Effect of deprivation and ethnicity on primary macula-on retinal detachment repair success rate and clinical outcomes: A study of 568 patients

Purpose Socio-economic deprivation and ethnic variation have been frequently linked to poorer health outcomes. We collected a large series of primary macula-on rhegmatogenous retinal detachment (RRD) cases and analysed the effect of socio-economic deprivation and ethnicity on both six-month retinal re-detachment rate and visual outcomes. Materials and methods Retrospective consecutive case series of 568 patients attending Birmingham and Midlands Eye Centre from January 2017–2020. Multiple Indices of Deprivation (IMD) deciles were used for deprivation status and split to two groups: IMD-A (Decile 1–5) and IMD-B (Decile 6–10). The two largest subgroups of ethnicities were compared, White and South Asians (SA). Results We report an overall retinal re-detachment rate of 8.5%. IMD-A re-detached significantly more than IMD-B (11.2% vs 6.0% respectively, p = 0.034). No statistical significance was found between White and SA re-detachment rate (9.1% and 5.6% respectively, p = 0.604). SA median age significantly lower at 49 years (IQR: 37–61) compared to White patients at 57 years (IQR: 50–65) (p = <0.001). IMD-A median age of 55 years (IQR: 46–64) was significantly lower to IMD-B median age of 58 years (IQR: 51–65) (p = 0.011). No differences in final visual outcomes were detected across all groups. Conclusion We demonstrated an increased retinal re-detachment rate in our more deprived patients according to IMD and a younger cohort of SA compared to White ethnicity. Further prospective studies are required to demonstrate the link between socio-economic deprivation and surgical success.

361 An Epidemiological Study into The Incidence of Facial Fractures Presenting to Addenbrooke’s Emergency Department

Introduction Our aim was to present the epidemiological estimates of facial fractures within East Anglia. Method We recorded all patients presenting with facial fractures to our Emergency Department between 2014-2019. All features relating to the patient profile and injury were recorded. We used the English Indices of Deprivation, along with the UK Census (2011), to assess for a correlation between factors such as deprivation status and age with specific causes of facial fractures. Results 2022 cases were collected totalling 2551 fractures. Mean patient age was 39. The overall leading causes of fractures were falls, assaults and sporting incidents (29.9%, 27.3%, and 17.1% respectively). Towns such as Newmarket and Cambridge demonstrated a distinct leading cause as a result of town-specific recreational activities; horse-riding and cycling respectively. We discovered a positive correlation between deprivation status and fractures due to assault. There was also a relationship between an older population and incidence of fractures due to falls. Conclusions Facial fractures reflect a significant cost-burden on the NHS, as well as an emotional burden on patients, which can be reduced by public health interventions and liaison between healthcare professionals and local county authorities. Sharing of these findings with the relevant parties may allow the implementation of location-specific interventions.

An analysis of inpatient and ED admissions within 30 days of chemotherapy: An OP-35 review.

e19302 Background: To evaluate patients who were within 30 days of outpatient chemotherapy infusion for an admission or ED visit associated with a primary or secondary diagnosis of anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia or sepsis. Methods: A review of Epic was performed on all Mercy patients with cancer who received at least one outpatient chemotherapy between 1/1/16-12/31/18. Non leukemia patients ≥ 18 years of age with an inpatient admission(IPA) or ED visit (EDV) were further evaluated for either the primary or secondary diagnosis for referral with at least one of the following diagnoses: anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia, or sepsis. Univariate and multivariable analyses were performed to identify significant clinical variables associated with the risk of referral. Adjusted Odds Ratios were calculated for the significant variables with a p value < 0.05 being significant. Results: Of the 9,590 cancer patients who presented to an outpatient infusion center during the study interval, there were 8,319 eligible patients excluding those with leukemia or age < 18 (n = 503) or for a presentation in which a chemotherapy agent was not infused. There were 90,030 eligible chemotherapy encounters of which 16.8% of patients (n = 1400) had an IPA and 11.8% (n = 980) had an EDV within 30 days of infusion. Age, social deprivation status, NCI comorbidity index, Epic readmission score, ECOG performance score, smoking, and malnutrition were significantly associated with either an IPA or EDV in both settings. Sepsis, pneumonia, and anemia were the most common OP35 related diagnoses for an IPA at 47.2%, 26.9%, and 23.2%, respectively. Similarly, pain, dehydration and nausea were the most common OP35 related diagnosis for an EDV at 48.1%, 14.2%, and 14.1% respectively. Factors having the strongest association with an IPA were malnutrition (OR: 2.34 2.08-2.65; p < 0.00001) and an antibiotic type of chemotherapy (OR: 2.16 1.72-2.72; p < 0.0001). Factors having strongest association with an EDV were severe pain score (OR: 2.56 2.21-2.97; p < 0.0001) and moderate to most deprived social deprivation status (OR: 2.10 1.62-2.72; p < 0.0001). ER referrals for pain, dehydration, and anemia most commonly occurred during clinic hours. Conclusions: Many clinical variables were found to be significantly associated with an IPV or EDV. These variables are opportunities for outpatient interventional algorithms to enhance patient care.

