The objective was to assess the effectiveness of a smoking cessation educational program on pediatric residents' counseling. Residents were randomly selected to receive the intervention. Residents who were trained were compared to untrained residents. Self-reported surveys and patient chart reviews were used. Measures included changes in self-reported knowledge, attitudes and behaviors of residents, and differences in chart documentation and caretaker-reported physician counseling behaviors. The intervention was multidimensional including a didactic presentation, a problem-solving session, clinic reminders, and provision of patient education materials. Results showed that residents who were trained were more likely to ask about tobacco use in their patients' households. They were also more likely to advise caretakers to cut down on or to quit smoking, to help set a quit date, and to follow up on the advice given at a subsequent visit. Trained residents were more likely to record a history of passive tobacco exposure in the medical record. These residents also reported improved confidence in their counseling skills and documented that they had done such counseling more often than did untrained residents. Caretakers of pediatric patients who smoke seen by intervention residents were more likely to report that they had received tobacco counseling. Following this intervention, pediatric residents significantly improved their behaviors, attitudes, and confidence in providing smoking cessation counseling to parents of their pediatric patients.

Poor compliance and high discontinuation rates of Depot-Medroxyprogesterone Acetate (DMPA) and other contraceptive methods are major factors in the continuing problem of adolescent pregnancy. In this study we attempted to determine if providing comprehensive health care for teen mothers and their babies would improve continuation rates of DMPA. Patients who started DMPA between 1/1/96 and 1/1/99 were included. Teen mothers and their babies received all their health care in this clinic, supported by State funding. Key elements regarding DMPA in this clinic were continuity of care, phone and mail reminders of appointments, free DMPA for patients without insurance, counseling at each visit and available evening clinic. In the study period a total of 299 (age 13-22 years) patients were started on DMPA. Fifty-one percent were white, 47% black and 2% others. Sixty-three percent were single, 20% married, 3% cohabitating and 14% undetermined (missing data). Seventy-eight percent had one baby and 22% more than one. A total of 189 patients (63.2%) continued to be compliant after one year of use and 101 patients (33.8% of total) continued beyond the second year. The most common side effect reported was bleeding or spotting (32%), However only seven patients (2.3%) discontinued use because of it. It is concluded that continuity of care (same staff and providers on each visit), regular counseling, flexible hours (evening appointments), financial ease (free DMPA and no visit charge for those without insurance), combined Teen-Tot health visits and regular reminders of appointments may help improve compliance and continuation rates in teen mothers leading to better success in preventing repeat teen pregnancy.

BackgroundRheumatic Diseases (RD) frequently affect women during reproductive age, therefore counselling on family planning is crucial for their quality of life. Children’s outcome is a major topic, but no large studies are available.ObjectivesTo assess the long-term health conditions of children born to women with RD in a large multicentre cohort.Methods24 Rheumatology Centres distributed the questionnaire (65 multiple-choice and 12 open-answer questions) to consecutive patients (18–55 years) in September 2015. Data were analysed dividing children upon maternal diagnosis: Chronic Arthritides (CA) and Connective Tissue Diseases (CTD).ResultsData were collected for 320 children (166 males, 52%) born to 184 mothers (63 CA and 121 CTD). At the time of interview, children had a mean age of 17.1±9.6 years. Preterm delivery (<37 w) was observed in 72 cases (22.5%), including 13 (4%)<34 w. Data on autoimmune/inflammatory disease (AIID) and/or neurodevelopmental disorders (ND)/learning disabilities (LD) is reported in table 1. 12 children (3.7%) had a diagnosis of AIID, mostly coeliac disease (8/12, 67%)and 11 children (3.4%) of a ND and/or LD by a Paediatric Neuropsychiatrist. To rule out the possible effects of in utero exposure to maternal autoantibodies and/or anti-rheumatic drugs in the pathogenesis of ND, these data were retrieved for 280 children (88%) and a comparison was performed between 11 affected and 269 not-affected children (table 2).Abstract FRI0373 – Table 1DM: diabetes mellitus; LD: learning disorder; ADHD: attention deficit hyperactivity disorderAbstract FRI0373 – Table 2ConclusionsIn this long-term follow-up of children born to mothers with RD in this large, multicenter study of randomly interviewed women each AIID did not display a significantly increased frequency as compared to the literature; only coeliac showed a mild increased frequency. Children with LD had a tendency to cluster in the group of mothers with CTD, especially after maternal diagnosis (4/63, 6.3%), with a higher frequency as compared to general paediatric population. No significant relationships between ND/LD and prematurity, intrauterine drug exposure or maternal autoantibodies were identified.AcknowledgementsStatistical analysis supported by an unrestricted grant by UCB Pharma. The authors wish to thank Patients Associations and Participants to the survey.Disclosure of InterestNone declared

