Day 3 :
Keynote Forum
Gary Stephen Young
Cooper Medical School of Rowan University, USA
Keynote: Socioeconomic deprivation in the causal pathway of disease
Biography:
Young graduated from the Johns Hopkins Bloomberg School of Public Health as Master and Doctor of Public Health, with specialization in Epidemiology and Social Medicine. He also took a Master’s degree in Sociology from Pennsylvania State University where he studied demography, biostatistics and quantitative research methods as a doctoral candidate. His research focuses on the distribution of air toxic exposure, neighborhood health effects, and vulnerability to chronic disease and health care disparities. He holds positions as Executive Vice President for Health Policy at Cooper University Health Care and Assistant Professor in the Department of Medicine of Cooper Medical School of Rowan University, where he is Director of the Center for Injury Epidemiology and Social Medicine.
Abstract:
There is no widely accepted conceptual framework for incorporating social causation and the role of social factors in the biomedical physiological model that dominates contemporary epidemiology. Social epidemiology has contributed significant insights about the distribution of disease and poses fundamental questions about disease pathology. The social determinate of health literature emphasizes inequality across populations, but typically uses status measures (SES, SEP) rather than socioeconomic deprivation (SED) to account for variability in health outcomes. This paper views population vulnerability as the interaction of differential exposure and differential susceptibility related to SED. This paper reviews the sociology of SED and explores plausible mechanisms of the disease process related to SED. Two indices of SED (Townsend Index, Neighborhood Concentrated Disadvantage) are then used in three demonstrations of SED-related vulnerability: (a) differential exposure to hazardous air pollution among U.S census tracts (1999-2005); (b) differential susceptibility to cardiorespiratory hospitalization among the 566 towns in New Jersey (2000-2005) ; and (c) differential vulnerability to premature mortality among U.S counties (1999-2008). Findings include support for construct and convergent validity of SED measures, and statistically significant effects (beta coefficients) for SED after adjustment for population size and density: (a) greater environmental respiratory hazard exposure (.17) among U.S. census tracts; (b) higher respiratory (.89) and cardiovascular (1.9) hospitalization among NJ adults 25-64 years; and (c) increased premature all cause mortality (.44) among adults aged 35-64 in U.S counties. This paper demonstrates how sociological models of SED can be incorporated into epidemiology and advances understanding of social causation in the disease process.
Keynote Forum
Roberto Antonio Flores
National University of Santiago del Estero, Argentina
Keynote: Impact of the association of some of the cardiovascular risk factors in patients with hypertension outpatient clinic
Biography:
Roberto Antonio Flores has been Graduated from National University of Tucuman, Argentina as Medical Doctor, with the specialties including Internal Medicine, Social and Community Medicine and Diploma in Cardiology from the National University of Tucuman and Medical Clinic National Academy of Medicine Argentina. Later on he obtained his post-graduation from National University of Cuyo with subjects Pharmacology & Biology and then started working at The Nurses School, Faculty of Humanities, Social Sciences and Health, National University of Santiago del Estero, Argentina where he has continued his research. Presently he has been working at the at the Regional Hospital Dr. Ramon Carrillo, Santiago del Estero City. He has got eminent memberships in many Scientific Societies including Internal Medicine and Cardiology at the Society of Santiago del Estero, Argentina, Membership of Argentina Federation of Cardiology, Membership of Hypertension Committee of Argentina Federation of Cardiology, Membership of Inter American Society of Cardiology and Board of Epidemiology of Inter American Society of Cardiology.
