The Relationship Between Storey of Buildings and Fall Risk

Purpose: This study examined the association between storey of building and fall risk in older adults' residences and residents' level of fear of falling.Methods: The National Health and Ageing Trends Study (NHATS) collected information that would provide an understanding of basic trends people aged 65 years and older. Using a longitudinal survey, the present study employed the first round of NHATS data that was collected in 2011. In the first round, 12,411 participants were enrolled, and 8,077 interviews were completed. The study sample sizes for falling and worry about falling are 6,153 and 6,142, respectively.Results: Unadjusted analysis revealed that storey of building was a risk factor for fall and worry about falling. There was a higher prevalence for fall and worry about falling when subjects lived in single storey of building compared with the subjects live in multi-storey. Logistic regression analysis showed no highly significant between storey of building and the fall/fear of falling.Conclusion: Several clinical factors independently were indicated pertaining to the fall and worry about falling in older adult's residences.

EPCO-33. CELL-TYPE PROPORTION DECONVOLUTION OF PEDIATRIC CENTRAL NERVOUS SYSTEM TUMORS FROM SINGLE NUCLEI RNA-seq UNCOVERS UNDERLYING TRANSCRIPTOMIC CHANGES FROM BULK TUMOR RNA-seq COMPARED TO NORMAL BRAIN

Identifying transcriptomic alterations in pediatric central nervous system (pCNS) tumors often relies on transcriptomic profiles from bulk tissue RNA-sequencing that can be confounded by varying cell type proportions across tumor and normal brain tissues. We utilized single nuclei RNA-sequencing (snRNA-seq) and bulk RNA-seq in 33 pCNS tumors and 3 non-diseased pediatric brain tissue samples collected from the Norris Cotton Cancer Center to identify variation in gene expression in bulk tissue attributed to overrepresentation of specific cell-type populations when determining differentially expressed genes comparing pCNS tumors to normal pediatric brain tissues. snRNA-seq of 43,515 nuclei (mean = 1,209 nuclei/sample) revealed large proportions of astrocytes (median = 0.45, range = 0.24–0.93) and oligodendrocytes (median = 0.37, range = 0.00–0.66) in pCNS tumors. Compared to normal pediatric brain, proportions of astrocytes were significantly higher (P = 9.2E-03) and neurons were significantly lower (P = 9.4E-03) in pCNS tumors. Differential expression analyses comparing bulk RNA-sequencing data from pCNS tumors to normal pediatric brain identified 902 additional differentially expressed genes (# DE genes = 1,802) when adjusting for astrocyte and neuron proportions compared with unadjusted analysis (# DE genes = 900). In cell-type proportion unadjusted analysis, top DE genes included astrocyte-specific markers, GFAP and CIITA, both of which were found to be not significantly differentially expressed in cell-type proportion adjusted analysis. Indeed, pathways enrichment analysis revealed DE genes in unadjusted models were associated with processes of the neurons and astrocytes such as interferon signaling and postsynaptic signal transmission. After adjustment for astrocyte and neuron proportions, DE genes were associated with defensins and DNA replication-related processes. Our results highlight new potential biological pathways essential in pCNS tumors and indicate the significance of the distribution of varying cell types in tissue samples when conducting studies to investigate transcriptomic alterations in bulk tissue of pCNS tumors.

P108 SARCOPENIA INCREASES THE RISK OF BURST ABDOMEN AFTER EMERGENCY MIDLINE LAPAROTOMY: A MATCHED CASE-CONTROL STUDY

Aim The aim of this study was to investigate the association of sarcopenia with the risk of burst abdomen after midline laparotomy. Material and Methods A single-center, retrospective, 1:4 matched case-control study of patients suffering from burst abdomen (cases) and controls. Sarcopenia was defined as lowest sex-dependent quartile of total cross-sectional psoas area adjusted for body surface area. Primary outcome was to evaluate the rate of sarcopenic patients among cases and controls. Secondary, risk-factors for burst abdomen and postoperative death, were evaluated by multivariate regression analysis. Results 67 patients suffering from burst abdomen were matched to 268 controls. Sarcopenia was associated with burst abdomen (OR 2.3, p = 0.006). Unadjusted analysis identified a higher 90-day mortality among sarcopenic patients compared to the non-sarcopenia group (32.9% vs. 21.1%, p = 0.029) but this association was not verified by the adjusted analysis. Conclusions Sarcopenia is an isolated risk-factor for burst abdomen after midline laparotomy.

Association of adverse childhood experiences (ACEs) with obesity and underweight in children

Purpose The aim of the study was to test the hypothesis that adverse childhood experiences (ACEs) are related to both obesity and underweight from childhood, and that the association of ACEs with weight abnormalities is modulated by type of ACEs, sex and socioeconomic status (SES) indices. Methods The relations between ACEs (0 vs ≥ 1), ACE accumulation and ACE type with weight status and z scores BMI were assessed in 503 children aged 6–12 years from Poznan, Poland. The effects of interaction of ACEs with sex and SES on z scores BMI were included in the analyses. Results ACEs were significantly related to both obesity and underweight, in unadjusted analysis, and when sex and SES indices, such as size of place of residence, people per room in household, and parental education were controlled. The relation of ACEs with z scores BMI was modulated by ACE type, parental subjective assessment of economic situation of a family and parental education. ACE accumulation was not related to an increase of obesity or underweight rate, or z scores BMI. Conclusion The study implicates the need for both obesity and underweight prevention in individuals with adverse experiences as early as in childhood. Level of evidence III: evidence obtained from well-designed cohort study.

