4^th World Congress on Public Health, Epidemiology & Nutrition May 24-25, 2018 Osaka, Japan

Biography:

Lynn Tepper's research focuses on the behavioral aspects of health promotion and disease prevention, with emphasis on anxiety-related medical and dental interventions, tobacco use, the application of theoretical models of health behaviors, and healthy aging. With more than 30 professional papers, book chapters, and textbooks, important products of her research have been the development of multidisciplinary health behavior assessment instruments, in both English and Spanish, for people with behavioral concerns related to the maintenance of health and the prevention of disease, as well as the testing of interventional protocols, which have been proven successful with older patients. Dr. Tepper is the primary investigator for three NIH-funded projects, and two U.S. Department of Education grants. In addition to her Columbia responsibilities, she officiates on community board committees related to long term care and the aging population.

Abstract:

Background: Mental health is essential to overall health, and must be recognized and treated at all ages, including later life.  Older people are currently the fastest growing age group, yet have the most widely under-recognized mental health conditions which result in either lack of treatment or under-treatment.  It is estimated that 20% of people age 55 years or older experience some type of mental health concern.  Most commonly experienced conditions include anxiety, cognitive impairment, and mood disorders.  Mental health issues are often implicated as a factor in cases of suicide, especially men over the age of 80 (45 per 100,000, compared to the overall rate of 11 per 100,000 for all ages).

Methods:  Data on the mental health of older adults are collected through the United States Center for Disease Control, through random, digit-dialed telephone surveys, of non-institutionalized Americans aged 50 years or older, using the Behavioral Risk Factor Surveillance System.  This questionnaire consists of core questions asked to all subjects, as well as supplemental modules which are a series of questions on specific topics.

Results:  Reported data indicates that there are significant mental health issues reported among older adults, grouped into the following areas of assessment: social and emotional support, life satisfaction, frequent mental distress, current and lifetime depression, and current and lifetime anxiety disorders. Incorporated into these results are the public health uses of this information to identify populations that might be most risk and to monitor the need for and the effectiveness of various public health interventions.

Conclusions: Continuous mental health surveillance should be used to develop public health programs. These agencies can incorporate mental health promotion into disease prevention efforts, conduct surveillance and research to improve the mental health evidence base, and collaborate with partners to enhance coordination of care for older adults.  

Biography:

Rebecca E. Lee is a professor in the College of Nursing and Health Innovation and previously served as founding director of the Texas Obesity Research Center in the Department of Health and Human Performance at the University of Houston. She still holds a courtesy appointment in the University of Houston Department of Health and Human Performance. Dr. Lee oversees the Understanding Neighborhood Determinants of Obesity (UNDO) research team, where she aims to provide innovative, theoretically-derived, trans-cultural, and community-based approaches to improving health to the science and community alike.

Abstract:

Aim: The Ecologic Model of Physical Activity (EMPA) suggests that actions in one micro-environment, like early care and education centers (ECEC), may influence actions in other micro-environments, like the home, via dynamic exo-environmental linkages. This collection of studies explored how experiences that children have at ECEC may influence parent behavior and the home environment.

Methods: Over three controlled experiments (SAGE 1 N=9; SAGE 2 N=11; SAGE 3 N=13), Sustainability via Active Garden Education (SAGE) was developed and tested as a 12-session, garden-based physical activity and fruit and vegetable promotion program for children age 3-5 years delivered in ECEC. SAGE uses the plant lifecycle as a metaphor for human development. Children learn how to plant, water, weed, harvest, and do simple food preparation along with active learning songs, games, science experiments, mindful eating exercises, and interactive discussions. In SAGE 2 and 3, parents received weekly newsletters linked to the curriculum and local resources and events. Newsletters were developed using nominal group technique and later evaluated by focus groups. SAGE 1 parents completed measures about perceived benefits from their child’s participation. SAGE 2 and 3 parents reported parenting practices and home fruit and vegetable availability.

Results: In SAGE 1, most parents believed that SAGE improved their child’s knowledge of physical activity (83%) and nutrition (92%) and improved their own knowledge of physical activity (69%) and nutrition (83%). Over half (54%) stated that their child asked to do SAGE activities at home. Focus groups rated newsletters favorably, liking content, colors, organization, layout, and reading level. SAGE 2 and 3 parents reported more practices encouraging and fewer practices discouraging (ps=.05-.17) their children’s physical activity after participation in SAGE. SAGE 2 and 3 produced modest but consistent increases in home fruit and vegetable availability after the SAGE interventions.