Abstract:
Purpose: The aim of this study was to obtain information related to the patients attending the outpatient clinic consultation, Medical Clinic with high blood pressure, and see how the presence of any risk factors for cardiovascular disease impacts the tension figures these hypertensive patients. Objectives: General: Perform the control and monitoring of the hypertensive population and investigate the presence of some risk factors for cardiovascular disease. Specific: +) Describe the hypertensive population that goes to the consultation. +) Demonstrate the presence of some risk factors for cardiovascular disease such as smoking and physical inactivity, impact on the blood pressure in hypertensive patients said. Methods: This is a quantitative, descriptive and transversal work, which began in October of 2015 ending in December 2015, registering the blood pressure and questioned about physical inactivity and smoking, in Office External Hospital. The variables studied were age, sex, sedentary lifestyle, smoking. Result: The total number of consultations were 60. 180 controls blood pressure were recorded, the first control was discarded and the last two controls were averaged and were questioned about smoking and physical activity. The blood pressure were normal in 26 patients (44% of the sample), 34 patients registered high pressure values (56.66% of the sample). All patients were medicated with a drug 15, and 45 with two drugs. According to age: 20-29: 05, from 30-39: 10, from 40-49: 12, from 50-59: 14, 60- 69:16, from 70-79: 02, of 80-89 1, with a total of 60 hypertensive, all medicated. According to sex: Men: 25, is 41.66% of the total population. Women: 35, is 58.33% of the population. Sedentary amount: 34, representing 56.66% of the total sample. Number of smokers: 33, representing 55% of the total sample. Conclusions: Hypertensive patients with drug treatment who do not perform physical activity and smoking, elevated blood pressure values recorded, despite pharmacological intervention. In patients with drug treatment, who are physically active and not smoking the blood pressure they were normal.
- Epidemiology
Surveillance
Disease Outbreak
Biostatistics
Environmental Health
Chair
Gary Stephen Young
Cooper Medical School of Rowan University, USA
Co-Chair
Roberto Antonio Flores
National University of Santiago del Estero, Argentina
Session Introduction
Rajlaxmi Basu
Medical College of Kolkata, India
Title: Combating thalassemia by a genetic tool: Prenatal diagnosis from chorionic villi sample
Biography:
Rajlaxmi Basu is a PhD student, working at Institute of Hematology and Transfusion Medicine and a registered Fellow at University of Calcutta. She has exposure in occupational toxicology and occupational health and has attained many international conferences past days with utmost fervor and many more in National and International level. She has published 6 international articles in premium peer reviewed journals and 3 are in pipe lines and a book chapter also been published. She is also interested to explore in writing and attach to an editorial board of a journal.
Abstract:
Congenital and hereditary genetic diseases are becoming a significant health burden in India, and hence there is a need for adequate and effective genetic testing and counseling services. In India,.
As there is no substantive cure for thalassemia, the financial burden of treatment and the mental trauma to the affected and their families are very severe, subcontinent. Prevention of the birth of new thalassemic babies is, therefore, important to control the occurrence of this disease. Prevention can be done by increasing the awareness and carrier testing at a mass level. Unfortunately, lack of awareness and an indifferent attitude towards thalassemia is very common among people of lower socio-economic group with grave consequences.
Though there is a definite need for carrier screening in our country, it is hard to draw a consensus regarding the time of screening. Due to lack of education and public awareness about the disease, even being a carrier status often becomes a stigma. Various options for preventing the spread of thalassemia are (i) screening of school going children (ii) premarital screening (iii) extended family screening for carriers (iv) routine antenatal screening in early pregnancy between 8-12 weeks. The first four options are logistically extremely difficult in a country like India with a very large population. The most feasible option is to test the mother antenatally (in early pregnancy) preferably in the first trimester. The parents are usually cooperative and would usually agree to get any tests done for the well-being of their child. Presently in the state of West Bengal (India) prenatal genetic screening and counseling has been given priority by the Government to eradicate thalassemia. In 2010 the West Bengal government started a program named “State Thalassemia Control Project( STCP)” with the aim of creating awareness about thalassemia and the detection of thalassemic patients as well as carriers
Stephanie Bispo
University of Southampton, UK
Title: Women’s employment and child nutritional status– the case of India
Biography:
Stephanie Bispo is doing a PhD at the University of Southampton in Social Statistics and Demography. She was graduated in Nutrition in 2010 and then she joined the Urban Health Observatory at the School of Medicine at the Federal University of Minas Gerais, Brazil in 2010, where she worked as a research assistant until 2014. She completed her Master in Child and Adolescent Health at the same University in 2013. She has being a Consultant for the WHO in few projects since 2014.