Covariate Adjustment in Randomized Controlled Trials

Introduction & Objective: Unadjusted analyses, fully adjusted analyses, or adjusted analyses based on tests of significance on covariate imbalance are recommended for covariate adjustment in randomized controlled trials. It has been indicated that the tests of significance on baseline comparability is inappropriate, rather it is important to indicate the strength of relationship with outcomes. Our goal is to understand when the adjustment should be used in randomized controlled trials. Methods: Unadjusted analysis, fully adjusted analysis, and adjusted analysis based on baseline comparability were examined under null and alternative hypothesis by simulation studies. Each data set was simulated 3000 times for a total of 9 scenarios for sample sizes of 20, 40, and 100 each with baseline thresholds of 0.05, 0.1, and 0.2. Each scenario was examined by the change in magnitude of correlation from 0.1 to 0.9. Results: Power of fully adjusted analysis under alternative hypothesis was increased as the correlation increased while adjusted analysis based on the covariate imbalance did not compare favorably to the unadjusted analysis. Type 1 error was decreased in adjusted analysis based on the covariate imbalance under null hypothesis. It was then observed that p-value does not follow a uniform distribution under the null hypothesis. Conclusion: Unadjusted and fully adjusted analyses were valid analyses. Full adjustment could potentially increase the power if adjustment is known. However, adjusted analysis based on the test of significance on covariate imbalance may not be a valid analysis. Tests of significance should not be used for comparing baseline comparability.

Abstract P264: Protective Effects Of Angiotensin II Inhibitors In Lebanese SARS-COV2 Hospitalized Patients

Introduction: SARS-CoV2 leads to increased Angiotensin II resulting in worsened cardiovascular disease (CVD) outcome and prognosis. ACEIs and ARBs prescribed drugs could be a crucial player in SARS-COV2 prognosis, owing that ACE2 is one SARS-CoV2 binding site and that ACE2 expression in the cardiovascular system is markedly elevated following the treatment with ACEIs and ARBs. Hypothesis: We hypothesized that hospitalized SARS-COV2 Lebanese patients with varying stages of heart failure (A through C) taking ACEIs or ARBs will exhibit an overall better cardiovascular prognosis than control patients with comparable demographics but on other cardiovascular medications. Method: Lebanese patients (N=66) classified as heart failure A-C and admitted to AUBMC for SARS-CoV2 infection were recruited as a part of an ongoing clinical study. Patients were assigned to the control group (No ACEIs or ARBs) or the study sample group (on ACEIs or ARBs). Baseline characteristics including cardiovascular, inflammatory, respiratory and overall outcomes were collected from the patients’ medical charts and analyzed. Unadjusted associations on recruited patients are presented here. Adjusted analyses will be performed when a total of 200 patients is reached. Results: The average age of patients was 69±12.42. The total average weight was 84.24±15.59 Kg and significantly higher in ACEIs/ARBs group (p=0.032). Most patients were males (48 of 66) and patients on ACEIs/ARBs medication were 38 of 66. Heart failure stage, systolic and diastolic blood pressures and heart rate were comparable on presentation between patients on ACEIs/ARBs and controls. Unadjusted analysis showed a significantly higher percentage of death (p=0.024), mechanical ventilation (p=0.05), and elevated troponin (p=0.03) in the control group. A trend towards higher percentage of elevated NT-ProBNP and high levels of peak IL-6 were observed in the control group (p = 0.088 and p=0.076 respectively). All patients had elevated CRP on admission. SARS-CoV2 treatments were comparable between the two groups. Conclusion: Higher mortality and worsened prognosis were observed in the control groups when compared to the ACEIs/ARBs group. Ongoing recruitment is currently underway to perform adjusted analyses.

Association of Adverse Childhood Experiences (ACEs) With Obesity And Underweight In Children

Purpose: The aim of the study was to test the hypothesis that adverse childhood experiences (ACEs) are related to both obesity and underweight from childhood, and that the association of ACEs with weight abnormalities is modulated by type of ACEs, sex and socioeconomic status (SES) indices. Methods: The relations between ACEs (0 vs ≥1), ACE accumulation and ACE type with weight status and z scores BMI were assessed in 503 children aged 6-12 years from Poznan, Poland. The effects of interaction of ACEs with sex and SES on z scores BMI were included in the analyses. Results: ACEs were significantly related to both obesity and underweight, in unadjusted analysis, and when sex and SES indices, such as size of place of residence, people per room in household, and parental education were controlled. The relation of ACEs with z scores BMI was modulated by ACE type, parental subjective assessment of economic situation of a family and parental education. ACE accumulation was not related to an increase of obesity or underweight rate, or z scores BMI. Conclusion: The study implicates the need for both obesity and underweight prevention in individuals with adverse experiences as early as in childhood.

