BackgroundThe indigenous Nenets reindeer herders in northern Russia annually migrate several hundred kilometers between summer and winter pastures. In the warming climate, ice-rich permafrost and glaciers are being significantly reduced and will eventually disappear from parts of the Arctic. The emergent changes in hydrological cycles have already led to substantial increases in open water that stays unfrozen for longer periods of time. This environmental change has been reported to compromise the nomadic Nenets’ traditional way of life because the presence of new water in the tundra reduces the Nenets’ ability to travel by foot, sled, or motor vehicle from the summer transitory tundra campsites in order to access healthcare centers in villages. New water can also impede their access to family and community at other herder camps and in the villages. Although regional and global models predicting hydrologic changes due to climate changes exist, the spatial resolution of these models is too coarse for studying how increases in open water affect health and livelihoods. To anticipate the full health impact of hydrologic changes, the current gap between globally forecasted scenarios and locally forecasted hydrologic scenarios needs to be bridged.ObjectivesWe studied the effects of the autumn temperature anomalies and increases in open water on health care access and transmigration of reindeer herders on the Kanin Peninsula.DesignCorrelational and time series analyses were completed.MethodsThe study population consisted of 370 full-time, nomadic reindeer herders. We utilized clinical visit records, studied surface temperature anomalies during autumn migrations, and used remotely sensed imagery to detect water bodies. Spearman correlation was used to measure the relationship between temperature anomalies and the annual arrival of the herders at the Nes clinic for preventive and primary care. Piecewise regression was used to model change in mean autumnal temperature anomalies over time. We also created a water body product to detect inter-annual changes in water area.ResultsCorrelation between arrivals to the Nes clinic and temperature anomalies during the fall transmigration (1979–2011) was r = 0.64, p = 0.0004; 95% CI (0.31; 0.82). Regression analysis estimated that mean temperature anomalies during the fall migration in September–December were stochastically stationary pre-1991 and have been rising significantly (p < 0.001) since then. The rate of change was estimated at +0.1351°C/year, SE = 0.0328, 95% CI (+0.0694, +0.2007). The amount of detected water fluctuated significantly interannually (620–800 km2).ConclusionsLater arrival of freezing temperatures in the autumn followed by the earlier spring thaws and more open water delay transmigration and reduce herders’ access to health care. The recently observed delays in arrival to the clinic are likely related to the warming trend and to concomitant hydrologic changes.

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e18314 Background: There is limited real-world information on the utilization of TPO-RAs, eltrombopag (ELT) and romiplostim (ROM), for the treatment of ITP. Methods: The study employed a retrospective, longitudinal cohort design using integrated healthcare claims data from July 2008-June 2015. Adults diagnosed with ITP initiating TPO-RA therapy from Jan 2009-July 2014 were included. Patients not continuously enrolled in benefits for 6-months prior and 12-months post the index date (first TPO-RA claim date) were excluded. Index TPO-RA discontinuation rates, concomitant therapy, restarts, subsequent therapy, and treatment free periods were assessed. Results: Of the 1,067 patients included, 26.5% (283) received ELT and 73.4% (784) ROM. Age (58.8 vs 59.3; P= 0.705) and gender (males: 45.9% vs 46.6%; P= 0.858) were similar between cohorts. Among ELT and ROM patients 35.7% and 27.6% continued therapy (no gap of ≥30 days) for ≥1 year ( P= 0.010). The average duration of continuous therapy (up to gap ≥30 days) was 131 and 108 days, respectively ( P= 0.001). During continuous course of index TPO-RA treatment 52.7% ELT and 47.2% ROM patients received concomitant ITP-related treatment ( P= 0.115). Following discontinuation, 42.9% of ELT patients restarted ELT, 22.0% did not initiate any subsequent ITP treatments, and 35.2% started a new ITP treatment. Among patients who discontinued ROM, 38.4% restarted, 26.9% did not receive any subsequent therapy, and 34.7% initiated a new treatment. Treatment free periods (≥30 days with no ITP treatment) were experienced by 52.7% of ELT patients and 61.6% ROM patients ( P= 0.009). Mean duration of treatment free period was 109 and 137 days ( P< 0.001), respectively. Conclusions: ITP patients receiving ELT had a longer duration of treatment and shorter treatment free periods compared to patients receiving ROM. Further research is needed to compare clinical outcomes (e.g., platelet counts, bleeding symptoms and remissions) among ITP patients receiving ELT and ROM, in the real-world setting.