Abstract:
Over the last few decades, India started to experience great economic growth. However, levels of child under nutrition did not decrease, and are still among the highest in the world. Economic growth normally comes accompanied of increased employment opportunities, especially for women who have children. Previous studies suggest that female employment is linked to better child health and nutrition, but this association is not fully understood, especially within the context of economic growth, nutritional transition and considering cultural constraints. This study aims to examine the association between a range of aspects of female employment and child nutritional status. Data was obtained from the National Family Health Survey (NFHS) from 1998 and 2005. Children were classified as stunted or wasted, according to the WHO Growth Curves. Multilevel logistic regression was performed using STATA 13. From 30% of mothers employed in both years, more than half were classified with some form of malnutrition, with significant differences from mothers who are not working for both years. When controlled by sociodemographic characteristics, being employed or not was no longer associated with child nutritional status.The only characteristics of the mother, which remained in the model where maternal education and mother’s BMI. Differences according to regions were identified when considering the percentage of employed women and women empowerment in each place. This study suggests that working mothers can be an important target for policies, and improving maternity leave and gender inequality can have an impact on nutrition for future generations in India and other emerging countries.
Biography:
Bishop worked as an Occupational Therapist for 5 years, during which she developed interests in public health and policy research. She studied her MSc in Professional Health and Social Care whilst working in the NHS, progressing her interests towards health determinants and epidemiology. She left the NHS to study a second MSc in Epidemiology and Biostatistics at the University of Leeds, during which was introduced to the Born in Bradford Project. On graduating she was awarded a scholarship to study her PhD with Born in Bradford. Her special interests are pathways through care for children with complex healthcare needs.
Abstract:
Introduction:
Bradford has high rates of infant mortality for children of Pakistani origin, with congenital anomalies (CA) being the most common cause of death and disability in this group. The CA rate in Bradford is higher than the national average before age of 1 at 399 per 10,000 live births1. We linked children with CA to General Practice (GP) data, allowing prospectively collected medical information to provide promising new insights into CA research including risk factors for CA and more complete case ascertainment.
Methods:
Of 11474 babies with questionnaire data available, children with one or more CA (n=1039) were linked to their mothers GP data and compared to those without CA (n=10435). Diagnoses were classified using ICD-10 and validated by clinicians. Data for case ascertainment were compared to national CA registries. We calculated univariate and multivariate risk ratios (RRs) with 95% confidence intervals for various maternal risk factors.
Findings:
The prevalence of CA was consistent to national registries for early diagnoses, but age to diagnoses was an important factor in demonstrating increased prevalence after age 1. We found the rates slightly higher but comparable to previous rates at 461 per 10,000 live births. Only 46% of diagnoses were made before age 1, increasing significantly to 902 per 10,000 live births up to age 8. Consanguinity was found to be a risk factor for anomalies in Pakistani mothers (multivariate RR 2.2, 95% CI 1.54-3.03), and maternal age >34 years for White British mothers (multivariate RR 1.72, 95% CI 1.02-2.92).
Lin Mu
Yale School of Medicine, USA
Title: Visits to emergency department for firearm injuries in the U.S
Biography:
Lin Mu graduated summa cum laude from Denison University with a BS in Biology and a BA in economics. Later, he conducted research for three years in the Division of General Medicine and the Harvard Catalyst Clinical Research Center at Beth Israel Deaconess Medical Center. Currently, he is completing an MD degree while continuing research at Yale School of Medicine. Lin has led several clinical and population research projects, published on topics related to chronic disease and epidemiology, and been frequently invited to present at national medical and public health conferences.
Abstract:
Background: Firearm injury leads to significant morbidity and mortality with large demographic and geographic differences. This study examines the prevalence and characteristics of emergency department (ED) visits due to firearm injuries in the United States.
