The Hassan Neonatal Morbidity Composite Scale and Neonatal Length of Stay—A Validation Study

Objective Obstetric studies often report neonatal morbidity as a composite score. Composite scores can simplify data analysis when multiple outcomes of interest are present and allows researchers to conduct smaller, more manageable trials. The Hassan scale is a neonatal morbidity composite scale that assigns high scores to infants with multiple morbidities and low scores to infants without or with single morbidities. The objective of this study was to validate the association between scores on the Hassan scale and neonatal intensive care unit (NICU) length of stay Study Design We conducted a cohort study of all infants born between 22 and 366/7 weeks' gestation and cared for within 419 neonatal units in the Pediatrix Medical Group between 1997 and 2018. Each infant was assigned a Hassan's score based on the number of neonatal morbidity events that occurred during the delivery hospitalization. The association between Hassan's scores and neonatal length of stay was evaluated using linear regression. Multivariable models were constructed to determine if the Hassan score was independently associated with neonatal length of stay. Results There were 760,037 infants included. The median (interquartile range [IQR]) gestational age of delivery was 34 (31, 35) weeks and the median (IQR) birth weight at delivery was 2,000 (1,503, 2,430) g. The median length of stay for infants discharged home was 17 (10–33) days. A Hassan's score was able to be assigned to 699,206 (92%) patients. Neonatal morbidities included in the Hassan scale were more common among infants born earlier in gestation. On adjusted analysis, the Hassan scale was found to be independently associated with neonatal length of stay (p < 0.001, coefficient = 10.4 days [95% confidence interval (CI): 10.3, 10.4 days]) with higher scores associated with longer lengths of stay. Conclusion The Hassan scale, more than a binary composite score, is able to differentiate preterm infants with prolonged hospitalizations from those with short hospitalizations. Key Points

P.229 Epidemiology and Outcomes of Neck Pain Following Surgery for Degenerative Cervical Radiculopathy

Background: Many studies have demonstrated improved arm pain (AP) following surgery for degenerative cervical radiculopathy (DCR); however, axial neck pain (NP) is generally not felt to improve. The purpose of this study was to determine whether surgery for DCR improves NP. Methods: A ambispective cohort study of the Canadian Spine Outcomes Research Network (CSORN) registry for patients who received 1-level, 2-level, 3-level ADCF (anterior cervical discectomy and fusion) or cervical disc arthroplasty (CDA) for DCR. Outcomes: 12-month post-operative Visual Analogue Scale for NP (VAS-NP), Neck Disability Index (NDI), VAS for AP (VAS-AP), Short-Form Physical Health Composite Scale (SF36-PCS), and Mental Health Composite Scale (SF36-MCS). Results: We identified 603 patients with DCR. CDA patients were the youngest (ANOVA; p<0.001). Patients reported similar pre-operative AP, NP, disability, and health-related quality of life, regardless of procedure (ANOVA; all P>0.05). All procedures offered a statistically significant reduction in VAS-NP, VAS-AP, and NDI (ANOVA; all P<0.001). Mean change from baseline in NP, AP, and disability, were similar across procedures. At 12 months, mean reduction in VAS-AP, VAS-NP, and NDI exceeded minimal clinically important differences for nearly all procedures. Conclusions: Patients undergoing surgery for DCR can expect a clinically significant, approximate 50% reduction in NP, AP, and neck-related disability.

Motor Dysfunction Questionnaire and Dopamine Transporter Imaging Composite Scale Improve Differentiating Dementia With Lewy Bodies From Alzheimer's Disease With Motor Dysfunction

Objective: Characteristic parkinsonism is the major comorbidity of dementia with Lewy bodies (DLB). We aimed to differentiate DLB from Alzheimer's disease (AD) with motor dysfunction using a composite scale with a characteristic motor dysfunction questionnaire (MDQ) and dopamine transporter (DAT) imaging. It could help detect DLB easily in healthcare settings without movement disorder specialists.Methods: This is a two-phase study. In the design phase, seven questions were selected and composed of a novel MDQ. In the test phase, all participants with DLB, AD, or non-dementia (ND) control completed dementia and parkinsonism survey, the novel designed questionnaire, DAT imaging, and composite scales of MDQ and DAT. The cutoff scores of the MDQ, semiquantitative analysis of the striatal–background ratio (SBR) and visual rating of DAT, and the composite scale of MDQ and DAT for discriminating DLB from AD or ND were derived and compared.Results: A total of 277 participants were included in this study (126 with DLB, 86 with AD, and 65 with ND). Compared with the AD or ND groups, the DLB group showed a significantly higher frequency in all seven items in the MDQ and a significantly lower SBR. For discrimination of DLB from non-DLB with MDQ, SBR, and composite scale, the cutoff scores of 3/2, 1.37/1.38, and 6/5 were suggested for the diagnosis of DLB with the sensitivities/specificities of 0.91/0.72, 0.91/0.80, and 0.87/0.93, respectively. The composite scale significantly improved the accuracy of discrimination compared with either the MDQ or SBR.Conclusion: This study showed that the novel designed simple questionnaire was a practical screening tool and had similar power to DAT scanning to detect DLB. The questionnaire can be applied in clinical practice and population studies for screening DLB. In addition, the composite scale of MDQ and DAT imaging further improved the diagnostic accuracy, indicating the superiority of the dual-model diagnostic tool.

