Risk of rheumatoid arthritis diagnosis in statin users in a large nationwide US study

Objective To evaluate the association between statin use and the risk of developing rheumatoid arthritis (RA) in a large, US case-control study. Methods Using the OptumLabs Data Warehouse, RA cases were identified as patients aged ≥18 years with ≥2 RA diagnoses between January 1, 2010 and June 30, 2019 and ≥1 prescription fills for methotrexate within 1 year of the first RA diagnosis. The first RA diagnosis was the index date. Cases were matched 1:1 to controls on age, sex, region, year of index date, and length of baseline coverage. Statin users were defined by having ≥2 statin prescription fills at least 90 days pre-index. Patients identified as statin users were further classified by statin user status (current or former), statin use duration, and intensity of statin exposure. Odds ratios for RA risk with statin use were estimated using logistic regression. Results 16,363 RA cases and 16,363 matched controls were identified. Among RA cases, 5509 (33.7%) patients were statin users compared to 5164 (31.6%) of the controls. Statin users had a slightly increased risk of RA compared to non-users (OR 1.12, 95% CI 1.06–1.18), and former statin users had an increased RA risk compared to current users (OR 1.21, 95% CI 1.13–1.28). However, risk was eliminated following adjustment for hyperlipidemia. The risk estimates for statin use duration and intensity did not reach significance. Conclusion This study demonstrates no significant increase in the risk of developing RA for statin users compared to non-users after adjustment for hyperlipidemia in addition to other relevant confounders. However, more information from prospective studies would be necessary to further understand this relationship.

Population Impact and Efficiency of Improvements to HIV PrEP Under Conditions of High ART Coverage among San Francisco Men Who Have Sex with Men

ABSTRACTBackgroundKey components of Ending the HIV Epidemic (EHE) plan include increasing HIV antiretroviral therapy (ART) and HIV preexposure prophylaxis (PrEP) coverage. One complication to addressing this service delivery challenge is the wide heterogeneity of HIV burden and healthcare access across the U.S. It is unclear how the effectiveness and efficiency of expanded PrEP will depend on different baseline ART coverage.MethodsWe used a network-based model of HIV transmission for men who have sex with men (MSM) in San Francisco. Model scenarios increased varying levels of PrEP coverage relative under current empirical levels of baseline ART coverage and two counterfactual levels. We assessed the effectiveness of PrEP with the cumulative percent of infections averted (PIA) over the next decade and efficiency with the number needed to treat (NNT) by PrEP required to avert one HIV infection.ResultsIn our projections, only the highest levels of combined PrEP and ART coverage achieved the EHE goals. Increasing PrEP coverage up to 75% showed that PrEP effectiveness was higher at higher baseline ART coverage with the PIA ranging from 61% in the lowest baseline ART coverage population to 75% in the highest ART coverage. The efficiency declined with increasing ART (NNT range from 41 to 113).ConclusionsImproving both PrEP and ART coverage would have a synergistic impact on HIV prevention even in a high baseline coverage city like San Francisco. Efforts should focus on narrowing the implementation gaps to achieve higher levels of PrEP retention and ART sustained viral suppression.

1398. Maternal Knowledge and Perceptions about Routine Immunisation in a Slum Area of Pakistan

Background To know the baseline coverage and potential obstacles for children vaccination before starting a health awareness program. Methods A cross sectional study on immunization coverage in the slum area of Multan, Pakistan was conducted and a total of 312 mothers were interviewed face to face for Knowledge, Attitudes, and Perceptions (KAP). Results Among the children less than 3 years, 33 % fully, 46 % partially and 21 % were not at all immunized. High levels of BCG and OPV zero rates (79%) and low rates of OPV3/DPT3 (48%) and measles (41%) vaccines were found. Majority of the mothers were satisfied with the program. Most of the mothers were aware about the importance of vaccination but were ignorant for the need to complete the schedule. There were many misconceptions and beliefs among the mothers of partial and unimmunized children. The majority were of view that vaccines contain ingredients that will make the children infertile. Conclusion There is a need to enhance the maternal knowledge about the vaccine preventable diseases and importance of completing the immunization schedule. Also the misconception about the vaccines need be specifically addressed. Disclosures All Authors: No reported disclosures

1686. Maternal Knowledge and Perceptions about Routine Immunization in a Slum Area of Pakistan

Background To know the baseline coverage and potential obstacles for children vaccination before starting a health awareness program. Methods A cross-sectional study on immunization coverage in the slum area of Multan, Pakistan was conducted and a total of 312 mothers were interviewed face to face for Knowledge, Attitudes, and Perceptions (KAP). Results Among the children less than 3 years, 33% fully, 46% partially and 21% were not at all immunized. High levels of BCG and OPV zero rates (79%) and low rates of OPV3/DPT3 (48%) and measles (41%) vaccines were found. Majority of the mothers were satisfied with the program. Most of the mothers were aware about the importance of vaccination but were ignorant for the need to complete the schedule. There were many misconceptions and beliefs among the mothers of partial and unimmunized children. The majority were of view that vaccines contain ingredients that will make the children infertile. Conclusion There is a need to enhance the maternal knowledge about the vaccine-preventable diseases and importance of completing the immunization schedule. Also the misconception about the vaccines need be specifically addressed. Disclosures All authors: No reported disclosures.

