4^th International Conference on Epidemiology and Public Health October 03-05, 2016 London, UK

Aneeta Minhas is an MS (Ophthalmology) from India, and worked as a private specialist in Mumbai. In 2003, I joined the prestigious Singapore General Hospital in the Health Information Management Systems department as a clinical coder and subsequently as an auditor. I also worked as a hospital internal auditor for preparation of JCI accreditation. In 2009, I joined the Medical board under Clinical Governance to undertake clinical quality and focused reviews as part of the Clinical Review Program team. My work entails reviewing flagged cases to identify adverse clinical events which are highlighted to the departments and solutions for prevention are implemented and monitored by our team. We also conduct RCA (Root Cause Analysis) of critical clinical incidents and follow-up on the recommendations of the QAC committees. I have been leading departmental projects in creating educational kits for the junior doctors teaching, and have been part of improvement projects for patient safety by our team and am also involved in paper writing. In my free time I like to read biographies and fiction. I love gardening and am in the process of creating an indoor succulent garden in my home. I enjoy acrylics, oils and Chinese brush painting.

Background: The objective of this project was to redesign the selection criteria for readmission cases so as to improve pick up rates of adverse events* during the clinical review of inpatient medical records. No similar study has been done in this subject and a new methodology was tried and tested through this project. (*Adverse events (AE) are defined as an unintended injury or complication resulting in an increased length of hospital stay, temporary or permanent disability or death, which is caused by healthcare management rather than by the disease process Level 1 AE’s: these are unpreventable events only for the information of the clinical departments Level 2 AE’s: these are preventable or potentially preventable events that are reported to the Heads of clinical departments to address.) Methods: Selected screening criteria were applied to the readmission cases for review in a series of iterative quality improvement cycles. Further modification was done by using Hospital Inpatient Discharge Summary (HIDS) screening of all the selected cases to further eliminate unnecessary cases for review. A checklist to simplify the screening of cases for review was implemented and a staff satisfaction survey was conducted to see the efficacy of these modifications. Results: It was seen that modifications of the selection criteria increased the total adverse effect pick up rate. Hospital Inpatient Discharge Summary (HIDS) screening was also effective in reducing the number of unnecessary reviews. The checklist for screening cases proved effective as shown by the staff satisfaction survey conducted. It improved knowledge about the review process and selection of cases resulting in better time management. Conclusion: This project was unique as no similar studies have been recorded in literature regarding improving AE pickup rates and significantly decreasing unnecessary reviews. The project resulted in a significant increase in the total AE pickup rate of 94.23% as compared to the baseline of 80%. The level 1 and 2 AE rates also increased to 92.31% and 1.92% from the baseline rates of 75% and 0.2%. There was also noted to be a significant decrease of 80.98% in the man hours required to review the inpatient readmission case-notes. These findings support the fact that an effective screening process for readmission review is beneficial and worth implementing.

Toshiko Sawaguchi has been acting as originally pediatric forensic pathologist and moved to the epidemiology and public health field since 1st April 2015 as the research managing director.

Aim: The aim is to estimate the emergency survival rate after traffic accidents if these rates could analyse the prefecture difference. Materials & methods: As for the totalized Japan, each prefecture in all Japan and 4 prefectures in the Hokuriku area in Japan, the number of traffic accidents, the number of the injured persons, the number of the injured dead persons were extracted from the total statistic book edited by the National Police Agency. The same kinds of data as for cities & towns in Niigata Prefecture were also extracted from the homepage of Niigata Prefecture in 2014,2013 & 2012. Using these data, the emergency survival rate after traffic accidents were calculated using the following formula; The emergency survival rate after traffic accidents = (the number of the injured & dead persons after traffic accidents―the number of the injured persons after traffic accidents)/ the number of the injured & dead persons after traffic accidents) Each rate by each 4 prefecture & by secondary medical area in Niigata was tested using non-parametric one-way ANOVA.SAS Analytic Pro was used for statistical analysis. Results: Significant differences were suggested as the following, between the secondary medical area only using the Cramer-Mises test only as for the number of traffic accidents, the number of dead persons after traffic accidents, the number of injured & dead persons after traffic accidents and the number of injured persons after traffic accidents(CM<1.5).

