6^th International Conference on Epidemiology & Public Health October 23-25, 2017 | Holiday Inn , Paris, France

Amir Baigi has 28 years experiences in health surveys, evaluation and expertise in improving the health and wellbeing. Anders Holmen has 30 years experiences in health and hospital care as well as supervising clinical trials by bio statistical methods. Their scientific network extends from Gothenburg University in west to Lund University in south of Sweden.

Statement of the Problem: In Sweden, the government has a platform on overall national goals for public health; to create social conditions for good health on equal terms for the entire population. The province of Halland has the highest life expectancy in Sweden. The recent health surveys in Sweden points to a noticeable better health in the county of Halland compared to Sweden as a whole. From a public health point of view, it is of interest to probe the distribution of the self-rated health among socio-demographic groups to explore if inequality in health exists even in this healthy population. Purpose: The purpose of the study was to analyze the distribution of obesity and psychosocial health in the largest municipality in Halland compared with the average for the province as a whole. Methodology & Theoretical Orientation: A simple random sample of 8,429 individuals was selected from a national survey that covered all individuals in the 18–84-year age group. A postal survey was thereafter conducted (The Statistics Sweden and The Public Health Agency in Sweden). General health Questionnaire (GHQ12) and Body Mass Index (BMI) were taken in the analyses. The statistically significant socio geographical differences in health were presented as maps using GIS-software (ArcMap 10.2). Analysis of the data was related to local key codes where densely populated areas with a higher response rate were assessed as the most statistically relevant to processing. Finding: There were clearly significant differences in health between socio-demographically vulnerable areas and the well-off parts of the municipality. The results were adjusted for age and sex. Conclusion and Significance: The socio-demographic disparities in health seem to exist even in a long-lived population. A better overall health situation is not likely to affect the state considerably. Recommendations for a more effective public health platform have been passed on to the politicians. Statement of the Problem: In Sweden, the government has a platform on overall national goals for public health; to create social conditions for good health on equal terms for the entire population. The province of Halland has the highest life expectancy in Sweden. The recent health surveys in Sweden points to a noticeable better health in the county of Halland compared to Sweden as a whole. From a public health point of view, it is of interest to probe the distribution of the self-rated health among socio-demographic groups to explore if inequality in health exists even in this healthy population. Purpose: The purpose of the study was to analyze the distribution of obesity and psychosocial health in the largest municipality in Halland compared with the average for the province as a whole. Methodology & Theoretical Orientation: A simple random sample of 8,429 individuals was selected from a national survey that covered all individuals in the 18–84-year age group. A postal survey was thereafter conducted (The Statistics Sweden and The Public Health Agency in Sweden). General health Questionnaire (GHQ12) and Body Mass Index (BMI) were taken in the analyses. The statistically significant socio geographical differences in health were presented as maps using GIS-software (ArcMap 10.2). Analysis of the data was related to local key codes where densely populated areas with a higher response rate were assessed as the most statistically relevant to processing. Finding: There were clearly significant differences in health between socio-demographically vulnerable areas and the well-off parts of the municipality. The results were adjusted for age and sex. Conclusion and Significance: The socio-demographic disparities in health seem to exist even in a long-lived population. A better overall health situation is not likely to affect the state considerably. Recommendations for a more effective public health platform have been passed on to the politicians.

Christopher B Stults is a Doctoral Candidate in the Counselling Psychology program at New York University (NYU) under the mentorship of Dr. Perry Halkitis and a Licensed Mental Health Counsellor in independent practice in New York City. His research and clinical interests focus on the mental and physical health of LGBTQ people. More specifically, he has co-authored several publications examining Intimate Partner Violence (IPV) among young gay and bisexual men. He has recently completed a study exploring Consensual Non-Monogamous (CNM) relationships (e.g., open relationships) among gay and bisexual men. He has presented his work at multiple national conferences and has served in various leadership positions at NYU and the American Psychological Association (APA). His clinical training experiences include: Montefiore Medical Center, Harlem Hospital Center, Barnard College Counselling Center, Baruch College Counselling Center, The Maesk Group, and Florida International University Counselling Center. Additionally, he is an Adjunct Instructor at NYU.

