Long-term Users Research Articles

Effects of Medication Period and Gastrin Levels on Endoscopic Gastric Mucosal Changes in Long-Term Proton Pump Inhibitor Users

Background/Objectives: Proton pump inhibitor (PPI) use has increased worldwide, including in continuous and longer-term users. Recent reports highlight PPI-related endoscopic gastric mucosal changes, including fundic gland polyps, hyperplastic polyps, multiple white and flat elevated lesions, cracked and cobblestone-like mucosa (CCLM), and black spots. PPI use elevates gastrin levels because of acid inhibition, and hypergastrinemia might be relevant to these findings. In this cross-sectional study, we retrospectively examined gastric mucosal changes in long-term PPI users, focusing on medication period and gastrin levels. Methods: We enrolled 57 patients who received a PPI (>1 year) at two clinics between January 2021 and March 2022. Participants were classified according to medication period: 1 < 5, 5–10, and ≥10 years. Gastrin levels were categorized as low, middle, and high (<250, 250–500, and ≥500 pg/mL, respectively). Odds ratios (OR) were estimated to assess the risk of endoscopic findings. Results: Of the 57 patients, 6 (10.5%), 25 (43.9%), and 26 (45.6%) were PPI users of 1 < 5, 5–10, and ≥10 years, respectively. There were no significant differences in the incidence of endoscopic findings among the medication periods. Low, middle, and high gastrin groups included 21 (36.8%), 21 (36.8%), and 15 (26.3%) patients, respectively. CCLM incidence was significantly elevated in higher gastrin level groups: middle (OR, 6.60; 95% confidence interval [CI], 1.46–29.75; p = 0.014) and high (OR, 9.00; 95% CI, 1.79–45.23; p = 0.0008) (p-trend = 0.0171). No significant differences were observed for other findings. Conclusions: No elevated risk of PPI-related gastric epithelial changes in long-term PPI users was observed time-dependently. Notably, higher gastrin levels were positively associated with CCLM development, irrespective of the medication period.

Abstract 4117180: Hyperkalemia-Related Hospitalization Associated with Short-Term vs. Long-Term Outpatient SZC Therapy Among RAASi Users: The GALVANIZE Outcome study

Introduction: Patients receiving renin-angiotensin-aldosterone system inhibitors (RAASi) are at increased risk of developing hyperkalemia (HK). Sodium zirconium cyclosilicate (SZC) is used to treat HK, but the impact of duration of SZC on healthcare resource utilization (HRU) in RAASi users is unknown. The GALVANIZE Outcome study compared HK-related HRU among RAASi users between long-term and short-term SZC users. Methods: Adults with ≥1 outpatient prescription for SZC (index date) and ≥1 RAASi prescription spanning the index date were identified from a large US insurance claims database (7/2018-12/2022) and were stratified based on duration of SZC use. Long-term SZC users (>90 days) and short-term SZC users (≤30 days) were exactly and propensity score matched on key baseline characteristics. Rates of HK-related hospitalizations or emergency department (ED) visits, HK-related ED visits, and HK-related hospitalizations were compared during follow-up from index to the earliest of 6 months post-index, end of data availability, other potassium binder use, or re-initiation of SZC post-discontinuation. Results: Among 1,586 matched pairs, the mean age was 65.5 years, 41.0% of patients were female, and most patients had any stage chronic kidney disease (91.9%), hypertension (90.8%), and diabetes (73.4%). Also, 30.0% of patients had heart failure. The most used RAASi therapies at index were angiotensin-converting enzyme inhibitors (57.3%) and angiotensin-receptor blockers (56.3%). Patients with long-term SZC use had a 44% lower rate of HK-related hospitalizations or ED visits, a 41% lower rate of HK-related hospitalizations and a 52% lower rate of HK-related ED visits than patients with short-term SZC use during follow-up (all p<0.01; Figure 1). Conclusions: Among patients with RAASi and SZC therapy use, long-term SZC use was associated with significantly lower rates of HK-related HRU compared to matched patients with short-term SZC use. Funding: AstraZeneca

A Proton Pump Inhibitor Independently Elevates Gastrin Levels as a Marker for Metachronous Gastric Cancer After Endoscopic Submucosal Dissection.

