Oral abstracts 3: RA Treatment and outcomesO13. Validation of jadas in all subtypes of juvenile idiopathic arthritis in a clinical setting

Background: Juvenile Arthritis Disease Activity Score (JADAS) is a 4 variable composite disease activity (DA) score for JIA (including active 10, 27 or 71 joint count (AJC), physician global (PGA), parent/child global (PGE) and ESR). The validity of JADAS for all ILAR subtypes in the routine clinical setting is unknown. We investigated the construct validity of JADAS in the clinical setting in all subtypes of JIA through application to a prospective inception cohort of UK children presenting with new onset inflammatory arthritis. Methods: JADAS 10, 27 and 71 were determined for all children in the Childhood Arthritis Prospective Study (CAPS) with complete data available at baseline. Correlation of JADAS 10, 27 and 71 with single DA markers was determined for all subtypes. All correlations were calculated using Spearman's rank statistic. Results: 262/1238 visits had sufficient data for calculation of JADAS (1028 (83%) AJC, 744 (60%) PGA, 843 (68%) PGE and 459 (37%) ESR). Median age at disease onset was 6.0 years (IQR 2.6-10.4) and 64% were female. Correlation between JADAS 10, 27 and 71 approached 1 for all subtypes. Median JADAS 71 was 5.3 (IQR 2.2-10.1) with a significant difference between median JADAS scores between subtypes (p < 0.01). Correlation of JADAS 71 with each single marker of DA was moderate to high in the total cohort (see Table 1). Overall, correlation with AJC, PGA and PGE was moderate to high and correlation with ESR, limited JC, parental pain and CHAQ was low to moderate in the individual subtypes. Correlation coefficients in the extended oligoarticular, rheumatoid factor negative and enthesitis related subtypes were interpreted with caution in view of low numbers. Conclusions: This study adds to the body of evidence supporting the construct validity of JADAS. JADAS correlates with other measures of DA in all ILAR subtypes in the routine clinical setting. Given the high frequency of missing ESR data, it would be useful to assess the validity of JADAS without inclusion of the ESR. Disclosure statement: All authors have declared no conflicts of interest. Table 1Spearman's correlation between JADAS 71 and single markers DA by ILAR subtype ILAR Subtype Systemic onset JIA Persistent oligo JIA Extended oligo JIA Rheumatoid factor neg JIA Rheumatoid factor pos JIA Enthesitis related JIA Psoriatic JIA Undifferentiated JIA Unknown subtype Total cohort Number of children 23 111 12 57 7 9 19 7 17 262 AJC 0.54 0.67 0.53 0.75 0.53 0.34 0.59 0.81 0.37 0.59 PGA 0.63 0.69 0.25 0.73 0.14 0.05 0.50 0.83 0.56 0.64 PGE 0.51 0.68 0.83 0.61 0.41 0.69 0.71 0.9 0.48 0.61 ESR 0.28 0.31 0.35 0.4 0.6 0.85 0.43 0.7 0.5 0.53 Limited 71 JC 0.29 0.51 0.23 0.37 0.14 -0.12 0.4 0.81 0.45 0.41 Parental pain 0.23 0.62 0.03 0.57 0.41 0.69 0.7 0.79 0.42 0.53 Childhood health assessment questionnaire 0.25 0.57 -0.07 0.36 -0.47 0.84 0.37 0.8 0.66 0.4

Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed analyses of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hyper-activity disorder, autism spectrum disorder, bipolar disorder, major depression, obsessive-compulsive disorder, schizophrenia, and Tourette syndrome. Genetic correlation analyses revealed a meaningful structure within the eight disorders, identifying three groups of inter-related disorders. Meta-analysis across these eight disorders detected 109 loci associated with at least two psychiatric disorders, including 23 loci with pleiotropic effects on four or more disorders and 11 loci with antagonistic effects on multiple disorders. The pleiotropic loci are located within genes that show heightened expression in the brain throughout the lifespan, beginning prenatally in the second trimester, and play prominent roles in neurodevelopmental processes. These findings have important implications for psychiatric nosology, drug development, and risk prediction.Peer reviewe

Effectiveness of a quality improvement collaborative in reducing time to surgery for patients requiring emergency cholecystectomy.

BACKGROUND: Acute gallstone disease is a high-volume emergency general surgery presentation with wide variations in the quality of care provided across the UK. This controlled cohort evaluation assessed whether participation in a quality improvement collaborative approach reduced time to surgery for patients with acute gallstone disease to fewer than 8 days from presentation, in line with national guidance. METHODS: Patients admitted to hospital with acute biliary conditions in England and Wales between 1 April 2014 and 31 December 2017 were identified from Hospital Episode Statistics data. Time series of quarterly activity were produced for the Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) and all other acute National Health Service hospitals (control group). A negative binomial regression model was used to compare the proportion of patients having surgery within 8 days in the baseline and intervention periods. RESULTS: Of 13 sites invited to join Chole-QuIC, 12 participated throughout the collaborative, which ran from October 2016 to January 2018. Of 7944 admissions, 1160 patients had a cholecystectomy within 8 days of admission, a significant improvement (P < 0·050) from baseline performance. This represented a relative change of 1·56 (95 per cent c.i. 1·38 to 1·75), compared with 1·08 for the control group. At the individual site level, eight of the 12 Chole-QuIC sites showed a significant improvement (P < 0·050), with four sites increasing their 8-day surgery rate to over 20 per cent of all emergency admissions, well above the mean of 15·3 per cent for control hospitals. CONCLUSION: A surgeon-led quality improvement collaborative approach improved care for patients requiring emergency cholecystectomy