Methods: Data were obtained from the National Hospital Ambulatory Medical Care Survey (2003-2012), a nationally representative study of visits to the hospital EDs conducted annually by the Centers for Disease Control and Prevention. Available information included visit reason, injury cause, and patient characteristics. We identified visits related to firearm injuries with the International Classification of Diseases, 9th Revision, Clinical Modification codes and studied the weighted prevalence, characteristics, and odds ratios of firearm-injury visits.
Results: Approximately 92 thousand ED visits occurred annually that were caused by firearm injuries, a weighted prevalence of 0.075% (95% confidence interval [CI]: 0.063%-0.090%), including 40.6% (33.3%-48.4%) intentional injuries and 31.1% (24.5%-38.7%) unintentional injuries. Among these visits, 85.9% (80.3%-90.1%) were from men (odds ratio [OR]: 7.31, 95% CI: 4.89-10.95, for ED visits due to firearm injuries versus not), 44.8% (38.0%-51.8%) from those aged 15-24 (OR: 4.76, 2.87-7.90, compared to those aged 45-64), 37.4% (30.7%-44.7%) aged 25-44 (OR: 2.22, 1.30-3.79), 41.4% (33.1%-50.2%) non-Hispanic blacks (OR: 2.88, 2.01-4.12, compared to non-Hispanic whites), 47.3% (36.4%-58.5%) from the South (OR: 2.50, 1.44-4.33, compared to the Northeast), and 88.2% (75.1%-94.8%) from metropolitan areas (OR: 1.43, 0.70-2.91).
Conclusions: Over 90 thousand ED visits occur annually due to firearm injuries in the U.S. with men, people aged 15-44, non-Hispanic blacks, and those from the South at higher risks.
Sabrina Naz
Western Sydney University, Australia
Title: Household air pollution and under-five mortality in South Asia
Biography:
Sabrina has been studying PhD in Epidemiology at the Centre of Health Research, School of Medicine, Western Sydney University, Penrith, NSW 2571, Australia. She has completed her Masters degree in Biostatistics. This study was part of her thesis for a doctoral disseration. The results from this study for Bangladesh has been published in International Journal of Environment Research and Public Health.
Abstract:
Household air pollution (HAP) - predominantly from cooking fuel is a major public health hazard and one of the leading causes of respiratory illness and deaths among children under-five years in South Asia. The association between HAP from cooking fuel and under-five mortality was examined using Demographic and Health Survey datasets for Bangladesh (2004-2011), India (1992-2006), Pakistan (1990-2013) and Nepal (2001-2011), and the extent to which the association differed by environmental and behavioral factors affecting the level of exposure. A total of 166,382 living children under-five from India, 18,308 from Bangladesh, 16,766 from Nepal and 11,507 from Pakistan were used for this study. Multi-level logistic regression models were used for analyses and the result showed strong association for Nepal (OR=1.99, 95%CI=1.25-3.18, P=0.004), followed by India (OR=1.30, 95%CI=1.18-1.43, P<0.001), Bangladesh (OR=1.14, 95%CI=0.83-1.55, P=0.422) and Pakistan (OR=1.13, 95%CI=0.83-1.53, P=0.433). Use of cooking fuel in the household is associated with increased risk of mortality in children aged under-five years. Improved infrastructure, household design and behavioural interventions can help reduce this pollution from cooking fuel resulting in further declines in under-five mortality in South Asian countries.