Background and Objective: Serum markers such as gastrin and pepsinogen are useful for stratifying gastric cancer risk. However, their utility in predicting metachronous gastric cancer after endoscopic submucosal dissection (ESD) in patients with gastric cancer after Helicobacter pylori eradication (GCAE) is unclear. This study aimed to clarify predictive factors for metachronous gastric cancer after ESD with a focus on serum markers. Methods: A retrospective analysis was conducted on 197 patients with 224 GCAE lesions who underwent ESD at Hiroshima University Hospital between April 2010 and December 2019. In total, 63 patients with 74 differentiated-type lesions were classified into metachronous gastric cancer (MG) and non-metachronous gastric cancer (NMG) groups, excluding proton pump inhibitor (PPI) users, female patients, and undifferentiated-type cases. The predictive value of serum markers was assessed using ROC curve analysis, and their association with carcinogenesis was evaluated using multiple logistic regression. Furthermore, the incidence of MG was compared between long-term PPI users and non-users. Results: ROC analysis revealed that serum gastrin had the highest discriminative ability for MG (AUC 0.77, cut-off 99 pg/mL, sensitivity 61.6%, and specificity 80.0%). Severe mucosal atrophy and high gastrin levels were significantly more common in the MG group and were independent predictors (p < 0.01). Although serum gastrin levels were significantly elevated in PPI users, no increased risk of MG was observed. Conclusions: In addition to severe mucosal atrophy, PPI-independent elevated serum gastrin levels may be associated with an increased risk of MG after ESD. Serum gastrin may serve as a valuable marker for post-ESD cancer surveillance in GCAE patients.

Postoperative opioid use in Norway—a population-based observational study on patterns of long-term use

BackgroundThe utilization patterns of opioid analgesics and the proportion of long-term opioid use after surgery in Norway is largely unknown.MethodsThis study aimed to estimate the proportion of one-year long-term prescription opioid use among all Norwegian postoperative opioid users. Complete data from central health registries (NPR, NorPD, Statistics Norway, CoDR) were linked via the personal identification number unique to all citizens. The study period was January 1st 2010 until December 31st 2019. Long-term opioid use was defined as at least two opioid dispensings within two subsequent 90-day periods, with a minimum average use of 10 MME/day for the first 90 days.ResultsThe study population consisted of 693 495 post-operative opioid users (53.6% women), whereof 73.2% had not used opioids the year before surgery (new users). Among the postoperative opioid users, 3.8% were one-year long-term opioid users. The corresponding figures for new and previous opioid users were 0.4% and 13.1%, respectively. The highest proportions of long-term opioid use were found after transluminal endoscopy, eye surgery and assessments related to surgical procedures. In previous opioid users, the proportion of one-year long-term use was higher among women than men in all age groups, a difference that increased with age.ConclusionsThe proportion of postoperative long-term opioid use in Norway is generally low. We detected higher proportions of long-term opioid use after certain types of surgery, but our crude surgery definition warrants further examination. Previous opioid users pose a particular challenge in the management of postoperative pain.Trial registrationThe study used national health registry data from the period 2010–2019. A pre-registered analysis plan is available at Open Science Framework.

Effects of long-term high-dose medroxyprogesterone acetate use on bone mineral density in postmenopausal women

Aims: The aim of this study was to investigate the relationship between long-term depot medroxyprogesterone acetate (DMPA) use and bone mineral density (BMD) in postmenopausal women. Methods: This study was conducted on 40 postmenopausal women who presented at the SSK Okmeydanı Training and Research Hospital Gynecology and Obstetrics Polyclinic. The sample for the study was randomly selected from postmenopausal women and divided into the control group (N=20) and the medroxyprogesterone acetate group (N=19). Results: A total of 39 participants were included in this study, 19 cases and 20 controls. Long-term DMPA users had higher BMD compared with the control group. These differences from the control group were statistically and potentially clinically significant. The BMD in the control group has decreased significantly during one year of study. Based on the results, the longterm use of DMPA significantly affects the bone mineral density in postmenopausal women, increasing BMD. Conclusion: Long-term use of DMPA was associated with improved BMD after treatment. The findings demonstrate the need for long-term, controlled, prospective studies with adequate sample size to evaluate the potential clinical impact of DMPA use on bone health outcomes in postmenopausal women.