Conclusions: Activities that happen in the child’s ECEC micro-environment may have exo-environmental ripple effects beyond what happens in the ECEC, enhancing the social return on investment from school programming. Children are part of a dynamic system and can serve as active change agents, influencing parents and other family members as well as the home environment.

Biography:

Jean-Pierre Marissal works as a health economist at the Catholic Institute of Lille, and the depending hospital structures. He gives lectures on microeconomics at the same academic institution.

Abstract:

Background: Malnutrition among elderly people is a major factor of frailty and dependency, having consequences on both health and quality of life. This factor is also associated with specific difficulties in the process of screening and caring, needing dedicated processes. Objectives: We analyse the economic and medical relevance of an experimental process going from the screening of malnutrition to the definition of individual care plans, and the assessment of the clinical impact. This process required the involvement of hospital workers and ambulatory networks around a specialized hospital team. Data and methods: 272 patients were included between April 2013 and October 2015. Patients were recruited by physicians from the emergency ward (34.9%), the external geriatrics consultation (26.1%), the traumatology ward (11.8%), the cardiology ward (11.0%), other short stay wards (4.6%), and the day hospital for geriatrics evaluation (2.6%). Five general practitioners recruited patients (4.4%). Among the 272 patients, 106 were seen during during a follow-up consultation, on average 7.2 months after their inclusion. Results: The specialization of the team and tts central position in the hospital organization ensured the economic viability of the process by allowing a relevant use of the available resources, a constant influx of cases, and a reduced cost of screening and assessing the medical needs. This process was associated with an improved nutritional status for 35.7% of persons displaying a risk of malnutrition, and for 54.5% of patients diagnosed as malnourished at the inclusion. Gains were not limited to the sole nutritional status, inducing positive externalities for the patients of their participation to a nutritional care. Conclusion: The involvement of hospital workers and ambulatory networks has a proven medical interest for the care of elderly patients with malnutrition-related problems.

Biography:

Sohyun Park, Ph.D. is an Assistant Professor at Hallym University in South Korea. Her research interests are centered on food and nutrition environments and their associations with nutritional and health status among vulnerable populations in the communities. Kirang Kim, Ph.D. is an Associate Professor at Dankook University in South Korea. Her research interests include measuring food  security and understanding its associations with various socioeconomic and behavioral factors. She has been involved in various researches to evaluate national and local nutrition and food policies.

Abstract:

This study was conducted to understand food acquisition practices from social networks and its relationship with household food security. In-depth interviews and a survey on food security were conducted with twenty-nine mothers and one father in metropolitan areas of South Korea. Many families acquired food from their extended families, mainly participants' mothers. Between low-income and non-low-income households, there was a pattern of more active sharing of food through private networks among non-low-income households. Most of the low-income households received food support from public social networks, such as government and charity institutions. Despite the assistance, most of them perceived food insecurity. We hypothesized that the lack of private social support may exacerbate the food security status of low-income households, despite formal food assistance from government and social welfare institutions. Interviews revealed that certain food items were perceived as lacking, such as animal-based protein sources and fresh produce, which are relatively expensive in this setting. Future programs should consider what would alleviate food insecurity among low-income households and determine the right instruments and mode of resolving the unmet needs. Future research could evaluate the quantitative relationship between private resources and food insecurity in households with various income statuses.

Biography:

Hua You currently works at the School of Public Health, Nanjing Medical University. Hua does research in Infectious Diseases, Public Health and Epidemiology. Their most recent publication is 'Income related inequality and influencing factors: A study for the incidence of catastrophic health expenditure in rural China.'

Abstract:

Purpose: To evaluate the association between weight status and health related quality of life (HRQoL) among elderly in Jiangsu, China.