Shih-Yen Chen is currently an attending physician in the Department of Pediatrics, Chang Gung Children’s Hospital and Chang Gung University, Taoyuan, Taiwan. He received his Doctor of Medicine degree from Taipei Medical College, and Doctor of Philosophy degree from Chang Gung University College of Medicine. He obtained his postdoctoral fellowship training from the Division of Pediatric Gastroenterology and Hepatology, Chang Gung Children’s Hospital. His research interests include pediatric gastrointestinal infection and molecular epidemiology of viral gastroenteritis.

Background. Rotavirus vaccine implementation has changed enteric virus infections in children. objective. To investigate the change in viral acute gastroenteritis (AGE) and associated infections in hospitalized children in a longer time after rotavirus vaccine implementation. design. During the period from January 2006 to December 2015, fecal samples from hospitalized children in Chang Gung Children’s Hospital with AGE were examined for enteric pathogens. Study period was divided into early post-vaccine (2006 Jan.-2010 Dec.) (EPV) and late post-vaccine (2011 Jan. -2015 Dec.) (LPV) periods. setting. A tertiary children’s medical center in northern Taiwan. results. A total of 905 stool samples were collected from hospitalized patients with AGE including 441 in EPV and 464 in LPV. In EPV period, enteric pathogens were identified in 318 (72.1%) including 113 (25.6%) rotavirus, 107 (24.3%) norovirus as major pathogens; In LPV periods, detection ratio of 315 (67.9%) with major infections of 88 (19 %) rotavirus and 107 (23.1%) norovirus. Statistical analysis showed a significantly decreased prevalence of rotavirus infection (P = 0.016) and a significantly increased prevalence of enteric bacteria infections (P < 0.001). Norovirus has outnumbered rotavirus (23.1% vs 19%) as the most common viral pathogen acute gastroenteritis. Rotavirus genotyping demonstrated a significant decrease of G1 (P=0.0002) in LPV compared to that of EPV. Norovirus GII.4 were the most predominant genotype in both periods with the commonest of GII.4 2006 b strain (35 of 59, 59.3%) in EPV and GII.4 2012a Sydney strain (29 of 65, 44.6%) in LPV period. Among vaccinated patients with AGE, norovirus is the most common etiology and there was relatively lower prevalence rotavirus infection in LPV with common genotypes of G1, G2, and G3. conclusions. In Taiwan, under a suboptimal rotavirus vaccination policy, rotavirus infection caused hospitalization AGE is definitely decreased and norovirus has replaced rotavirus as the leading cause for hospitalized children with AGE. Enrichment of rotavirus vaccine coverage, development of norovirus vaccination, and sustained bacterial infections control important for infection containment and hospital care in Taiwan.

Zhou Yi has been graduated from School of Medicine,Shanghai Jiaotong University as clinical doctor, with the specialties including cardiovascular medicine. Later on she worked in the Department of Chronic Disease Prevention and Control, Shanghai Pudong New Area Center for Disease Control and Prevention. She obtained her PhD major in Epidemiology from School of Public Health, Shanghai Fudan University, where she has continued her research.

Few population-based studies have examined the association between metabolic syndrome (MS) and chronic kidney disease (CKD) in China. 10,657 Chinese adults aged 18-95 years were selected from Pudong New Area of Shanghai through a multistage random sampling and interviewed. Demographic and lifestyle characteristics, anthropometry and blood pressure were measured. Biochemical assays included fasting plasma glucose, serum creatinine, lipids, urinary creatinine and albumin. The prevalence of albuminuria [urine albumin-to-creatinine ratio (ACR) ≥ 30 mg/g], decreased kidney function and CKD (either decreased kidney function or albuminuria) among MS and non-MS population were estimated. Based on WHO definition and MDRD( Modification of Diet in Renal Disease) study equation, the overall prevalence of MS and CKD were 18.2% (age standardized 15.7%) and 19.9% (age standardized 15.2%). The prevalence of microalbuminuria, macroalbuminuria, decreased kidney function and CKD in subjects with MS were 22.2%, 3.0%, 3.8% and 26.8%, higher than those without (8.6%,0.5%,1.0% and 9.5%, P < 0.001). Regard of the components of MS, the adjusted odds of BMI ≥ 25.0, dysglycemia, hypertension and dyslipidemia were 1.36(95% confidence interval [CI]: 1.14-1.62), 2.40(95% CI: 1.99-2.89), 1.67(95% CI: 1.38-2.01) and 1.29(95% CI: 1.08-1.54) for albuminuria, while 1.45(95% CI: 1.22-1.72), 2.24(95% CI: 1.86-2.68), 1.67(95% CI: 1.39-2.00) and 1.25(95% CI: 1.05-1.49) for CKD, respectively. The risk of CKD increased with increasing number of MS components. MS was independently associated with the increased prevalence of albuminuria, decreased kidney function and CKD among population in Pudong New Area, Shanghai. Prevention and control of MS should be a high priority in reducing the CKD burden in China.