Incidence and risk factors of antidepressant withdrawal symptoms: a meta-analysis and systematic review.

Antidepressants are among the most extensively prescribed psychotropic drugs worldwide. Discontinuation induced withdrawal symptoms have been reported for almost all antidepressants. The incidence of antidepressant withdrawal syndrome (AWS) and other characteristics remain unknown. We searched the PubMed, Embase, PsycINFO, MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials databases from inception to December 31, 2023. Randomized double-blinded trials, longitudinal or cross-sectional studies that reported the incidence and other characteristics of antidepressant withdrawal symptoms were included. The pooled incidence of AWS was calculated by a random effects model. We included 35 studies, of which 2 studies just provided incidence of specific withdrawal symptoms, and 4 studies only described other characteristics. The pooled incidence of AWS from all available studies was 42.9%, from 11 RCTs was 44.4%, in studies in which the treatment duration was mostly 8-12 weeks, which usually appear within 2 weeks, and were generally measured for <4 weeks. The incidence in selective serotonin-norepinephrine reuptake inhibitors was the lowest (29.7%), followed by selective serotonin reuptake inhibitors (45.6%) and tricyclic antidepressants (59.7%), without significant differences (p = 0.221). Treatment duration showed a dose-response to the incidence of AWS (6-12 W: 35.1%, 12-24 W: 42.7%, >24 W: 51.4%). The half-life did not show such a simple dose-dependent relationship. The pooled estimate was robust regardless whether withdrawal symptoms were measured in RCTs or observational studies (including face-to-face and online survey studies). Tapering the dose reduced the incidence of AWS compared with abrupt stoppage (34.5% vs 42.5%), without a significant difference (p = 0.484). Risk factors for withdrawal symptoms included being female, younger, experiencing adverse effects early in treatment, taking higher doses or longer duration of medication, abrupt cessation of drugs, and those with a lower clearance of drugs or with serotonin 1A receptor gene variation. The findings suggest the incidence of AWS are common and some clinical characteristics and risk factors which can help clinicians identify who is at greater risk of experiencing AWS. Discontinuation studies on long-term antidepressant users with long follow-up periods are required in the future.

Romosozumab versus denosumab in long-term users of glucocorticoids: A pilot randomized controlled trial.

To compare the efficacy of romosozumab (ROMO) and denosumab (DEN) in prevalent long-term glucocorticoid (GC) users. Adult patients receiving oral prednisolone (≥5mg/day) with high risk of fracture were randomized to receive subcutaneous ROMO (210mg monthly) or DEN (60mg 6-monthly) for 12 months, followed by DEN for two more doses. The primary end point was the change in spine bone mineral density (BMD) from Months 0 to 12. Secondary end points included changes in BMD of the spine/hip/femoral neck and bone turnover markers at various time points and adverse events. Seventy patients (age 62.6±9.1 years; 96% women; median prednisolone dose 5.0mg/day; duration of therapy 10.7±7.4 years) were enrolled, and 63 completed the study. At Month 12, the spine BMD increased significantly in both ROMO (+7.3%±4.5%; p<0.001) and DEN (+2.3%±3.1%; p<0.001) groups. The absolute spine BMD gain from Months 0 to 12 was significantly greater in ROMO-treated patients (p<0.001). Although the total hip BMD at Month 12 also increased significantly in the ROMO (+1.6%±3.3%; p=0.01) and DEN groups (+1.6%±2.6%; p=0.003), the absolute BMD gain was not significantly different between the groups. At Month 24, the spine BMD continued to increase in both the ROMO (+9.7%±4.8%; p<0.001) and DEN group (+3.0%±3.0%; p<0.001) compared to baseline, and the absolute BMD gain remained significantly greater in ROMO-treated patients. The total hip BMD continued to increase in both groups (ROMO +2.9%±3.7%; p<0.001; DEN +2.2%±3.4%; p=0.001), but the changes from baseline were similar. Injection site reaction was more frequently reported in ROMO-treated patients. ROMO was superior to DEN in raising the spine BMD at Month 12 in chronic GC users. After switching to DEN, ROMO-treated patients continued to gain spine BMD to a greater extent than DEN until Month 24.

Overall Survival and Treatment Patterns Among Patients With Warm Autoimmune Hemolytic Anemia in Sweden: A Nationwide Population-based Study.