Methods: A total of 10,257 elderly (≥60 years) of a cross-sectional community-based study were included. BMI was calculated based on self-reported height and weight, and divided into three categories: “underweight” (<18.5), “normal weight” (18.5-24.9), “overweight” (25.0-29.9) and “obese” (≥30.0). HRQoL was measured via the Eq-5d-3L. Demographic information and subjects’ behaviors were also collected. Chi-square tests and One-way ANOVA analyses were used to compare the frequencies and scores of Eq-5d responses among different BMI groups. Also, Logistic regression analyses were conducted to examine the associations between BMI categories and below Chinese elderly norm of Eq-5d scores.

Results: The subjects’ mean age was 69.57 years (SD=7.5). Among them, the proportion of “normal weight”, “underweight”, “overweight” and “obese” was 66.0%, 8.3%, 23.1%, 2.6%, respectively. The score of Eq-5d index among total participants was 0.8036 and the VAS was 75.47. Either for responses frequency or scores of Eq-5d-3L, there were significant differences among different BMI groups (P<0.001). After controlled both demographic characteristics and health related behaviors, the two abnormal BMI groups (under weight and overweight/obese) still more likely had Eq-5d index and VAS below the Chinese elderly norm, the adjusted OR(95%CI) was 1.57(1.31,1.87), 1.36(1.21,1.54), 1.53(1.29,1.83) and 1.14(1.03,1.27), respectively.

Conclusion: As well as excess weight, underweight should be paid attention to, since these two weight situations both significantly associated with a low quality of life in the Chinese elderly.  

Key Words: Body Mass Index; Quality of life; elderly

Biography:

Before joining the University of Portsmouth, she worked as a Teaching Fellow in the Department of Social Statistics and Demography at University of Southampton from where she taught and coordinated modules in Quantitative methods, Research methods and Demography.  Prior to that, she worked with the Malawi Government's National Economic Council and Ministry of Finance as Economist.  My main responsibility was providing advice to policy makers on economic and development policies.  During this time, she participated on a qualitative study on people's perception on the impact of government policies and programmes on their poverty situation.

Abstract:

Child under-nutrition is a major global health challenge that is implicated in child deaths in developing countries every year and contributes to poor cognitive development.  Recent estimates reveal that in Malawi 37% children are stunted, 12% are underweight and 3% are wasted.  This paper used the 2000 and 2015 Malawi Demographic and Health Survey data to examine the co-existence of stunting and underweight within a child, identify children that suffer from stunting only, and performed a multinomial logistic regression to analyse changes in the determinants of child nutritional status in Malawi.  The percentage of children that are stunted reduced from 37.2% in 2000 to 26.8% in 2015.  The majority of children identified as underweight were also stunted: 14.5% in 2000 and 8.8% in 2015, indicating the existence of the double burden of child undernutrition.  The following factors were significantly associated with a child’s nutritional status:  age, sex, size at birth and household wealth status.  Mother education level was only consistently associated with child stunting while mother height, mother weight and having a younger sibling were important associates of the double burden of child undernutrition.   Child stunting and the double burden of child undernutrition have declined but remain high.  Increased female education especially at secondary or higher level and child spacing are likely to help tackle child undernutrition in Malawi. Replacing the underweight measure by the double burden of undernutrition measure may help with the formulation of appropriate policy interventions to tackle child undernutrition in Malawi and affected countries. 

Biography:

Anuj Tiwari is doing a PhD from Erasmus MC, Netherlands. He has a background in medicine and health economics. He is working as Scientific Researcher in the Department of Public Health, Erasmus MC. His work is mainly on public health aspects of neglected tropical disease and infectious diseases.           

Abstract:

Background

Leprosy is a major public health problem in many low and middle income countries, especially in India. Leprosy and poverty are closely associated, and therefore the economic burden of leprosy is a concern. Evidence on patient’s expenditure is scarce. We estimated the expenditure in primary care (outpatient) by leprosy households in two different public health settings. 

Methodology

We performed a cross-sectional study, comparing the Union Territory of Dadra and Nagar Haveli with the Umbergaon block of Valsad, Gujrat, India. A household (HH) survey was conducted between May and October, 2016. We calculated direct and indirect expenditure by zero inflated negative binomial and negative binomial regression. The sampled households were comparable on socioeconomic indicators.

