MethodsThis is a two-phase study. Phase I was a cross-sectional analytical study of patients from north (26.85° N) and south India (11.94° N). Plasma 25-hydroxyvitamin-D(25(OH)D) was measured, and its association with demography, serology, disease activity, Galectin-9 and CXCL-10 was analysed. In phase II, patients with SLEDAI-2KG < 10 and on stable immunosuppression were randomised to receive either high dose (weekly 60,000 U*5, followed by 60,000 U monthly) or routine dose (30,000 U monthly) oral vitamin D. Outcomes were assessed at 6 monthsResultsPhase I included 702 patients with a mean age of 29.46 + 10.7 years. The median plasma vitamin D was 22.83 (13.8–31.8) ng/ml. Deficiency (< 20 ng/ml) was seen in 41.5% of patients. Patients from South India had higher vitamin D levels (27.06 ± 20.21 ng/dl) as compared to North India (17.15 ± 16.07 ng/ml) (p < 0.01). Univariate analyses demonstrated weak negative correlation of vitamin D with SLEDAI2K and positive correlation with age. Galactin-9 had modest correlation with SLEDAI2K but not with vitamin D levels. On multiple linear regression, centre of recruitment (β = 4.37) and age (β = 0.18) predicted (p < 0.05) plasma vitamin D levels.In the phase II, 91 randomised to 2 groups completed 6 months. Median change in plasma vitamin D levels was more in high dose (9.5 versus 2.6 ng/ml; p = 0.04). There were 14 SLE flares and six minor adverse events which were equal across both groups.ConclusionVitamin D deficiency is common in SLE. Geographical location of residence is the major determinant rather than the disease activity. The IFN regulated proteins reflect disease activity independent of vitamin D levels. High-dose oral vitamin D supplementation seems safe and more effective in improving vitamin D levels in SLE.Trial registrationThe second phase of this study was a registered randomised controlled trial CTRI/2019/06/019658 [registered on: 14/06/2019].

Reporting of Sociodemographic Data in Cochlear Implant Clinical Trials: A Systematic Review.

The purpose of this study was to systematically evaluate the literature on the frequency of reporting of sociodemographic data (gender, race, ethnicity, education status, health insurance status, geographic location of residence, and socioeconomic status) among interventional clinical trials involving cochlear implant patients. A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, Web of Science, and SCOPUS to identify peer reviewed research. A systematic review was performed, which included original prospective clinical trial research studies involving cochlear implantation and/or interventional trials involving cochlear implant patients. Collected data included funding type, level of evidence, race reporting, ethnicity reporting, socioeconomic status reporting, education level reporting, type of insurance, geographic location, and gender of patients. A total of 644 articles were included for review. Gender was the most reported sociodemographic factor (70% of included studies). Reporting of other data among included studies was low: educational level (6%), socioeconomic status (2%), race (1%), ethnicity (1%), insurance status (0.3%), and geography (1%). The odds of reporting gender (odds ratio [OR] = 1.51), education (OR = 1.81), and geography (OR = 2.72) increased with each subsequent publication date decade; however, this trend was not seen for reporting of race, ethnicity, socioeconomic status, or insurance. The reporting of gender was less likely to be reported in studies with the pediatric participants (OR = 0.62), level II evidence (OR = 0.14), and device programming interventional studies (OR = 0.26). Reporting of sociodemographic data, other than gender, is low among prospective clinical trials involving cochlear implant patients. The lack of reporting of this key data may limit research rigor and generalizability. Clinical researchers are advised to prospectively collect these data to promote equity in cochlear implant research and clinical care.

Factors affecting rates of neurodevelopmental follow-up in infants with congenital heart disease

BackgroundNeurodevelopmental outcomes programs for children with congenital heart disease (CHD) support early identification and intervention for developmental impairments; however, not all eligible children attend such programs. The purpose of our study was to examine factors, including sociodemographic, associated with cardiac neurodevelopmental outcomes program attendance. MethodsChildren with CHD born April 2013–April 2018 who underwent cardiac surgery before age 6 months were included. The primary outcome was at least one neurodevelopmental clinic visit, and secondary outcome was number of visits attended during the first two years of life. Predictor variables included maternal and infant characteristics, surgical data, geographic location of residence, and neighborhood-level socioeconomic metrics. ResultsOf 730 eligible infants, median age at surgery was 13 days (IQR 7-44), and 37% were Hispanic, 45% were non-Hispanic White, and 10% were non-Hispanic Black. Twenty-three percent lived >200 miles from the institution. A total of 462 (63%) attended at least one visit. On multivariable analysis, factors associated with attending at least once were Hispanic ethnicity (if living <200 miles from the institution or Spanish-speaking), older maternal age, and shorter driving time. On multivariable analysis of the secondary outcome, factors associated with a greater number of visits were Hispanic ethnicity (if living <200 miles from the institution), older maternal age, shorter driving time, and private health insurance. ConclusionsOur data demonstrate that Hispanic ethnicity and closer distance from the institution were associated with increased attendance in our neurodevelopmental program. Continued education on the importance of neurodevelopmental follow-up and making adaptations to current practices to reach all individuals with CHD will be important moving forward. Whether these higher rates of attendance improve neurodevelopmental outcomes for this specific population requires further research.