Statement of the Problem: The June 2016 mass shooting at Pulse Nightclub in Orlando, Florida was the deadliest terrorist attack in the United States since 9/11 and was an event that shocked LGBTQ people and their allies across the globe. Acts of mass violence that target marginalized groups may have consequences that extend beyond the geographic region immediately affected. Indeed, LGBTQ people may have experienced collective trauma, the psychological effects shared by a group or community after witnessing or experiencing a large-scale traumatic event (e.g. mass shootings). Furthermore, how LGBTQ people interpreted the shooting and the shooter’s motives in particular, may relate to dimensions of collective trauma experienced in the aftermath of the shooting. Purpose: The purpose of this study is to examine how beliefs about the shooter’s motives are related to differences in dimensions of collective trauma. Methodology: Using survey data collected from (n=1,395) LGBTQ-identified respondents from June 15 to September 20, 2016, three distinct multivariate regression models were constructed to predict dimensions of collective trauma (emotional distress, cognitive burden, and fear for safety) from beliefs about the shooter's motives, controlling for relevant sociodemographic and event-specific variables. Findings: Beliefs that the shooter was motivated by anti-LGBTQ bias and racism, were associated with increased emotional distress and fear for safety whereas, beliefs that the shooter was motivated by mental illness and religious extremism were associated with decreased emotional distress and fear for safety. Conclusion & Significance: LGBTQ people varied in their experiences of collective trauma in the aftermath of the 2016 Pulse massacre, based on their beliefs about the shooter’s motives. As such, when working with victims of collective trauma (e.g. 2016 Pulse massacre, 2017 Manchester bombing), it is important for healthcare providers to examine patients’ beliefs about the event, in order to assist in their post-traumatic adjustment.

Bok Nam Seo has his expertise in improvement of healthcare and research. She has built up the model after gaining experience in the planning and implementation of years of research, evaluation, training and clinical trials in Korean Oriental Medicine Institute which promotes evidence-based TM including its interactions with other medicines applied for complementary and alternative medicine.

Background: Complications of the Metabolic Syndrome (MetS) consist of several factors that increase the risk of cardiovascular disease and diabetes. Functional changes in the vascular system are important factors in predicting cardiovascular disease. The hs-CRP (high-sensitive C-reaction protein) index is used as a cardiovascular risk prediction. MetS has been reported to be closely related to vascular damage. In this study, we investigated the association between MetS risk factors and blood circulation index in prolonged fatigue. Method/Design: Total of 197 participants with prolong fatigue were participated in this study, each individual was examined for physical measurements and blood tests. We identified metabolic syndrome by using the International Diabetes Federation (IDF, 2005). Eleven participants were deemed to have metabolic syndrome when 3 or more of the following criteria were satisfied. The groups were classified into 3 groups (non-MetS group, pre- MetS group, MetS group) according to the number of MetS of risk factors. This study was followed up at 6-month intervals. Result: Relationship between hs-CRP and the risk factors of the metabolic syndrome were significantly positively correlated with waist circumference and glucose by adjusting sex and age (p<0.05). Repeated measures ANOVA does provide results that ECO, ECRI, CMBP, BP and PP in pulse wave showed significant in the comparison of the groups among MetS (p<0.05). Conclusion: It has shown these findings suggest that blood circulation index, such as hs CRP, ECO, ECRI, CMBP, BP and PP could be a useful method for predicting MetS. MetS patients had a significantly increased risk of diabetes during follow-up. It is expected that the measurement of the pulse wave will become an important part of clinical application.

David Salas-Vargas has completed his Ph.D. at the age of 35 years at the Autonomous University of Baja California (UABC), Mexico. He was the Dean of the School of Health Sciences for almost eight years. He is currently the Coordinator of Postgraduate and Research Studies at the School of Health Sciences at UABC and lecture Epidemiology to undergraduate and postgraduate students.

Objective: To assess the effectiveness of the Group of Mutual Support (GMS), two centers of health ISESALUD of Ensenada (Jalisco and Loma Linda) on the medical supervision of patients diagnosed with diabetes, hypertension and obesity, by the determination of the mean and the variance of haemoglobin glycosylated, BMI, capillary glycaemia in fasting measurement of waist, and systolic and diastolic. Material and Methods: Observational, longitudinal, analytical, cohort retrospective study. The sample is not probabilistic, carried out in the period January - December 2011. Information from clinical records and record of mutual support group format was sought. With a total of 89 patients with diabetes, hypertension and obesity, of which and 27 are integrated into the GAM and 62 only attend the clinical consultation. It was determined the average and variance and analysed differences in haemoglobin, glycosylated, index, capillary fasting glycaemia of BMI (BMI), the circumference of waist.