Result

The mean direct expenditure was USD 6.5 (95% CI: 2.4-17.9) in Dadra and Nagar Haveli and USD 5.4 (95% CI: 3.8-7.9) in Umbergaon. The mean indirect expenditure was USD 8.7 (95% CI: 7.2-10.6) in Dadra and Nagar Haveli and USD 12.4 (95% CI: 7.0-21.9) in Umbergaon. The age of the leprosy patients and type of heath facilities were the major predictors of total expenditure on leprosy primary care. The higher the age, more is the expenditure at both sites. The private facilities are more expensive than the government facilities at both sites. If the public health system is enhanced, government facilities are the first preference for patients.    

Conclusions

An enhanced public health system reduces the patient’s expenditure and improves the health seeking behaviour. We recommend investing in health system strengthening to reduce the economic burden of leprosy. 

Biography:

Amal Farahat Mohamed Allam is an acting Dean of medical Research Institute, Alexandria University she is also the Vice Dean of community service and environmental affairs & Professor of Parasitology in Parasitology Department. She published her papers in many international Journals. She participates in many national health education campaigns and help in the treatment of poor population.

Abstract:

Objective To evaluate the performance of Percoll sedimentation and real-time polymerase chain reaction (PCR) for the detection of S. mansoni cases previously tested as negative by Kato–Katz technique in two low-endemic areas in Alexandria, Egypt, Abis 4 and 8 villages.

Methods:  Stool samples of 824 primary schoolchildren were examined by Kato–Katz technique (three slides of 41.7 mg each). After obtaining the results of this survey, stool samples were recollected from a subset of 150 students, who gave negative results after Kato–Katz. These samples were microscopically examined after the concentration with Percoll technique. Part of the 150 negative stool samples and five positive samples (used as controls) were kept at _20 °C and further processed by SYBR Green PCR.

Results:  Prevalence of S. mansoni infection as determined by three Kato–Katz thick smears was 1.82% (15 cases). Three more cases tested positive by Percoll sedimentation among the 150 samples that were negative by Kato–Katz. Specific amplification by SYBR Green PCR was noted in all positive controls and in three cases of Kato–Katz-negative samples, two of which were also positive by Percoll.

Conclusion: Percoll sedimentation and SYBR Green PCR proved useful in detecting low-intensity S. mansoni infections in low-endemicity areas in Egypt.

keywords Schistosoma mansoni, Kato–Katz, percoll, SYBR Green, real-time PCR

Biography:

Ayan Mao hold two master degrees: Master of Public Health, School of Public Health, Peking University, Beijing, China, 2007; Master of Art in Ecnomic Policy, Center for Development Economics, Williams College, MA, USA,2010. She is the deputy director of Division of Public Health, Institute of Medical Information, Chinese Academy of Medical Sciences. She has published more than 40 papers in reputed journals.

Abstract:

Objective To conduct with a crude cost analysis of the lung cancer screen program in Beijing, and provide data evidence for further cost--utility analysis. Methods Based on stratified cluster sampling method, we carried out a 2-stage lung screen program within 6 districts, Dongcheng, Xicheng, Chaoyang, Haidian, Fengtai and Shijingshan, of Beijing city between October, 2012 to May 2013. The first stage of the program was to conducting a packaging cancer risk level evaluation for community residents who were forty years older, and the second stage’s task was to providing low-dose CT scan exam for those high risk people who were selected from the first stage. There were about 12,953 residents were involved in this program. We calculated the main cost of the lung cancer screen program in Beijing, include cost for program management and operation, stage 1 and 2 screening, and other  indirected cost. Result 2,172 high risk residents were selected by the first stage and 1,739 accepted the Low-dose CT exam, participate rate was 80.06%. A total 233 participates had been found positive nodules and 12 of them were suspected of lung cancer at the second stage. The total cost for this lung cancer screen program, was 982,281 RMB (155,242US$), and cost per funding was about 4,216 RMB (667US$). Discussion: Compare with other Low-dose CT scan based lung cancer screening programs, the cost per finding in our study was low. The average medical cost for a lung cancer patient was 79,583 RMB (12,582US$) in Beijing city while the medical cost for a precancerous case was 14,350 RMB(2,269 US$). Although the follow-up cost for further medical care data was not available by now, we could expect a good promising for cost-benefit result in this screening program.  Conclusion The Low-dose CT scan based lung cancer screening program shows its potential on medical expenditure saving in Beijing city．

Biography:

Yuka Yamazaki has completed her MD degree from Juntendo School of Medicine in 2002 and  her PhD in 2010 from Juntendo University Graduate School of Medicine. She is an assistant professor at the department of Medical Education from Tokyo Medical University. She has published papers in public health and medical education fields. 