BackgroundThe spondyloarthritis (SpA) complex also includes forms that do not meet criteria for the definite forms and are called undifferentiated SpA (uSpA). Recently the Assessment in SpondyloArthtritis international Society (ASAS) suggested criteria for axial and peripheral SpA that have substituted the Amor and the European Sondylarthropathy Study Group (ESSG) criteria for all forms of SpA. In the ASAS criteria for axial disease the entry criterion is chronic low back pain in a patient with an age less than 45 years. Only 15% of the patients included in the study for the ASAS criteria for peripheral disease were older than 45 years.ObjectivesThe objective of our study was to evaluate the sensitivity of the ASAS criteria for axial and peripheral SpA in a cohort of consecutive patients with HLA-B27 positive uSpA with onset of disease after the age of 45 (late onset uSpA) consecutively recruited in a 12-year period in comparison with a cohort of consecutive patients with HLA-B27 positive uSpA with onset before age 45 (ordinary onset uSpA) recruited in the same period.MethodsPatients HLA-B27 positive with at least one clinical manifestation of SpA and not meeting the New York criteria for ankylosing spondylitis (AS) and with a negative personal history for psoriasis, inflammatory bowel disease and preceding infection seen since January 2001 were entered in a special register and were followed prospectively. Each patient was examined at 6-month interval even if asymptomatic.ResultsDuring the 12-year recruitment period, 93 patients (35 M, 58 F; age 58.4±9.8) with late onset uSpA were seen. The first 93 consecutive patients (54 M, 39 F; age 29.6±8.6) with ordinary onset uSpA seen in the same period were evaluated for comparison. Compared to the 93 patients with ordinary onset uSpA, the 93 patients with late onset uSpA were more frequently females (62.4% vs. 41.9%, p<0.05) had a significant shorter diagnostic delay (time elapsed between the day of onset and the day of diagnosis) (24.2±45.6 vs. 65.1±97 months, p<0.05) and showed more frequently increased levels of ESR (Erythrocite Sedimentation Rate)(57% vs. 33.3%, p<0.05) and CRP (C-reactive proteine) (62,4% vs. 48,4%, p=0,07). In addition, patients with late onset uSpA developed more frequently inflammatory extremity swelling with pitting edema (IESPE) over the dorsum of hands and/or of the feet (25.8% vs. 4.3%, p<0.01) and peripheral enthesitis (48.4% vs.31.2%, p<0.05). In contrast, patients with ordinary onset uSpA showed more frequently acute anterior uveitis (20.4% vs. 7.5%, p<0.05). The sensitivity of the ASAS criteria was similar in the ordinary onset (90.3%) and the late onset (91.4%) cohorts of patients with uSpA.ConclusionsThe ASAS classification criteria for axial and peripheral SpA showed a similar high sensitivity in patients with ordinary and late onset uSpA. In addition, this study confirms that some clinical and laboratory features of SpA may differ with the age at onset of the disease.Disclosure of InterestNone declared

Background:Tumor necrosis factor-α inhibitors (TNFi) are usually the first biologic drugs employed in rheumatoid arthritis (RA) after failure of conventional disease-modifying antirheumatic drugs (DMARDs). Retention rate is a useful surrogate marker of effectiveness and safety in real life, but few studies investigated the causes of early discontinuation of these drugs.Objectives:Aim of the study was to investigate the possible predictors of early discontinuation (within 1 year of treatment) of etanercept (ETA) in RA patients enrolled into the GISEA (Italian Group for the Study of Early Arthritis) registry.Methods:RA patients who began etanercept as first biologic DMARD were included in the study. For all patients age, sex, disease duration, smoking status, the intake of glucocorticoids and DMARD, clinical and serological data, comorbidities and extra-articular manifestations were collected.Results:We analyzed 477 RA patients (females/males 382/95, mean age 51.3±14.1 years; mean DAS28 5.4±1.5); rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA) were positive in 66% and 62.3%, respectively. Comorbidities were observed in 16.6% of patients, mainly cardiovascular diseases, while extra-articular RA manifestations were recorded in 6.3%. Concurrent DMARDs therapies were reported in 54.3% of patients, mainly methotrexate (40.5%), while 52.4% of subjects taken low doses of steroids.Seventy patients (14.7%) discontinued ETA during the first year (for inefficacy in 43 patients, adverse events in 22, and other reasons in 5). The presence of comorbidities and a combination therapy with DMARDs different by MTX were independent predictors of early discontinuation of ETA at multivariate analysis (see table 1). The association with MTX didn’t increase the 1-year retention rate of ETA. No significant associations were observed with steroids, presence of RF or ACPA or the disease activity at baseline.Table 1Multivariate analysis. Factors associated to early discontinuation of etanerceptParameterStandard ErrorOdds ratio95% Confidence Intervalp Comorbidities0,281,861.07–3.250,029DMARDs different by MTX0,352,011.014–3.9820,045ETA monotherapy0,2970,7010.392–1.2560,232Conclusions:ETA demonstrated a high persistence in RA patients and after 12 months more than 85% of patients continued the treatment. The presence of comorbidities and a combination therapy with DMARDs different by MTX were associated to an early withdrawal of the drug.Disclosure of Interest:None declared