Warm autoimmune hemolytic anemia (wAIHA) is a rare autoantibody-mediated disorder, and first-line treatment primarily relies on corticosteroids. This study assessed overall survival (OS) and treatment patterns of wAIHA in Sweden. Adults with ≥ 1 primary diagnosis code for wAIHA (or AIHA plus oral corticosteroids (OCS)/immunosuppressants as sensitivity analyses) between 2011 and 2022 were identified from five Swedish national registers and linked through each patient's unique identity number. Kaplan-Meier curves with log-rank tests and Cox regressions were performed to assess OS for patients with primary versus secondary wAIHA and patients with wAIHA and long-term versus short-term (≥ 3 vs. < 3 months) OCS users. The main analysis included 292 patients; 1791 patients were included in the sensitivity analysis. At a median 3.7-year follow-up, a median OS in primary wAIHA was not reached versus 6.0 years for secondary wAIHA (log-rank test: p = 0.003). Subgroup analyses showed no significant difference in risk of death between long-term and short-term OCS users; however, in the sensitivity analysis, long-term OCS users showed significantly higher risk of death (adjusted hazard ratio: 1.45; 95% confidence interval: 1.180, 1.781; p < 0.001) versus short-term OCS users. Secondary wAIHA or long-term OCS use was associated with lower OS, underscoring the disease burden and unmet need for efficacious wAIHA treatments.

Short term sodium glucose transport protein 2 inhibitors are associated with post contrast acute kidney injury in patients with diabetes

Although sodium–glucose transport protein-2 (SGLT2) inhibitors (SGLT2i) do not increase the risk of acute kidney injury (AKI) in general, they may pose a risk in patients undergoing angiography. This prospective cohort study aimed to evaluate the safety and efficacy of SGLT2i for post-contrast AKI (PC-AKI) in patients with type 2 diabetes mellitus (T2DM). Following screening, 306 patients with T2DM selected to undergo coronary arterial angiography with or without percutaneous intervention were enrolled. Patients were divided into the SGLT2i exposure and non-exposure groups. The primary outcome was PC-AKI, defined as an increase in serum creatinine levels > 0.5 mg/dL (44.2 µmol/L), or 25% above the baseline, within 48–72 h after exposure to contrast medium. The incidence of PC-AKI in the overall T2DM population was 5.2% (16/306). Following 1:1 propensity score matching, the incidence of PC-AKI was significantly higher in the SGLT2i group than in the non-SGLT2i group (10.7% vs. 2.9%; P = 0.027), with an odds ratio of 4.5 (95% confidence interval: 1.0–20.2; P = 0.047). Furthermore, PC-AKI occurred at a higher rate among short-term users of SGLT2i than long-term users (20.5% vs. 3.4%, P = 0.018). Thus, our findings suggest an increased risk of PC-AKI associated with short-term SGLT2i therapy in patients with T2DM.

Corneal endothelial density and morphology in long-term soft contact lens users in Japan: a retrospective cross-sectional study of 17,732 eyes

Purpose There is a lack of long-term and large-scale studies on the adverse effects of soft contact lenses (SCLs) on the corneal endothelia of Asian populations. Here, we aimed to examine the effects of long-term SCL use on corneal endothelial density and morphology. Materials and Methods This retrospective study involved consecutive patients at the Miyata Eye Hospital (Miyazaki, Japan), who had used SCLs for more than 1 year. Patients with ophthalmological disorders without refractive errors were excluded. The period of SCL use, SCL type, corneal endothelial cell density (ECD), appearance rate of hexagonal cells (HEX), and coefficient of variation of cells (CV) were analyzed. Results In total, 17,732 eyes of 8866 patients were included in the analysis (age, 26.0 ± 8.8 years). The mean period of SCL use was 6.3 ± 5.4 years. Multivariate regression analysis revealed that ECD and HEX were significantly negatively correlated with the period of SCL use, age, and sex (p < 0.001 for all). The CV was significantly positively correlated with the period of use (p < 0.001), sex (p = 0.002), and age (p < 0.001). Conclusions Corneal ECD, HEX, and CV were significantly associated with the period of SCL use in long-term users. It is essential to regularly check the corneal endothelium in patients with a history of long-term SCL use.