Household transmission of COVID-19 cases associated with SARS-CoV-2 delta variant (B.1.617.2): national case-control study.

SummaryBackgroundThe SARS-CoV-2 Delta variant (B.1.617.2), first detected in India, has rapidly become the dominant variant in England. Early reports suggest this variant has an increased growth rate suggesting increased transmissibility. This study indirectly assessed differences in transmissibility between the emergent Delta variant compared to the previously dominant Alpha variant (B.1.1.7).MethodsA matched case-control study was conducted to estimate the odds of household transmission (≥ 2 cases within 14 days) for Delta variant index cases compared with Alpha cases. Cases were derived from national surveillance data (March to June 2021). One-to-two matching was undertaken on geographical location of residence, time period of testing and property type, and a multivariable conditional logistic regression model was used for analysis.FindingsIn total 5,976 genomically sequenced index cases in household clusters were matched to 11,952 sporadic index cases (single case within a household). 43.3% (n=2,586) of cases in household clusters were confirmed Delta variant compared to 40.4% (n= 4,824) of sporadic cases. The odds ratio of household transmission was 1.70 among Delta variant cases (95% CI 1.48-1.95, p <0.001) compared to Alpha cases after adjusting for age, sex, ethnicity, index of multiple deprivation (IMD), number of household contacts and vaccination status of index case.InterpretationWe found evidence of increased household transmission of SARS-CoV-2 Delta variant, potentially explaining its success at displacing Alpha variant as the dominant strain in England. With the Delta variant now having been detected in many countries worldwide, the understanding of the transmissibility of this variant is important for informing infection prevention and control policies internationally.

A Descriptive Analysis of the Epidemiology and Motivations for Laser Tattoo Removal in an Underserved Population.

Tattoos of formerly gang-involved and incarcerated individuals can negatively impact their ability to reintegrate into society. Laser tattoo removal is essential to helping individuals obtain employment, re-cultivate positive relationships, and disengage from gangs. The objective of this study is to describe the demographics and motivations for laser tattoo removal at a large nonprofit clinic. This was a single center retrospective study conducted on patients presenting to Ya'stuvo Tattoo Removal between January 2016-December 2018 and had at least three laser tattoo removal sessions. Data was recorded on patient demographics, geographic location of residence (e.g. zipcode), comorbidities, probation/parole status, referral source, transportation mode, and motivations for receiving and removing tattoos. A representative sample of 862 patients was used to conduct our analysis. Average age at first visit was 30. 16% (n = 134) were on probation, 8% (n = 66) were on parole, and 63% (n = 544) did not report their probation/parole status. Reasons for receiving a tattoo included gangs (46%, n = 368), a current or ex-relationship (28%, n = 223), and decoration (20%, n = 159). The most common reasons for tattoo removal were employment (66%, n = 546), readiness to change life (47%, n = 392), maturity (47%, n = 392), family (43%, n = 356), and negative attention from tattoos (37%, n = 303).The current study highlights the importance of laser tattoo removal in reintegration and gang disengagement. Expanding cost efficient laser tattoo removal is paramount to meet the safety and socioeconomic needs of this population.

Environmental Factors as a Cause of Differences in the Feet of Ecuadorian Children and Its Relation to Their Footwear.

The objective of this study was to analyze the differences in foot measurements of Ecuadorian children according to their geographical location of residence, taking into account climatic differences (1). A total of 1662 children (2) participated in the study. Three groups were established: coast, mountains and amazonia. The type of footwear (3) used was recorded and the lengths, widths, perimeters, heights and angles of both (4) feet were analyzed with a 3D foot digitizer (5). The variable ‘fitting of the foot to footwear’ was also obtained. Children living in coastal areas presented greater lengths, widths, perimeters and heights compared to those living in the mountain (p > 0.001) and amazonia (p < 0.001) between ages 5 to 13. Mountain residents showed a greater first toe angle than coast residents (p > 0.001) aged 8 to 17. Children used shoes smaller than required by their foot length (p < 0.01). Ecuadorian children from the coast presented longer and wider feet with higher foot arches, whilst those from mountains presented greater first toe angle. The studied sample used footwear up to one size smaller than the size corresponding to their foot length. The fitting and type of footwear used according to climatic differences could be interfering with normal foot development.