Influence of prior feeding experience and food deprivation on flour selection and utilization by the red flour beetle, Tribolium castaneum (Herbst)

The influence of prior feeding experience and food deprivation on selection and utilization of wheat flour (WF), melon seed flour (MSF) and mung bean flour (MBF) by Tribolium castaneum reared on WF was investigated in this study. Flour selection, measured by percentage gravitation and acceptance of the flours by beetles (when fed and also when starved for 48 hours), was studied in choice and no-choice tests. On the other hand, T. castaneum’ s utilization of flours for growth and development was determined by monitoring population changes for three months in each flour type infested with 10 beetle pairs. Results of three-flour choice tests showed that gravitation (55.56%) and acceptance (54.44%) were significantly higher (p < 0.05) in WF than MSF and MBF. Also, MBF significantly (p < 0.05) had higher beetle gravitation (80.56%) and acceptance (72.78%) than MSF in a two-flour choice test. In no-choice tests, percentage gravitation and acceptance of beetles to the control (no flour situation) was significantly lower (p < 0.05) compared to MBF. Selection of MSF by T. castaneum was, however, not significantly different (p > 0.05) from the control in the study. Flour utilization followed a similar trend with significantly higher (p < 0.05) mean adults and larvae numbers in WF (211.33, 81.33) and MBF (87.67, 31.00), respectively compared to MSF (28.33, 7.67) at three months after infestation. The study concluded that flour selection in T. castaneum is influenced by prior feeding experience but not by food deprivation status of the beetles. Flour utilization is, however, neither influenced by prior feeding experience nor by food deprivation. Key words: Tribolium castaneum, host range, choice test, no-choice test, flour

Missing Dimensions of Poverty? Calibrating Deprivation Scales Using Perceived Financial Situation

Deprivation scales usually cover some but not all aspects of poverty. Missing dimensions could affect who is and is not identified as poor. Despite its importance, whether missing dimensions affect the measurement of poverty has not been empirically examined in the EU context. Such an examination requires data on missing dimensions that existing surveys do not usually collect. In this article, I get around this problem with an innovative design and using the rich content of the British Household Panel Survey (1999–2008). I use perceived financial inadequacy as a proxy for poverty and show that, independent of the deprivation status, having a need in healthcare, childcare, social care, or education increases the risk of reporting financial inadequacy. The main explanations for these effects are extra spending and reduced earnings of the families (as a response to having extra needs), and not other biases that might arise from using a self-assessed proxy measure such as scale heterogeneity, personality traits, state dependence, anticipations, or psychological negativity. These findings demonstrate the need for more comprehensive measures. Unless relevant indicators of missing dimensions (e.g. cost-related unmet needs in healthcare) are included in the analysis, deprivation scales might fail to identify some people experiencing poverty.

Examining the potential preventative effects of minocycline prescribed for acne on the incidence of severe mental illnesses: A historical cohort study

Background: Animal studies suggest that the antibiotic and microglial activation inhibitor, minocycline, is likely to have a protective effect against the emergence of psychosis but evidence from human studies is lacking. The aim of this study is to examine the effects of exposure to minocycline during adolescence on the later incidence of severe mental illness (SMI). Methods: A historical cohort study using electronic primary care data was conducted to assess the association between exposure to minocycline during adolescence and incidence of SMI. The Incidence Rate Ratio (IRR) was measured using Poisson regression adjusted for age, gender, time of exposure, socioeconomic deprivation status, calendar year and co-medications. Results: Early minocycline prescription ( n=13,248) did not affect the incidence of SMI compared with non-prescription of minocycline ( n=14,393), regardless of gender or whether or not the data were filtered according to a minimum exposure period (minimum period: IRR 0.96; 95% CI 0.68–1.36; p=0.821; no minimum period: IRR 1.08; 95% CI 0.83–1.42; p=0.566). Conclusions: Exposure to minocycline for acne treatment during adolescence appears to have no effect on the incidence of SMI.