Long-term safety and subjective satisfaction of Bonebridge and Vibrant Soundbridge in congenital unilateral conductive hearing loss.

The objective of this study was to assess and compare the long-term safety and subjective satisfaction levels of Bonebridge (BB) and Vibrant Soundbridge (VSB) in patients with congenital unilateral conductive hearing loss (UCHL). The hearing effectiveness was measured using sound field hearing threshold (SFHT) and word recognition score (WRS). Long-term safety and subjective satisfaction levels were measured by questionnaires, including Speech, Spatial, and Qualities of Hearing Scale-12 (SSQ-12) and Abbreviated Profile of Hearing Aid Benefit (APHAB). Both BB and VSB were effective in improving the hearing of patients with congenital UCHL. Four of the 20 patients discontinued wearing the device postoperatively, and no complications were reported by long-term users. Patients experienced an overall improvement in their hearing experience across most subscales of SSQ-12 and a lower hearing problem rate across most subscales of the APHAB after implantation. However, the 'quality of hearing' subscale in the SSQ-12 did not show any improvement, and the aversiveness subscale in the APHAB exhibited a relatively higher percentage of reported problems after BB or VSB implantation. No significant differences were observed in SFHT, WRS, SSQ-12, and APHAB between the two groups. Both BB and VSB are effective in improving the hearing of UCHL patients, with high subjective satisfaction and low complication rates in the long-term postoperative period, with no significant difference between the two devices. Follow-up device fitting is essential, especially to address increased device sound or noise after surgery, reduce non-usage rates and achieve higher subjective satisfaction levels.

S2327 Identifying High-Risk Profiles for Hypomagnesemia in Long-Term Proton Pump Inhibitor Users

S2327 Identifying High-Risk Profiles for Hypomagnesemia in Long-Term Proton Pump Inhibitor Users

Evaluating Adherence to AAO Hydroxychloroquine Screening Guidelines

PurposeHydroxychloroquine (HCQ) is commonly prescribed for autoimmune disorders but carries a risk of retinal damage, which increases over time. The American Academy of Ophthalmology (AAO) issued updated guidelines in 2016 to optimize screening for HCQ retinopathy, recommending dosing based on real body weight and specific visual field (VF) testing patterns. This study aimed to assess adherence to the AAO guidelines for HCQ retinopathy screening in a clinical setting and to identify deviations in the implementation of these guidelines. DesignWe employed a large, single-center retrospective case series study design. MethodsWe conducted a retrospective analysis of 391 patients treated with HCQ at a single academic center from 2017 to 2019. The study focused on the appropriateness of screening tests, specifically optical coherence tomography (OCT) and VF testing, based on the duration of HCQ therapy. ResultsOur analysis showed that over-testing with OCT and VF was prevalent among patients on HCQ for five years or less, occurring in 56% and 48% of encounters, respectively. Conversely, there were missed screenings in patients on HCQ for more than five years, with 12% and 16% of encounters lacking OCT and VF testing, respectively. Notably, adherence to VF testing guidelines for Asian patients was poorly implemented, with the recommended wide pattern VF testing conducted in only two of nine cases. Additionally, there were significant instances where HCQ dosages exceeded recommended levels without subsequent adjustments, despite ophthalmologists' recommendations. ConclusionsThe study highlights a critical need for improved guideline adherence to prevent unnecessary testing costs and undetected retinopathy in long-term HCQ users. It underscores the importance of using real body weight for dosing decisions and enhancing collaboration between ophthalmologists and rheumatologists to manage the delicate balance between disease control and the risk of retinopathy. Further multi-center studies are warranted to evaluate adherence variations and develop strategies for guideline implementation.