Biography:
Ngatho S Mugo is an Australian South Sudanese.Currently enrolled as a higher degree research student, PhD (Medicine), in the School of Public Health, University of Sydney. Her research interest is to identifying the determines of maternal, neonate and child health in order to reduce maternal and child mortality in South Sudan
Abstract:
Background: In South Sudan, home deliveries attended by un-skilled birth attendants put the mother and her newborn at increased risk of perinatal morbidity and mortality. This study aimed to identify risk factors associated with home delivery by unskilled birth attendants or unassisted delivery. Methods: We examined data for 2,767 (weighted total) women aged 15-49 years who delivered at home two years prior to South Sudan Household Health Survey 2010. Multinomial logistic regression analyses were used to identify risk factors for home delivery by unskilled birth attendants. Results: The prevalence of unassisted home delivery, un-skilled birth attendants and skilled birth attendants (SBAs) was 19% [95% confidence interval (CI): (17.0, 20.5)], 45% [95% CI: (42.4, 47.0)] and 36% [95% CI: (34.2, 38.6)] respectively. After adjusting for potential confounding factors, the following were associated with an increased odds for unassisted deliveries, or by unskilled birth attendants: mothers with no schooling, mothers who did not attend antenatal care (ANC) during pregnancy, mother who had lower quality of ANC services, mothers from poor households, and mothers who had no prior knowledge about obstetric danger signs. Conclusions: This study found that non-utilization of maternal health care services, such as ANC, was significantly associated with unattended home birth or home birth attended by un-skilled health providers. To increase uptake of SBAs at home delivery will require easier access to ANC services, health promotion of the importance and benefits of the use of SBAs for delivery, targeting both mothers and their families, and training and deployment of more skilled birth attendants across the country.
Udom Pongpila
Ubonratchathani Public Health Office,Thailand
Title: The investigation of patients with Meningococcal Meningitis in prisons at Ubonratchathani from August 31st– 10th September 2015
Biography:
Udom Pongpila has been Graduated from Rajchaput Ubonratchathani University of Thailand, Bachelor of science (Public Health), with the specialties including Internal Medicine, Social and Community Medicine and Diploma in Epidemiology from the University of Khon Kaen. Later on he obtained his post-graduation from National University of Thailand with subjects Epidemiology and then started working at The Ubonratchathani health office where he has continued his research. Presently he has been working at the Ubonratcthathani City and then started working at The Ubonratchathani health office where he has continued his research. Presently he has been working at the Ubonratcthathani City.
Abstract:
On August 31st 2015 at 8:30 am.Ubonratchathani Public Health Office was informed by the authorities of Epidemiology & Social Medicine in Sanpasitthiprasong Hospital, Thailand that a male patient aged 18 years sick with a fever, sore throat, body aches, available bleeding, diarrhea since 3 days. A staff nurse, nursing Prison Province had sent to receive further treatment. Sanpasitthiprasong Hospital. The study aims to understand the epidemiological aspects of meningococcal meningitis, finding the active cases along with the measures for the control of disease. Data were collected from the registeries of medical records. The results of this investigation is in contact with the patient in prison, as many people feel they should be monitored closely for a period of two times the incubation period and should increase awareness for the disease in the area. Investigation by team to the area to control the concentration has controled the disease effectively there by no patients increased.
Biography:
Since joining Estate and Urban Health Unit of Ministry of Health, in 2013, Subaskaran has been involved in studies related to child nutrition, safety of estate children and health related habits of estate population. Before joining the Estate and Urban Health Unit, Subaskaran worked as a medical officer under various units under Public Health Services of Ministry of Health, Sri Lanka and carried out researches related to food safety.
Abstract:
World Health Organization (WHO) identified parenting intervention as the first strategy to improve adolescent health. The objectives of the study were to develop and validate a tool to describe parenting in selected dimensions, to describe parenting and its associated factors among parents of 13 to 15 years old schooling adolescents and to assess the effectiveness of a parenting intervention. The study comprised of three components. Component one developed and validated a self administered tool to describe the patterns of parenting- Parenting Patterns Questionnaire (PPQ) by, item selection, expert consensus and item analysis. In the component 2, a descriptive cross sectional study was carried out among 1863 schooling adolescents, in 97 clusters, by multi stage cluster random sampling probability proportionate to a student population in different types of school and age group. In the third component, a Parenting Education Package was designed and a randomised control trial was conducted to assess the effectiveness of intervention with a sample of 73 parents each group. The data analysis was done using SPSS 15. The PPQ is a reliable and valid tool to assess parenting in selected dimensions (connection, control and respect) in Jaffna district. According to PPQ, parenting was good among 23.1% of parents. Factors such as age and sex of the child, educational level and occupation of parents, substance use of fathers and domestic violence were associated with quality of parenting. Improvement was achieved in parenting by intervention in 3 month period.