Acupuncture for Prostatectomy Incontinence: Study Protocol for A Multicenter Single Blind Randomized Parallel Controlled Trial

Background: Urinary incontinence is a common complication after prostatectomy. Acupuncture is considered an effective treatment for prostatectomy incontinence (PPI), but evidence is still limited. We propose to evaluate the effectiveness of acupuncture in a rigorously conducted trial.Methods: Twenty hospitals will recruit 340 participants with urinary incontinence after prostatectomy in China from April 2021 to April 2022. Participants will be randomly allocated to acupuncture or sham acupuncture with a 1:1 ratio using computerized simple random sampling. The study plan consists of 1-week baseline, 6-week treatment, and 18-week follow up. Eighteen 30-mintute sessions of acupuncture or sham acupuncture treatment will be provided between weeks 1 and 6. The primary outcome is the change in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) score at the week 6 from the baseline. Secondary outcomes include the change in volume of urine leakage at weeks 4 and 6 from a baseline measured using the 1-h Pad Test;72-h incontinence episode frequency based on a 72-h voiding diary; change in the Expanded prostate cancer Index Composite scale (EPIC-26); change in the Self-Rating Anxiety Scale; weekly consumption of pads; the severity of urinary incontinence based on a 72-h bladder diary and self-assessment of the therapeutic effect. The safety of acupuncture will also be assessed.Discussion: This trial will help to identify whether acupuncture is effective for PPI, and, if so, whether it exerts a therapeutic rather than a placebo effect.Trial Registration: The trial was registered on www.Chictr.org.cn. ChiCTR2100042500. Retrospectively registered on 22 January 2021.

381 Evening Chronotype Predicts Subjective Sleep Symptom Severity in Pregnant Women with Insomnia Disorder

Introduction Evening chronotype is associated with greater reports of insufficient sleep and sleep-related distress. Little research has examined this relationship within the context of pregnancy. This study investigated whether eveningness predicts insomnia severity, sleep effort, dysfunctional sleep beliefs, and sleep reactivity to stress in pregnant women with insomnia disorder. Methods Pregnant women with insomnia disorder who spoke English or Spanish enrolled in a clinical trial of cognitive behavioral therapy for insomnia (N = 178; M age = 32.6 years). Before beginning treatment, participants completed the Composite Scale of Morningness (CSM), Insomnia Severity Index (ISI), Glasgow Sleep Effort Scale (GSS), Dysfunctional Beliefs and Attitudes about Stress Scale (DBAS), and Ford Insomnia Response to Stress Test (FIRST). Participants were categorized into evening, intermediate, or morning chronotypes (bottom 25%, middle 50%, or top 25% of CSM scores, respectively). MANCOVA examined whether chronotype predicted higher baseline ISI, GSS, DBAS, and FIRST scores after adjusting for age, gestational week of pregnancy, and language. Results Sleep measures collectively differed by chronotype, F(8, 336) = 4.05, p &lt; .001; Wilk’s Λ = .83, partial η-sqd = .09. Follow-up ANOVAs testing individual dependent variables were all significant (partial η-sqd = .04 – .10, p &lt; .05). Pairwise comparisons (Bonferroni-adjusted; p &lt; .05) found that evening types had higher ISI scores than intermediate (M difference = 2.21) and morning types (M difference = 2.30), and higher DBAS scores than morning types (M difference = .95). Morning types had lower FIRST scores than evening (M difference = 5.44) and intermediate types (M difference = 3.89). Conclusion Evening chronotype was associated with greater insomnia severity and maladaptive sleep-related cognition than other chronotypes among pregnant women with insomnia disorder. Future research may examine whether differences in chronotype have implications for insomnia treatment outcome during pregnancy, and whether greater morningness confers protection against sleep challenges during the early postpartum period. Support (if any) NIH R01 NR013662