Pumpkin seed oil lessens the colchicine-induced altered sex male hormone balance, testicular oxidative status, sperm abnormalities, and collagen deposition in male rats via Caspase3/Desmin/PCNA modulation

This study examined the efficiency of pumpkin seed oil (PSO) to rescue the colchicine (CHC)-induced adverse impacts on sperm characteristics, male sex hormones, testicular architecture, oxidative status, DNA content, collagen deposition, and immune expression of desmin and PCNA. Male Sprague Dawley rats were divided into four experimental groups (n = 10 each): control (distilled water), CHC (0.6 mg/kg b.wt), PSO (4 mL/kg b.wt), and CHC + PSO. After 60 days of dosing, CHC significantly reduced sperm motility (19%), sperm concentration (38%), estradiol (52%), testosterone (37%), luteinizing hormone (54%), and follicle-stimulating hormone (29%) compared to the control. Yet, the testicular tissues of CHC-administered rats exhibited elevated abnormal sperms (156%), malondialdehyde (354%), lactate dehydrogenase (73%), Caspase-3 (66%), and 8-hydroxyguanosine (65%) but lower reduced glutathione (74%), catalase (73%), and superoxide dismutase (78%) compared to the control group. Moreover, CHC induced testicular degeneration, distorted seminiferous tubules, apoptotic cells, exfoliated spermatogenic cells, reduced DNA content, decreased PCNA and desmin immune-expression, and increased collagen deposition. PSO effectively reversed the CHC-induced alterations in sperm quality and testicular function and architecture, likely through its antioxidant, antifibrotic, anti-apoptotic, and DNA-protective properties. These results suggest that PSO may be a beneficial intervention for long-term CHC users and may protect against CHC-induced male reproductive toxicity.

Long-Lasting, Transparent Antibacterial Shield: A Durable, Broad-Spectrum Anti-Bacterial, Non-Cytotoxic, Transparent Nanocoating for Extended Wear Contact Lenses.

The increasing incidence of serious bacterial keratitis, a sight-threatening condition often exacerbated by inadequate contact lens (CLs) care, highlights the need for innovative protective technology. This study introduces a long-lasting antibacterial, non-cytotoxic, transparent nanocoating for CLs via a solvent-free polymer deposition method, aiming to prevent bacterial keratitis. The nanocoating comprises stacked polymer films, with poly(dimethylaminomethyl styrene-co-ethylene glycol dimethacrylate) (pDE) as a biocompatible, antibacterial layer atop poly(2,4,6,8-tetramethyl-2,4,6,8-tetravinylcyclotetrasiloxane) (pV4D4) as an adhesion-promoting layer. The pD6E1-grafted (g)-pV4D4 film shows non-cytotoxicity toward two human cell lines and antibacterial activity of >99% against four bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), an antibiotic-resistant bacteria and Pseudomonas aeruginosa, which causes ocular diseases. Additionally, the film demonstrates long-lasting antibacterial activity greater than 96% against MRSA for 9 weeks in phosphate-buffered saline. To the best knowledge, this duration represents the longest reported long-term stability with less than 5% decay of antibacterial performance among contact-killing antibacterial coatings. The film exhibits exceptional mechanical durability, retaining its antibacterial activity even after 15 washing cycles. The pD6E1-g-pV4D4-coated CL maintains full optical transmittance compared to that of pristine CL. It is expected that the unprecedentedly prolonged antibacterial performance of the coating will significantly alleviate the risk of infection for long-term CL users.

Glucose-Lowering Drugs and Primary Prevention of Chronic Kidney Disease in Type 2 Diabetes Patients: A Real-World Primary Care Study

Background/Objectives: The burden of chronic kidney disease (CKD) is increasing, as is the prevalence of type 2 diabetes mellitus (T2DM). Post-hoc analyses of clinical trials support that sodium–glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptors agonists (GLP-1RAs) prevent CKD in T2DM patients. Methods: We used the Spanish primary care database BIFAP to perform a retrospective cohort study with a nested case-control analysis to assess the incidence, risk factors, and the effect of glucose-lowering drugs (GLDs) on the primary prevention of CKD. Results: From a cohort of 515,701 T2DM subjects (2.75 million person-years), we found 89,075 incident CKD cases, yielding an overall incidence rate (95%CI) of 324.3 (322.1–326.5) per 10,000 person-years. In the nested case–control analysis, gout, hyperuricemia, and hyperkalemia were the factors showing the highest AORs. Long-term users (≥3 years) of GLP1-RAs and SGLT-2i, compared to other GLDs, showed a decreased risk for CKD (AOR = 0.85; 95%CI: 0.73–0.99 and AOR = 0.89; 95%CI: 0.74–1.08, respectively), and for incident CKD at KDIGO stages G3-G5 (AOR = 0.72; 95%CI: 0.56–0.94 and AOR = 0.64; 95%CI: 0.46–0.91, respectively). Conclusions: In a real-world primary care setting, the long-term use of GLP-1RAs and SGLT-2i, but not other GLDs, appeared to decrease the risk of incident CKD in T2DM, supporting a role in primary prevention of CKD.