Patrick Timpel
Technische Universitaet Dresden, Germany
Title: Identifying patient needs in chronic care to formulate requirements for individualised chronic care management
Biography:
Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited practical research is needed to tailor chronic care to individual needs of patients.
A mixed method study was applied. A survey (n = 92) of experts in chronic care was conducted to analyse chronic care programs focusing on successful, unsuccessful and missing components. An expert workshop (n = 26) was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus (T2DM) and comorbidities. This list was validated and ranked using a multilingual online survey (n = 642).
The study results demonstrate that patients’ unmet needs are mostly part of complex situations and competing demands which are not limited to medical conditions. The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs.
The results suggest that future care models should focus on individual patient needs and promote their active involvement. The results of the study are translated into practical recommendations to be used for systematic implementation.
Abstract:
Patrick Timpel, MHS, Dipl. Soc. Pedag., (male) has graduated in Social Work (Diploma) and Health Sciences (Master of Science). As a research assistant and post-graduate he presently works in the research team Prevention and Care of Diabetes at the Technische Universität Dresden. He has scientific expertise in healthcare research and patient pathways and puts special focus on active and healthy aging as well as on individualised chronic care management.
Ruchira Pangtey
Maulana Azad Medical College, India
Title: Anthropometric and behavioral risk factors for chronic non communicable diseases: An urban community based survey in Delhi, India
Biography:
Ruchira Pangtey has completed her MBBS and internship from G.S.V.M. Medical College, C.S.J.M. University, Kanpur, Uttar Pradesh. Currently, she is persuing her Post Graduate degree in Community Medicine and Public Health from one of the reputed college of India, Maulana Azad Medical College, University of Delhi. She has participated in conference (international and national) and CMEs. She has presented poster in international conference and national conference. She is doing her thesis on “Prevalence of risk factors for chronic non communicable diseases”.
Abstract:
The burden of non-communicable diseases (NCDs) is increasing worldwide largely due to prevalence of various risk factors, which can be controlled. Monitoring of these risk factors for NCDs over a period of time would be useful to make an indirect assessment of the actual disease burden. A cross-sectional survey was done among adults aged 25-65 years, to study the prevalence of anthropometric and behavioral risk factors of NCDs. Information was collected on the socio demographical factors, tobacco use, alcohol intake, diet, salt consumption, and physical activity, using a predesigned and pretested interview schedule. Anthropometric measurements were taken. A study found that 26% were consuming alcohol and 17% were smoking. A sedentary lifestyle was present among 19% of the men. Consumption of fruits and vegetables atleast 3 times a week was only 12%. Majority (77.5%) had a raised waist circumference, and more than two-thirds were either overweight or obese. More males were found to be overweight in comparison to females, but in contrast, obesity and raised waist circumference were more common in females. Tobacco use was more common in lower class, whereas obesity was commoner in the upper socio-economic class. Most of the subjects were not aware of the risk factors leading to NCDs. Screening and IEC activities need to be strengthened and hence that diagnosis and preventive measures can be implemented at an early stage of life.
Asma Baazaoui
High institute of Management,Tunisia
Title: Prescription Habits And Perception Of Medical Ethics
Biography:
Biography
Asma Baazaoui is a PhD student at Institut Supérieur de Gestion (ISG) in Tunisia
Abstract:
This research paper presents an assessment of the factors that affect doctor prescribing practices, and shows if the institutional environment influences the perception of ethic regarding general practitioners.
We employed a qualitative inductive approach, using semistructured interviews in order to explore the prescribing behavior of doctors and to investigate if the institutional environment influence the ethical perception of physicians.
The findings of the paper will help the pharmaceutical industry actors to establish more efficient strategies to promote their drugs. The results also help to give clear insights to government in order to improve controlling interactions between healthcare stakeholders.