Hye Yeon Koo has her expertise in chronic disease care and health promotion of cancer survivors. She has been taking responsibility for long-term cancer survivorship care at the cancer center in Seoul National University Bundang Hospital. Her recent research in long-term survivors of breast cancer shows her passion in behavioural intervention for cancer patients.

Background: Recent studies have suggested that smokers with new cancer diagnosis are more likely to quit smoking compared with those without cancer. However, up to 70% of cancer survivors continue to smoke. Smoking has a significant impact on mortality and morbidity of cancer patients. Aim: This study aimed to describe prevalence and predictors of sustained smoking after cancer diagnosis among smokers. Patients & Methods: 15,201 men who were first diagnosed with cancer between January 1, 2004 and December 31, 2011 were included in the study. Data were obtained from The Korean National Health Insurance database. Changes in smoking status after diagnosis were investigated for patients with smoking related cancers and those with non-smoking related cancers. The association between sustained smoking and demographic, socioeconomic, and clinical variables were examined. Results: Of the 4,680 smokers newly diagnosed with cancer, 2,265 (48%) quitted smoking and 279 (6%) reduced the amount of smoking. Sustained smoking rate was higher among patients with non-smoking related cancer (54%) than among patients with smoking related cancer (41%). In univariate analyses, age at cancer diagnosis, pre-diagnosis smoking amount, socioeconomic status, cancer type, and fasting serum glucose level were associated with sustained smoking (all p-values<0.05). Multivariate logistic regression analysis showed that patients who were younger (OR =1.36, 95% CI: 1.20-1.54, p <0.001); smoking >20 cigarettes per day (OR =1.23, 95% CI: 1.08-1.40, p=0.001); in low socioeconomic status (OR =1.29, 95% CI: 1.14-1.45, p<0.001); diagnosed with non-smoking related cancer (OR =1.67, 95% CI: 1.42-1.95, p<0.001); and had high blood glucose level (OR =1.25, 95% CI: 1.05-1.48, p=0.012) were more likely to continue smoking after cancer diagnosis. Conclusion: Almost half of male smokers continue to smoke after diagnosis of cancer. Patient age, amount of smoking, socioeconomic status, and type of cancer might need to be considered when implementing the intervention for smoking cessation.

Mi Hee Cho graduated from School of Material Science & Engineering, Purdue University, USA with PhD degree. Later, she started studying at School of Medicine, Pusan National University, Republic of Korea and graduated as Medical Doctor. After graduation from the medical school, she completed her residency with the specialty of Family Medicine and presently has been working as a Fellow at Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.

Adherence to antihypertensive medication is critical factor to control blood pressure and prevent complications in the patients with hypertension. Medication management requires cognitive ability such as attention and working memory and cognitive impairment can negatively affect medication adherence. In this study, we investigated the association of cognitive function and antihypertensive medication adherence among the elderly hypertensive patients in Korea. This retrospective cohort study was conducted by using the Korean National Health Insurance Service-National Sample Cohort Data of the Elderly. Study population included the elderly who took the National Life-Transition Health Examination in 2007 and 2008. Cognitive function was screened by Pre-screening Korean Dementia Screening Questionnaire (KDSQ-P). A cut off score of 4 or more are subjective to further dementia screening test. Medication adherence of antihypertensive medications was calculated based on prescription data and the cut-off values for appropriate adherence was 80%. Multivariate logistic regression analysis was conducted to analyse association between cognitive function and medication compliance, adjusting for sex, income level, residential area, comorbidities, and level of depression. A total of 20,303 elderly patients with hypertension were included in the study. The prevalence of poor medication adherence of antihypertensive medications among the elderly patients was 16.5%. Lower cognitive function was associated with poor medication adherence (Adjusted odds ratio 0.980, 95% CI 0.961-0.999 per score). Patients with cognitive impairment are a vulnerable group to poor medication adherence. Clinicians involved in the geriatric care should evaluate the cognitive function of the elderly thoroughly and make more efforts to educate patients with cognitive impairment and their caregivers about the significant risk associated with inappropriate adherence. Further studies investigating the reasons for non-adherence are needed in order to establish effective interventions for improving medication adherence.