The Adoption of a “Diseased Identity” in Traditional 12-Step Groups: Exploring the Implications of These Processes for Individuals and Practitioners in Health and Social Care Services

Self-help groups are increasingly utilised by communities of interest and shared experience, services, and government departments as platforms for supporting and improving health and social care outcomes for drug and alcohol users. Traditional 12-step self-help groups like Narcotics Anonymous and Alcoholics Anonymous (NA and AA) are worldwide organisations and each have their own programme of change, language, criteria for membership, processes for problem resolution, and self-transformation. Within these types of groups, members are openly encouraged to identify with and adopt an (diseased) identity that is consistently invoked to work on the self. In the self-help recovery literature, it is widely recognised that individuals can benefit by thinking about themselves as “diseased” and then acting and behaving in a manner which is congruent with their reframed “identity”. Less is known about the processes involved in this and social-, psychological-, and health-related implications for individuals in drug- and alcohol-specific self-help groups. A thematic analysis of data from (n-36) in-depth qualitative interviews with long-term (6 months–10 years) self-help users identified four themes associated with the adoption of a diseased identity and self-help group processes: (1) normalising the disease and illness; (2) identifying as diseased; (3) living as a diseased individual; and (4) one addict helping another addict. The results of this research should not be interpretated as a critique of the 12-step approach or groups. Instead, it should be recognised that whilst improvements to individual wellbeing are reported, identifying as diseased can exacerbate negative self-perceptions that individuals hold about themselves, their character, capabilities, and ability. Being diseased, accepting disease, and identifying as diseased also has the potential to inhibit their engagement with wider social networks and professional services outside of their own fellowship or group. We conclude this paper by exploring the implications of a “diseased identity” and self-help processes for individuals who access self-help groups, and health and social care practitioners who support self-help users as they engage with services and self-help groups.

Association of long-term use of low-dose aspirin with Helicobacter pylori infection and effect on recurrence rate.

To investigate the relationship between long-term use of low-dose aspirin and Helicobacter pylori (HP) infection, and its effect on eradication and recurrence of HP. According to the results of C14-Urea Breath Test (C14-UBT), 3256 patients with cardiovascular and cerebrovascular diseases from March 2019 to December 2020, were divided into HP infection group and non-infection group. Univariate and multivariate was used to investigate the relationship between Low-dose aspirin use and HP infection. 859 patients with hypertension combined with HP infection were divided into aspirin group, non-aspirin group and control group, the eradication rate after 2 weeks of bismuth-containing quadruple drug treatment and the recurrence rate after 1,3 year were compared. The overall infection rate of HP was 53.3%. The results of univariate analysis showed that the infection rate of female, age, BMI, LDL-C, FBG of HP infected group was higher than non-infection. The infection rate of patients who took low-dose aspirin was higher than no-aspirin [56.6% vs. 51.3%, χ2 = 8.548, P = 0.003]. Multivariate Logistic regression analysis showed that long-term aspirin use still increased the risk of infection (OR = 1.433, 95% CI 1.196-1.947, P < 0.001). The Per-Protocol analysis showed that the overall eradication rate was 87.6%, and among the eradication rates of aspirin group, non-aspirin group and control group were not statistically significantly (87.8%, 88.5%, and 86.6%, respectively), The Intention-To-Treat analysis showed that the overall eradication rate was 84.3%, and the eradication rates among the three groups were not statistically significantly. The overall 1-year recurrence rate was 1.3%, and the recurrence rates of the three groups were no statistical significance. The overall 3-years recurrence rate was 3.1%, and the recurrence rate of aspirin group was higher than non-aspirin group and control group (5.30%, 1.90% and 1.70%, respectively, χ2 = 6.118, P < 0.05). The main adverse reactions in the first month of eradication treatment were constipation and mild nausea, and there was no statistical significance between the three groups. Long-term use of low-dose aspirin increases the risk of HP infection and the recurrence rate in 3 years after eradication. It is suggested that HP should be tested and eradicated regularly in long-term users.