VLBI imaging of black holes via second moment regularization

The imaging fidelity of the Event Horizon Telescope (EHT) is currently determined by its sparse baseline coverage. In particular, EHT coverage is dominated by long baselines, and is highly sensitive to atmospheric conditions and loss of sites between experiments. The limited short/mid-range baselines especially affect the imaging process, hindering the recovery of more extended features in the image. We present an algorithmic contingency for the absence of well-constrained short baselines in the imaging of compact sources, such as the supermassive black holes observed with the EHT. This technique enforces a specific second moment on the reconstructed image in the form of a size constraint, which corresponds to the curvature of the measured visibility function at zero baseline. The method enables the recovery of information lost in gaps of the baseline coverage on short baselines and enables corrections of any systematic amplitude offsets for the stations giving short-baseline measurements present in the observation. The regularization can use historical source size measurements to constrain the second moment of the reconstructed image to match the observed size. We additionally show that a characteristic size can be derived from available short-baseline measurements, extrapolated from other wavelengths, or estimated without complementary size constraints with parameter searches. We demonstrate the capabilities of this method for both static and movie reconstructions of variable sources.

Abstract 287: Simulating the Effects of Sudden Cardiac Arrest Responders Embedded in a Marathon Cohort

Introduction: Risk of sudden cardiac arrest may increase during distance running. In marathons, this risk is typically mitigated by deployment of medical resources, e.g. automated external defibrillators (AED), at fixed locations, potentially leaving racers vulnerable for periods of the race. We investigated utilization of marathon runners themselves as mobile emergency resources (R-AEDs). We hypothesized that systematic R-AED deployment would increase AED coverage of a race cohort over baseline coverage from static public AEDs. Methods: A simulation was constructed in MATLAB (vR2018a) incorporating the route of the 2018 Pittsburgh Marathon, detailed publicly available runner performance data from a nearby local marathon (N=1536), and known locations of S-AEDs with 1/8 th mile of any part of the Pittsburgh Marathon course (N = 47). During each simulation run, participants were randomly selected based on several distribution schemes (including age, pace category and pure chance) to carry an R-AED. R-AED coverage was assessed per minute by determining the proportion of racers up to 3 minutes ahead of each R-AED. S-AED coverage was calculated similarly based on whether runners were within 3-minutes of a public AED. All simulation variants were repeated 100 times and aggregated. Results: At baseline, 44% of the Pittsburgh Marathon course was within 3-minute walking distance of a public AED. Full coverage could be achieved with an additional 54 S-AEDs. Of the schemes we tested, when R-AEDs were deployed to random participants, optimal overall coverage was achieved with 1 R-AED per 25 runners (61 total for 57%), with 10% of race time achieving over 95% coverage. Weighted distribution of R-AEDs within age categories or pace categories achieved 72% coverage (155 AEDs) and 71% coverage, and over 95% coverage for 33% and 32% of the race duration, respectively. Conclusion: R-AEDs provided varying levels of additional coverage over baseline public access AED coverage during a simulated marathon. More work is necessary to fully determine the practical utility of this approach.

Newspaper coverage of mental illness in England 2008-2011

BackgroundBetter newspaper coverage of mental health-related issues is a target for the Time to Change (TTC) anti-stigma programme in England, whose population impact may be influenced by how far concurrent media coverage perpetuates stigma and discrimination.AimsTo compare English newspaper coverage of mental health-related topics each year of the TTC social marketing campaign (2009-2011) with baseline coverage in 2008.MethodContent analysis was performed on articles in 27 local and national newspapers on two randomly chosen days each month.ResultsThere was a significant increase in the proportion of anti-stigmatising articles between 2008 and 2011. There was no concomitant proportional decrease in stigmatising articles, and the contribution of mixed or neutral elements decreased.ConclusionsThese findings provide promising results on improvements in press reporting of mental illness during the TTC programme in 2009-2011, and a basis for guidance to newspaper journalists and editors on reporting mental illness.