Stress Incontinence Surgery Does Not Cause Pelvic Malignancy: A Population-Based Cohort Study

We sought to determine if stress urinary incontinence surgery (mesh or nonmesh) is associated with the development of pelvic malignancies later in life. We performed a retrospective cohort study between January 1, 2002 and October 31, 2015 of all women in Ontario, Canada without a history of pelvic malignancy who underwent an index stress incontinence surgery. The primary outcome was a composite of any pelvic malignancy (including urological and gynecological cancers) following stress incontinence surgery. Secondarily, we considered each cancer individually. A survival analysis using a Cox proportional-hazards model with a 3-level categorical exposure (mesh surgery, nonmesh surgery, and control) was performed. Patients were followed until death, emigration or the study end (October 31, 2017). Of the women 74,968 underwent stress urinary incontinence surgery during the study period. There were 5,505,576 women in the control group. Over a median followup of 8.5 years (IQR, 5.5-11.9), 587 pelvic malignancies occurred in the surgery group. Women who underwent stress incontinence surgery had a reduced risk of pelvic malignancy independent of surgery type, compared to controls (Wald type 3 p <0.001; mesh HR, 0.68 [95% CI, 0.62-0.76]; p <0.0001; nonmesh HR, 0.37 [95% CI, 0.29-0.46]; p <0.0001). The individual pelvic cancers similarly demonstrated a reduced risk of malignancy following stress incontinence surgery. At a median followup of 8.5 years, women had no increased risk of pelvic malignancy following either mesh or nonmesh stress urinary incontinence surgery in a large population-based cohort.

The Concept and Formula of Happiness: Historical and Contemporary Criteria

The article presents a historical and philosophical analysis of happiness as a socio-cultural phenomenon, considers the proposed criteria and components of the state of happiness as well as proposes the author's integrative definition of happiness. The relevance of this study is determined by the importance of the actual humanitarian indicators in assessing socio-political progress. As a result of the analysis of how the concept of happiness was historically formed and developed, it was shown that (a) the concept of happiness became widespread in the humanitarian discourse relatively late, (b) its predecessors are the ancient Greek concepts of agathon (the good) and eudaimonia (welfare, prosperity, supreme good), (c) in Western European philosophy, the understanding of good is contradictory and includes a wide range of meanings, from utilitarian to axiological, (d) the content of the concept of happiness includes two aspects: one is in the person's power and the other is determined by external factors. The article analyzes modern theories of happiness and feelings of life satisfaction as well as scientific studies of the components of the state of happiness. As a result of the analysis of these approaches, it is shown that in most modern studies, the emphasis in understanding happiness is placed on either socio-biological or socioeconomic factors. The author examines the criteria for the state of happiness. The author quotes other researchers and proposes certain steps as an algorithm for determining happiness, i.e., a formula for happiness. The importance of harmony of the following components of the human personality and life is substantiated: the belief system (and living in accordance with one's beliefs), abilities (and the possibility of their implementation in professional, cognitive activity), geographical location of residence, as well as social circle (and the balance of socio-psychological proximity and distancing).

Age and ability differentiation in children: A review and empirical investigation.

Differentiation hypotheses concern changes in the structural organization of cognitive abilities that depend on the level of general intelligence (ability differentiation) or age (developmental differentiation). Part 1 of this article presents a review of the literature on ability and developmental differentiation effects in children, revealing the need for studies that examine both effects simultaneously in this age group with appropriate statistical methods. Part 2 presents an empirical study in which nonlinear factor analytic models were applied to the standardization sample (N = 2,619 German elementary schoolchildren; 48% female; age: M = 8.8 years, SD = 1.2, range 6-12 years) of the THINK 1-4 intelligence test to investigate ability differentiation, developmental differentiation, and their interaction. The sample was nationally representative regarding age, gender, urbanization, and geographic location of residence but not regarding parents' education and migration background (overrepresentation of children with more educated parents, underrepresentation of children with migration background). The results showed no consistent evidence for the presence of differentiation effects or their interaction. Instead, different patterns were observed for figural, numerical, and verbal reasoning. Implications for the construction of intelligence tests, the assessment of intelligence in children, and for theories of cognitive development are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Gut Microbial Profile Is Associated With Residential Settings and Not Nutritional Status in Adults in Karnataka, India.