Inequalities in the distribution of the general practice workforce in England: a practice-level longitudinal analysis

BackgroundIn England, demand for primary care services is increasing and GP shortages are widespread. Recently introduced primary care networks (PCNs) aim to expand the use of additional practice-based roles such as physician associates (PAs), pharmacists, paramedics, and others through financial incentives for recruitment of these roles. Inequalities in general practice, including additional roles, have not been examined in recent years, which is a meaningful gap in the literature. Previous research has found that workforce inequalities are associated with health outcome inequalities.AimTo examine recent trends in general practice workforce inequalities.Design & settingA longitudinal study using quarterly General Practice Workforce datasets from 2015–2020 in England.MethodThe slope indices of inequality (SIIs) for GPs, nurses, total direct patient care (DPC) staff, PAs, pharmacists, and paramedics per 10 000 patients were calculated quarterly, and plotted over time, with and without adjustment for patient need.ResultsFewer GPs, total DPC staff, and paramedics per 10 000 patients were employed in more deprived areas. Conversely, more PAs and pharmacists per 10 000 patients were employed in more deprived areas. With the exception of total DPC staff, these observed inequalities widened over time. The unadjusted analysis showed more nurses per 10 000 patients employed in more deprived areas. These values were not significant after adjustment but approached a more equal or pro-poor distribution over time.ConclusionSignificant workforce inequalities exist and are even increasing for several key general practice roles, with workforce shortages disproportionately affecting more deprived areas. Policy solutions are urgently needed to ensure an equitably distributed workforce and reduce health inequities.

Impact of the DREAMS interventions on educational attainment among adolescent girls and young women: Causal analysis of a prospective cohort in urban Kenya

Background DREAMS promotes a comprehensive HIV prevention approach to reduce HIV incidence among adolescent girls and young women (AGYW). One pathway that DREAMS seeks to impact is to support AGYW to stay in school and achieve secondary education. We assessed the impact of DREAMS on educational outcomes among AGYW in Nairobi, Kenya. Methods and findings In two informal settlements in Nairobi, 1081 AGYW aged 15−22 years were randomly selected in 2017 and followed-up to 2019. AGYW reporting invitation to participate in DREAMS during 2017–18 were classified as “DREAMS beneficiaries”. Our main outcome was being in school and/or completed lower secondary school in 2019. We used multivariable logistic regression to quantify the association between being a DREAMS beneficiary and the outcome; and a causal inference framework to estimate proportions achieving the outcome if all, versus no, AGYW were DREAMS beneficiaries, adjusting for the propensity to be a DREAMS beneficiary. Of AGYW enrolled in 2017, 79% (852/1081) were followed-up to 2019. In unadjusted analysis, DREAMS beneficiaries had higher attainment than non-beneficiaries (85% vs 75% in school or completed lower secondary school, Odds Ratio (OR) = 1.9; 95%CI: 1.3,2.8). The effect weakened with adjustment for age and other confounders, (adjusted OR = 1.4; 95%CI: 0.9,2.4). From the causal analysis, evidence was weak for an impact of DREAMS (estimated 83% vs 79% in school or completed lower secondary school, if all vs no AGYW were beneficiaries, difference = 4%; 95%CI: -2,11%). Among AGYW out of school at baseline, the estimated differences were 21% (95%CI: -3,43%) among 15−17 year olds; and 4% (95%CI: -8,17%) among 18−22 year olds. Conclusions DREAMS had a modest impact on educational attainment among AGYW in informal settlements in Kenya, by supporting both retention and re-enrolment in school. Larger impact might be achieved if more AGYW were reached with educational subsidies, alongside other DREAMS interventions.

Are Fractures To The Bony Cage Protecting the Abdomen Associated with Splenectomy in Cases of Abdominal Trauma? A Cohort Study

Background The spleen is protected by the ribs anteriorly, the vertebral column posteriorly and the pelvis inferiorly. Fractures to this bony cage may indicate a high-grade splenic injury necessitating splenectomy. We aim to determine whether fractures to the bony cage protecting the abdomen are associated with splenectomy. Methods We performed a subgroup analysis of patients with splenic injury from a prospective trauma registry study named ‘Towards Improved Trauma Care Outcomes’ (TITCO) in India. Out of the 16047 patients enrolled in the TITCO study, 267 patients with splenic injury were included. Categorical variables were analyzed using the chi square test and logistic regression was used to assess the significance of continuous variables. A multivariate analysis was performed on the factors deemed clinically most significant. Results Patients with a higher grade of splenic injury were more likely to require splenectomy when adjusted for other variables (p value < 0.05). Patients with fractures to the vertebrae or pelvis had reduced odds of splenectomy on unadjusted analysis [Odds ratio 0.43 (0.19–0.94)], but this was not significant when adjusted for other variables. Conclusion In contradiction to our initial hypothesis, we found that fractures to the bony cage protecting the abdomen were not significantly associated with the splenectomy.