Mahmoud Magdi is an undergraduate in the Mansoura University, School of Medicine, Mansoura, Egypt. He was born in Fujairah, UAE, from full Egyptian parents, and later moved to the Egypt for higher Education. In 2014, He made the decision to pursue Medicine as a life career and was a member of Mansoura University Safety Society (MUSS). He aspires to seek higher education and health care profession in other continents such as Europe and North America. Because of his love for research, he continues to strive for the needs of international students by leading the Mansoura University Safety Society from 2016. He also plans to continue making research in the future regarding the implementation and improvement of health care

Background: Methicillin-resistant Staphylococcus Aureus(MRSA) is a strain of Staphylococcus Aureus that has developed resistance to beta-lactam antibiotics and thus is considerably dangerous. Aim(s)/Objective(s): To evaluate the current level of knowledge of MRSA among medical students and para medical students given that health workers are vulnerable to catching the disease. Also to raise awareness of the risk factors for MRSA infection and the protective measures individuals and institutions can take. Method: This is a field study carried in the campus of the Faculty of Medicine, Mansoura, Egypt. A stand has been divided into: a pre-survey, an awareness station and a post-survey. Students were asked to participate in the survey and were handed the pre-survey questionnaire. The students were asked to identify their gender, area of study and level of education. The questionnaire addressed basic facts about MRSA and how to prevent it, its route of transmission, risk of morbidity and mortality, treatments available and countries afflicted. The next station was an awareness station where a talk was given to students about MRSA in small groups. Brochures and educational videos were shown to them. Last station was post-survey; which had the same questionnaire as pre-survey. Results: were collected and analysed Results Out of 674 students surveyed, 534 acknowledged the prevention measures needed to prevent MRSA. 620 even knew how to diagnose it roughly by learning more about its complications. Moreover, after the post survey 545 students knew how to effectively attempt treating the MRSA. Conclusion: Involving health care workers through awareness to follow infection control measures to limit developing the spread of MRSA in hospital settings.

Goldberg received his PhD in 1978 from the Johns Hopkins University School of Hygiene and Public Health in Baltimore, MD, where he also completed a post-doctoral fellowship in cardiovascular epidemiology. He is a Professor and Chief of the Division of Epidemiology of Chronic Diseases and Vulnerable Populations at the University of Massachusetts Medical School in Worcester, MA. He has published more than 440 papers on a wide array of topics in clinical epidemiology and clinical research in peer reviewed journals and has sat on several scientific study sections at the National Institutes of Health.

We have been carrying out population-based surveillance of hospitalized events of acute myocardial infarction (AMI) in approximately one half million residents of Central Massachusetts (U.S.) hospitalized with confirmed AMI at all medical centers (n=11-16) in Central Massachusetts on an approximate biennial basis between 1975 and 2011. This includes an examination of multi-decade long trends in the incidence rates, in-hospital and post-discharge death rates, and hospital management practices in approximately 10,500 residents of Central Massachusetts hospitalized with an independently validated first AMI during the years under study. After an initial increase in the incidence rates of initial AMI during the early years of this community-wide investigation, there has been a decline in the incidence rates of AMI during the most recent decade long period under study (2001-2011). There have been consistent declines in the in-hospital case-fatality rates of AMI over time (16.3% in 1975-84; 12.9% in 1986-1999; 8.8 % in 2001-2011) in both crude and multivariable adjusted analyses as well as increases in one year post-discharge survival rates during the years under study. In addition to these encouraging trends, there have been marked increases over time in the hospital prescribing of several effective cardiac medications including angiotensin converting enzyme inhibitors, aspirin, beta blockers, statins, thrombolytic agents, and coronary revascularization procedures (e.g., percutaneous coronary intervention). We will also present data on recent trends in the type of AMI (e.g., ST-segment vs. Non ST-segment elevation) and the impact of type of AMI on the natural history and management of AMI.