083 Circadian Preference is Associated with Impulsivity at Both the Trait and State Level

Introduction Impulsivity is a multifaceted construct with well-documented risk for substance use problems. A circadian preference towards eveningness has been linked to trait, global impulsivity. Here we extend existing literature by investigating whether eveningness is associated with multiple facets of impulsivity at both trait- and state-level impulsivity. We also examined these associations utilizing daily measures of sleep timing and duration. Methods The primary sample included 78 moderate-to-heavy social drinkers (aged 21–35, 100% White men) with circadian preference data (Composite Scale of Morningness: CSM). Five facets of impulsivity were assessed via the UPPS-P, both at baseline (full scale) and up to 6 times per day over 10 days (reduced scale). Daily sleep timing (midsleep) and duration were assessed via self-report over 10 days. Multilevel models were used to examine between- and within-person associations, accounting for covariates and correcting for multiple comparisons. Results Between-person models found that eveningness was associated with multiple facets of impulsivity, at trait (lack of perseverance) and state levels (negative urgency, positive urgency, lack of perseverance, and lack of premeditation). However, average midsleep and duration were generally unrelated to impulsivity when accounting for circadian preference. Within-person models in the primary sample largely paralleled the between-person findings. In a larger, more diverse sample (29.1% self-identified as Black, 29.7% female) without CSM data, later midsleep timing was associated with greater mean state-level impulsivity across multiple facets. These effects largely appear to be driven by White women. Conclusion A circadian preference for eveningness is strongly associated with multiple facets of impulsivity, at both trait- and state-levels, potentially increasing risk for substance use. This association does not appear to be driven by actual daily sleep timing and/or duration. Future research with objective measures of sleep in larger, more diverse samples will be important to clarify implications for sleep-focused prevention and/or treatment of substance use. Support (if any) Supported by grants from NIH (R01AA026249; K01 AA021135), as well as a Foundation Grant from ABMRF/The Foundation for Alcohol Research.

Factors associated with Health-Related Quality of Life in Hispanic population with mental disorders using medical expenditure panel survey 2013-2017

There is a lack of U.S. population-based research surrounding the marked decrease in health-related quality of life (HRQoL) caused by the morbidity of mental disorders in the U.S. Hispanic demographic. This cross-sectional study utilized data from the 2013-2017 Medical Expenditure Panel Survey (MEPS) to identify Hispanic community-dwelling residents with mental disorders in the U.S. The independent variable was the presence of mental disorders, and the dependent variable was HRQoL. HRQoL was measured with the Short Form 12 (SF-12) Physical Health Composite Scale (PCS) and Mental Health Composite Scale (MCS). A total of 34,434 patients met the inclusion criteria, representing about 38,683,299 Hispanic individuals. Of this group, those older than 18 were stratified by the presence of mental disorders. The two groups were those with mental disorders: 4,122 individuals representing a sample size of 4,789,634; and those without mental disorders: 30,312 individuals representing a sample size of 33,893,665. Based on our study, Hispanic patients with mental disorders were associated with lower HRQoL scores. SF-12 PCS scores (95% CI) were 45.3 (44.5, 46.1) for those with mental disorders and 50.8 (50.5, 51.0) for those without mental disorders. SF-12 MCS scores (95% CI) were 42.6 (42, 43.3) in patients with mental disorders and 52.6 (52.3, 52.8) in patients without mental disorders. These differences in scores denote the impact of mental health disorders on HRQoL scores in the Hispanic demographic and mark the way for further research on identifying means of improving such scores for Hispanic patients.

An Item Response Theory–Informed Strategy to Model Total Score Data from Composite Scales

Composite scale data is widely used in many therapeutic areas and consists of several categorical questions/items that are usually summarized into a total score (TS). Such data is discrete and bounded by nature. The gold standard to analyse composite scale data is item response theory (IRT) models. However, IRT models require item-level data while sometimes only TS is available. This work investigates models for TS. When an IRT model exists, it can be used to derive the information as well as expected mean and variability of TS at any point, which can inform TS-analyses. We propose a new method: IRT-informed functions of expected values and standard deviation in TS-analyses. The most common models for TS-analyses are continuous variable (CV) models, while bounded integer (BI) models offer an alternative that respects scale boundaries and the nature of TS data. We investigate the method in CV and BI models on both simulated and real data. Both CV and BI models were improved in fit by IRT-informed disease progression, which allows modellers to precisely and accurately find the corresponding latent variable parameters, and IRT-informed SD, which allows deviations from homoscedasticity. The methodology provides a formal way to link IRT models and TS models, and to compare the relative information of different model types. Also, joint analyses of item-level data and TS data are made possible. Thus, IRT-informed functions can facilitate total score analysis and allow a quantitative analysis of relative merits of different analysis methods.