Abstract A036: Hair relaxers use and breast cancer risk by tumor estrogen receptor status: Results from the Ghana Breast Health study

Abstract Background: Hair relaxer use is highly prevalent among women of African descent world-wide and in previous analyses within the Ghana Breast Health Study (GBHS) ever use was associated with a 60% elevated risk of breast cancer. Subsequent studies in the GBHS showed selected alterations in estrogen metabolites with hair relaxer use among controls, suggesting a possible hormonal mechanism may underlie the relation of hair relaxers to breast cancer risk. We investigated if the association between relaxer use and breast cancer risk differed by tumor estrogen-receptor (ER) status and hypothesized ever-users would be at a higher risk of ER+ tumors. Methods: The GBHS is a population-based case-control study conducted between 2013– 2015 in Accra and Kumasi of 1,071 cases with pathologically confirmed invasive breast cancer and 2,106 controls, aged 18-74 years. A standardized interview-based questionnaire collected information on currency and duration of use of hair relaxers and whether products used were lye or non-lye formulations. ER status was available for 915 cases, determined using either mRNA expression data from nCounter® Breast Cancer 360™ Panel (65% of 915 cases) or immunohistochemistry. We used multivariable multinomial logistic regression models to estimate odds ratios (OR) with 95% confidence intervals (CI) for ER+ vs. ER- breast cancers. Models were adjusted for age, hospital site, education, body size, age at menarche, parity, age at first birth, median breastfeeding months/child, menopausal status. To determine if risk related to exposure to relaxers differed by ER status, we used logistic regression analyses with ER+ tumors as the reference and calculated heterogeneity p-values (p-het). Results: The majority of women reported ever use of relaxers (96% of cases and 94% of controls). Of the 1,071 cases included in analyses, 422 (44%) were ER+, 438 (41%) ER-, and 156 (15%) unknown for ER. Elevated risk did not differ by ER status for ever compared to never use (OR ER+ =1.67, 95% CI [0.95–2.93]; OR ER - =1.59, 95% CI [0.92–2.76], p-het=0.90). Risks were highest among former users (OR ER+ =2.19, 95% CI [1.21–3.95]; OR ER- =2.21, 95% CI [1.24–3.93], p-het=0.98. Additional analyses showed elevated risk for those with long durations of use, and those who predominantly used non-lye products, but associations did not differ according to ER tumor status. Conclusion: Our analysis of relaxer use in Ghanaian women showed elevated breast cancer risk, particularly for former, long-term users of non-lye formulations, irrespective of tumor ER status. Additional analyses by tumor and other characteristics related to biologically aggressive tumor types needed to determine if associations differ beyond ER consistent with disparities seen in African ancestry women. Further, future research is warranted regarding specific products used that may provide insights into hormonal and non-hormonal mechanisms underlying observed associations. Citation Format: Kaitlin E. White, Quiera Booker, Nicholas Titiloye, Lawrence Edusei, Louise Brinton, Beatrice Wiafe, Ernest Adjei, Jonine Figueroa, On behalf of the Ghana Breast Health Study Team. Hair relaxers use and breast cancer risk by tumor estrogen receptor status: Results from the Ghana Breast Health study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A036.

Investigating Older Adults' Use of a Socially Assistive Robot via Time Series Clustering and User Profiling: Descriptive Analysis Study.

The aging population and the shortage of geriatric care workers are major global concerns. Socially assistive robots (SARs) have the potential to address these issues, but developing SARs for various types of users is still in its infancy. This study aims to examine the characteristics and use patterns of SARs. This study analyzed log data from 64 older adults who used a SAR called Hyodol for 60 days to understand use patterns and their relationship with user characteristics. Data on user interactions, robot-assisted content use, demographics, physical and mental health, and lifestyle were collected. Time series clustering was used to group users based on use patterns, followed by profiling analysis to relate these patterns to user characteristics. Overall, 4 time series clusters were created based on use patterns: helpers, friends, short-term users, and long-term users. Time series and profiling analyses revealed distinct patterns for each group. We found that older adults use SARs differently based on factors beyond demographics and health. This study demonstrates a data-driven approach to understanding user needs, and the findings can help tailor SAR interventions for specific user groups. This study extends our understanding of the factors associated with the long-term use of SARs for geriatric care and makes methodological contributions.