Undernutrition is a leading contributor to disease and disability in people of all ages. Several studies have reported significant association between nutritional status and gut microbiome composition but other factors such as demographic settings may also influence the adult microbiome. The relationship between undernourishment and gut microbiome in adults has not been described to date. In this study, we compared the gut microbiome in fecal samples of 48 individuals, from two demographic settings (rural and urban slum) in Karnataka, India using 16S rRNA sequencing. Nutritional status was assessed based on BMI, with a BMI of < 18.5 kg/m2 classified as undernourished, and a BMI in the range 18.5–25 kg/m2 as nourished. We analyzed 25 individuals from rural settings (12 undernourished and 13 nourished) and 23 individuals from urban slum settings (11 undernourished and 12 nourished). We found no significant difference in overall gut microbial diversity (Shannon and Unweighted UniFrac) between undernourished and nourished individuals in either geographical settings, however, microbial taxa at the phylum level (i.e., Firmicutes and Proteobacteria) and beta diversity (unweighted UniFrac) differed significantly between the rural and urban slum settings. By predicting microbial function from 16S data profiling we found significant differences in metabolic pathways present in the gut microbiota from people residing in different settings; specifically, those related to carbohydrate and lipid metabolism. The weighted sum of the KEGG Orthologs associated with carbohydrate metabolism (Spearman's correlation coefficient, ρ = −0.707, p < 0.001), lipid metabolism (Spearman's correlation coefficient, ρ = −0.330, p < 0.022) and biosynthesis of secondary metabolites (Spearman's correlation coefficient, ρ = −0.507, p < 0.001) were decreased in the urban slum group compared to the rural group. In conclusion, we report that the geographical location of residence is associated with differences in gut microbiome composition in adults. We found no significant differences in microbiome composition between nourished and undernourished adults from urban slum or rural settings in India.

371 - Outcomes in Allogeneic Transplant Based on Race and Geographic Location of Residence

371 - Outcomes in Allogeneic Transplant Based on Race and Geographic Location of Residence

A prospective study monitoring carer distress during (chemo)radiotherapy for head and neck cancer via an electronic platform.

IntroductionResearch has shown that electronic platforms can assist data capture of patient‐reported outcome measures (PROMs) to guide clinical care. In comparison, routine collection of carer‐reported outcome measures (CROMs) to support the patient–carer dyad during cancer treatment has had limited attention. The current study utilised a novel electronic CROM (eCROM) system, ScreenIT Carer, to monitor the prevalence and nature of distress in carers of patients undergoing (chemo)radiotherapy ((C)RT) for head/neck cancer (HNC), and explore factors associated with carer distress.MethodsCarers completed ScreenIT Carer weekly when attending patients’ (C)RT treatment sessions from planning to 2 weeks post‐treatment. ScreenIT Carer included the Distress Thermometer (DT) and Problem List, and a purpose‐built Mealtime‐Specific DT and Problem list. Data were first examined descriptively, then associations between demographic/treatment‐related factors and distress severity were analysed using mixed‐effects general linear modelling.Results135 carers provided 434 ScreenIT Carer entries during the study period (mean entries = three/carer; yielding average adherence rate of 41% (range 11–100%)). A high prevalence of general (59%) and mealtime‐specific distress (46%) was reported by carers. Nature of distress was multifactorial, with emotional problems and the patients’ physical condition/symptoms common contributing factors. Based on multivariate analysis, tumour site, geographical location of residence and time during (C)RT when ScreenIT Carer was completed were significant predictors of carer distress severity.ConclusionsCarer distress is prevalent and multifactorial during (C)RT. This study highlights the feasibility of utilising eCROM platforms such as ScreenIT Carer, to monitor carer wellbeing and guide supportive care services as part of a holistic care pathway.

Adolescent idiopathic scoliosis detection and referral trends: impact treatment options

Study designRetrospective cross-sectional study.ObjectiveTo analyze the patient demographic referred for scoliosis to the Hospital for Sick Children to determine the proportion of patients suitable for brace treatment, as per the Scoliosis Research Society guidelines.Summary of background dataThere is level 1 evidence that bracing in adolescent idiopathic scoliosis (AIS) decreases the risk of curve progression and need for surgery, but optimal brace treatment requires early curve detection.MethodsWe performed a retrospective review of 618 consecutive patients who underwent initial assessment in our Spine Clinic between Jan. 1 and Dec. 31, 2014. We included children 10–18 years, with scoliosis greater than 10°, excluding those diagnosed with non-idiopathic curves. Primary outcomes were Cobb angle, menarchal status, and Risser score. We analyzed the effect of specific referral variables (family history, the person who first noticed the curve, and geographic location of residence) on presenting curve magnitude.ResultsDuring the study period, 335 children met the inclusion criteria, with an average age of 14.1 ± 1.8 years and a mean Cobb angle of 36.8 ± 14.5°. Brace treatment was indicated in 17% of patients; 18% had curves beyond optimal curve range for bracing (> 40°), and 55% were skeletally mature, therefore not brace candidates. The majority of curves (54%) were first detected by the patient or family member and averaged 7° more than curves first detected by a physician. A family history of scoliosis made no difference to curve magnitude, nor did geographic location of residence.ConclusionThe majority of AIS patients present too late for effective management with bracing.Level of evidenceIII.