Investigating the relations between youth sport participation and parental mental health

Parents are active participants in their child’s youth sport endeavours and can influence their athlete’s experience through their parenting practices, styles, and interactions. However, parents experience their own range of outcomes as a result of their involvement in their child’s sport activities. In fact, recent decades have brought forth a rich body of literature that point to the benefits and challenges of having a child involved in organised sport. Despite this, the mental health experiences of parents in youth sport have yet to be investigated explicitly. As such, the overarching purpose of this doctoral research was to further the understanding of the relationship between youth sport participation and parents’ mental health and wellbeing. To achieve this aim, a five-study program of research was conducted

Exploring the relations between personal and social identity on competitive youth sport parents' moral intentions towards antisocial parent behaviour

This thesis was completed and submitted at Nipissing University, and is made freely accessible through the University of Toronto’s TSpace repositoryThere is emerging evidence that youth sport parents may experience a range of cognitive, affective, and behavioural outcomes as a result of their involvement in their children's sport participation (Dorsch, Smith, & McDonough, 2009). For example, parents' degree of investment in their children's sport activities may carry behavioural repercussions towards both ingroup and outgroup members, much like that of a child towards his/her teammates. Grounded in personal and social identity research, the purpose of this research was to explore whether personal and social identity perceptions would advance or hinder moral intentions towards antisocial parent behaviour in youth sport. Parents of competitive youth hockey players (N=437) read a vignette which either described an ingroup or outgroup parent acting antisocially towards either an ingroup athlete, outgroup athlete, or their own child. I then asked parents whether they would respond to the antisocial behaviour in the form of direct or indirect criticism or report the behaviour to the coach or to the league. There was a significant main effect of parent actor with regard to parents' intentions to directly criticize ingroup parents, F(1, 429) = 5.05, p=.03, n2p=.012, and indirectly criticize outgroup parents, F(1.429) = 15.23, p<.001, n2p=.034. Further, the strength of social identity to their child's sport team moderated the effect. Parents with stronger social identities were more likely to report higher intentions to indirectly criticize an outgroup parent. There were no significant main effects for reporting behaviour (to coach or league), and personal identity did not moderate relationships with moral intentions towards antisocial behaviour. I discuss the theoretical and practical implications of the findings to better understand and potentially curb antisocial parent behaviour in competitive youth sport.M.Sc

Prevalence of drop-out from organised extracurricular sports and associations with body fat percentage during childhood and adolescence

Objectives This paper aimed to report the prevalence of drop-out from organised sports between the ages of 10 and 14 years, and to examine potential associated detriments to levels of body fat. Methods All data were drawn from waves 4-6 of the Longitudinal Study of Australian Children. Participants\u27 sport participation was parent reported and body fat percentage was measured using bioelectrical impedance analysis. A total of 4159 participants had sports participation data at age 10 years (M=10.32 years, SD=4.68). Results From 3013 sport participants at age 10 years, 29.7% (n=894) had dropped out of sports at age 12 years. Of 2016 sport participants at age 12 years, 33.3% (n=705) had dropped out of sports by the age of 14 years. There were no differences in body fat percentage at any age according to differences in sport participation behaviours. Conclusions Based on a high prevalence, drop-out from organised extracurricular sports during childhood and adolescence may be an important public health behaviour to consider. A solution-oriented approach to dropout from organised sports is recommended, but more evidence as to potential health detriments is needed using high-quality research designs

Psychological safety in sport:A systematic review and concept analysis

There has been a rapid proliferation of empirical research on the relationship between sport participation and mental health. As a result of this movement, there has been an increased focus on the constructs that can predict or explain mental health outcomes in sport. Psychological safety in sport is among the constructs surfaced in the movement. Despite this, there is a considerable lack of conceptual clarity regarding how to define psychological safety and how it can be fostered in sport. As such, the aim of this study was to provide conceptual clarity of the term psychological safety in the context of sport. To achieve this aim, we first systematically searched for all currently available studies that have discussed psychological safety in a sport context. Then, a concept analysis approach was applied wherein the definitions, attributes, antecedents, and consequences were thematically analysed across 67 studies. As a result of this synthesis, psychological safety in sport was conceptualised as a continuous, group level construct that is perceived (and reported) at an individual level. We also provide a descriptive model of psychological safety in sport that we hope lends clarity and debate to the field moving forward.</p

Prevalence of drop-out from organised extracurricular sports and associations with body fat percentage during childhood and adolescence

Objectives This paper aimed to report the prevalence of drop-out from organised sports between the ages of 10 and 14 years, and to examine potential associated detriments to levels of body fat.Methods All data were drawn from waves 4–6 of the Longitudinal Study of Australian Children. Participants’ sport participation was parent reported and body fat percentage was measured using bioelectrical impedance analysis. A total of 4159 participants had sports participation data at age 10 years (M=10.32 years, SD=4.68).Results From 3013 sport participants at age 10 years, 29.7% (n=894) had dropped out of sports at age 12 years. Of 2016 sport participants at age 12 years, 33.3% (n=705) had dropped out of sports by the age of 14 years. There were no differences in body fat percentage at any age according to differences in sport participation behaviours.Conclusions Based on a high prevalence, drop-out from organised extracurricular sports during childhood and adolescence may be an important public health behaviour to consider. A solution-oriented approach to dropout from organised sports is recommended, but more evidence as to potential health detriments is needed using high-quality research designs