Elisabetta Tanzi is a professor of Hygiene at the University of Milan, Italy. She has a consolidated research activity focused mainly on the study of the biological, epidemiological and preventive aspects of infectious diseases relevant to Public Health. She is the coordinator of the Research Center "EpiSoMI, Molecular Epidemiology and Surveillance of Infections" of the University of Milan. She has published over 200 papers, more than 110 of which in national and international indexed journals, and is a member of editorial board in scientific journals.

Statement of the Problem: A large measles outbreak has been on-going in Milan and surrounding areas. Rapid and active surveillance was set up by the Subnational Reference Laboratories (SRL) Milan, established as part of the measles and rubella surveillance network MoRoNet in March 2017. The task of the SRL is the confirmation of measles cases (MV) and genotypic characterization of the circulating MV strains. This study reports the virological surveillance data of the MV outbreak from March to September 2017. Methodology: Serum, urine and oropharyngeal swabs collected during the acute phase of the disease (4-10 days after the onset of rash) were analyzed for serological (MV IgM on serum) and molecular (RT-PCR on RNA from urine and oropharyngeal swabs) confirmation of MV cases. The genotype of MV strains was identified by sequencing the highly variable region of nucleoprotein (N) gene (N-450). Findings: From March to September 2017, 386 suspected cases of measles were investigated and there were 327 (84.7%) laboratory-confirmed cases (median age: 30 years; range: 2 months–77 years). Overall, 60% of the confirmed cases were individuals aged 15–39 years and 6% were ≤ 1 year of age; 88% were not vaccinated. The genotype of MV strains was identified in 294/327 (89.9%) confirmed cases. The most common genotype was D8 (Osaka lineage; 85%, 250/294 cases), while genotype B3 (Dublin variant) was identified in 44/294 (15%) cases. Conclusion & Significance: Eliminating measles and rubella is a core goal of WHO European Region Member States. Since the beginning of 2017 and up to 19 September, the Italian Ministry of Health has reported 4,532 cases of measles and three deaths. Timely measles surveillance is critical to disease control. Moreover, a high-quality and sensitive virological surveillance is a tool for monitoring the outbreak and achieving the elimination of the disease.

Xianfeng Zhou has her expertise in disease surveillance and passion in chronic disease prevention and control. She and her project team built a cohort based on the community and contained ten thousand people in Pudong New Area. Since 2013, she and her project team carried out a follow-up survey every three year to observe the incidence and prevalence of chronic diseases such as hypertension, diabetes, chronic obstructive pulmonary disease and the dynamic change trend of risk factors related to chronic diseases. At the same time, they built Biobank. She is focused on the study of internal and external environmental exposure factors of chronic disease, further provide data support for chronic disease prevention and control in Pudong New Area.

Introduction: The latest China Guideline for Type 2 diabetes mellitus (T2DM) in 2013 didn’t recommend HbA1c for diagnosis of diabetes and pre-diabetes. It requires considerable research to evaluate HbA1c diagnostic threshold for diagnosis of hyperglycaemia. Materials & Methods: We included 7909 subjects aged ≥15 without known diabetes from the baseline of Pudong community cohort in 2013. Participants took oral glucose tolerance test (OGTT) and HbA1c assay. Receiver operating characteristic curve determined the HbA1c threshold in the diagnosis of hyperglycaemia. Results: The optimal HbA1C threshold for diagnosing newly diagnosed diabetes (NDD) and pre-diabetes in this population was 6.0% (AUC=0.798, 95%CI: 0.779-0.818, P<0.001) and 5.6% (AUC=0.655, 95%CI: 0.638-0.671, P=0.008). The sensitivity (pre-diabetes: 51.78%, NDD: 63.60%) and specificity (pre-diabetes: 72.63%, NDD: 84.86%) of pre-diabetes was lower than NDD. The AUC of HbA1c for diagnosing NDD and pre-diabetes in subjects <60 years was larger than older (≥60 years) subjects (NDD: P=0.002, pre-diabetes: P=0.02). There were 13.81% and 14.34% of participants would be newly detected as NDD and pre-diabetes via HbA1c criteria; meanwhile almost 3.20% and 15.52% diagnosed as NDD and pre-diabetes by OGTT criteria would be missed diagnosis. Conclusions: The optimal HbA1c thresholds for NDD and pre-diabetes were lower than ADA criteria. HbA1c and OGTT are discordant for diagnosis of hyperglycaemia. It is necessary to carefully consider whether choose HbA1c as a diagnostic criterion or combine two diagnostic standards. Age-specific diagnostic thresholds should be considered when HbA1c was recommended as diagnostic standard.