Victor Adekanmbi graduated with Bachelors of Medicine and Surgery (MBChB) from the College of Health Sciences, Obafemi Awolowo University, Nigeria in 2005. Following his bachelors, he worked in a number of hospitals, then moved to the UK where he achieved Masters in Public Health (Epidemiology and Biostatistics) from the University of Birmingham in 2010 and subsequently worked in some International Non-Governmental Organisations. He also has a PhD in Health Sciences obtained from the University of Warwick in 2015. Presently he works as a Research Fellow at Warwick Medical School, and works on CLAHRC WM Theme 3, Prevention and Detection of Disease

Objective: To identify determinants of variation in health care utilization for children in communities in Nigeria. Methods: Secondary analysis of the 2013 Nigeria Demographic and Health Survey data (DHS) using univariable and multivariable mixed Poisson regression models. We included the index of maternal deprivation, gender of child, community environmental factor index, and maternal health seeking behavior index, multiple childhood deprivation index and ethnicity diversity index as the independent variables. The outcome variable was under-fives’ hospital attendant rates for acute illness. Results: 31,482 children from 896 communities in Nigeria were included. 1, 936 (6.2%) were taken to the health care facilities for treatment. The final adjusted model revealed that both multiple childhood deprivation (incidence rate ratio [IRR] = 1.24, 95% confidence interval [CI] 1.17 to 1.32) and children living in communities with a high ethnic diversity (IRR = 1.005, 95% CI 1.003 to 1.006) significantly increased the rate of health service use. Maternal health seeking behaviour on the other hand significantly reduced the rate of usage of health care services. Conclusions: There are striking differences in health services utilization for sick children across Nigerian communities. Sociodemographic and cultural factors beyond the scope of health authorities and healthcare delivery systems are important in these variations.

Sara Nabeel Al gahtani. Born in Riyadh, KSA. Graduated from high school 2009. She is now a senior student at Almaarefa university medical college in Riyadh, She intends to specialize in surgical oncology.

It is widely known that cancer is a disease of “old-age”. However available data show that this is not the case for many types of cancers. Incidences of breast and ovarian cancers have varying rates of change with age. Breast cancer data of Arabian-gulf women, show that the incidence rates increase with age and reaches a maximum of 39 years. It then declines linearly with age to about 55 years. The rate of increase and its changes with age are similar to that of many other countries. In the premenopausal phase the relationship between incidence and age could be adequately modeled using a linear model for the logarithmic transformations of age and incidence. Similar observations are made for the ovarian cancer incidences. Data and Methods: We analyze data from the gulf center for cancer registration, which was established in 1998 as a collaborative venture to collect and provide data for cancer incidence of the six Gulf-states; Results: It was found that the rate of change with respect to age in both breast and ovarian cancers in the Arabian Gulf countries is statistically identical. It is shown that the rate of increase in breast and ovarian cancer incidence with respect to age is increasing in the premenopausal ages. However, the burden of the disease with respect to age standardized mortality and “Disability Adjusted Life Years” or DALY, varied considerably among the six gulf countries.

Simon Cavinato has been Graduated from Barts and The London School of Medicine and Dentistry as Batchelor of Medicine and Surgery, and Batchelor of Science in Biomedical Science from the University of Leeds. He then complete foundation training in Princess Alexandra Hospital, Harlow and Queens Hospital, Romford. Presently he has been working at St George’s Hospital in London as Clinical Fellow in Intensive Care.

Creutzfeld-Jakob disease (CJD) is a fatal neurodegenerative disorder caused by the accumulation of prion protein in neural tissue. The most common of these is sporadic CJD (sCJD), with an estimated incidence of 0.4-1.8/million/year. This case series looked at a high incidence of sCJD in the catchment area of Broomfield Hospital, Essex, UK, where 8 patients were diagnosed between 2010 and 2015. This incidence of 3.72/million/year is significantly higher than the UK national average of 1.07/million/year from 1990 to 2014 (p=0.011). The aim of this presentation is to look at the potential causes of this high incidence, which include an iatrogenic cause with a common origin, high diagnostic vigilance, a disease incidence higher than previously considered, or chance occurrence. None of the patients had surgery, making iatrogenic cause unlikely. CJD affects predominantly the elderly population and shows clinical similarity to other neurological conditions, potentially leading to misdiagnosis. Initial changes on MRI were not found on 7 of the 8 patients, though retrospective analysis showed changes visible in 6 of those scans, exhibiting the difficulties in diagnosis. The incidence of sCJD in Britain has been increasing, which is a trend observed in other European countries, considered to be due to increased accuracy in diagnosis and surveillance. We propose that the raised incidence of sCJD in Mid-Essex could reflect a higher true incidence of CJD than is currently reported, as a result of underdiagnosis of the disease.