Abstract:

Background & Objectives: In Japan, the number of foreign residents is increasing. In addition, the numbers of foreign visitors will also increase because of the Olympic in 2020. Therefore, it is crucial for the Japanese government to develop a system for foreigners to live in and stay at Japan comfortably. In particular, language barrier prevents foreigners from accessing hospitals and having smooth communication with doctors. Recently, several articles suggest that appropriate interpreters specialized in medical fields are necessary for foreign patients to see doctors generally. However, previous studies mention that sometimes family members or friends with the similar cultural background as patients are more effective than certified interpreters. Therefore, to identify what type of interpreters is appropriate in Japanese hospitals, we conduct a questionnaire survey.

Methods: We are planning to collect total 250 foreign visitors and residents who visit the department of general medicine in Tokyo Medical University with an interpreter. Inclusion criteria is those who are 20 years and older and those who were born in foreign countries. Questionnaire and psychological tests will be conducted. Questionnaires were developed in four languages: Japanese, English, Chinese, and Korean. Question items are mainly patients’ demographics, social economics, disease, and interpreter’s demographics. Visual Analogue Scale and Profile of Mood of States will be used to evaluate patients’ care satisfaction. Qui square tests and Logistic Regression Model are used for data analysis.

Results & Conclusions: We will start this survey in April. Therefore, in this conference, we will present the progress of this research.  

Biography:

Sundrapragasen Pillay is a medical doctor and researcher based in South Africa. He is Director of the Enhancing Care Foundation, a Research Institute of the Durban University of Technology, which undertakes medical research, capacity development and health systems strengthening. He heads an international infectious diseases research site funded by the US National Institutes of Health, has led various health systems strengthening and implementation projects and has been involved in ground breaking behavioural research for disease prevention and treatment adherence. He was the Principal Investigator of the Medical Education Partnership Initiative grant of the University of KwaZulu Natal.

Abstract:

In South Africa (SA), adolescents and youth represent a critical target group at high risk of HIV infection and other health and psycho-social challenges, yet they make insufficient use of public sexual and reproductive health (SRH) services.

The project objectives were to address this core issue by improving the youth friendliness of clinics in the target South African sub-districts, increasing youth utilisation of SRH services and improving youth ratings of service quality. The multi-faceted approach comprised: (1) improving training of nurses, (2) improving youth health relevant skills, (3) enhancing knowledge and attitudes of service providers, (4) supporting the application of a quality management approach to health service delivery, (5) addressing shortage of youth health-targeted support materials, (6) engaging youth in the process,  (7) enhancing cooperation and  coordination between key stakeholders.

Results indicated that from a baseline measurement of zero, 58% of clinics met the National Department of Health’s (NDOH) 5 minimum standards to be classified as Adolescent and Youth Friendly Services Implementing sites. The number of SRH services used by young people aged 10-24 years increased by a margin of 59%. Strong positive change was reported for satisfaction with quality and confidentiality of the services as well as for helpfulness of staff.

These results achieved in a relatively short timeframe support a case for the scaling up this approach which could potentially accelerate the successful implementation of the Adolescent Youth Friendly Services Program of the SA NDOH as well as provide valuable lessons to other countries aiming improve such services.

Biography:

Moll received Biochemistry PhD and MD from University of Chicago Pritzker School of Medicine. He is Tenured Professor Pediatrics and Pediatric Endocrinology at University of Mississippi Medical Center (UMMC) where he has been Division Chair for 25 years. He published over 50 peer reviewed papers and 100 abstracts. Dr. Moll has over 40 years Clinical practice, Education as Graduate Faculty UMMC School of Medicine, and Research experience. He is UMMC Sigma XI Chapter President and holds Chair or Vice-Chair in Mississippi Academy of Sciences Division of Health Sciences. He serves as Abstract and Journal Reviewer and Mississippi Health Department Genetics Advisory Board member.

Abstract:

Diabetes mellitus (DM) requires individualized treatment programs to optimize quality of life and survival. Mississippi has a 2017 population 2.98 million including about 3 per 1000 school age children with DM over 48,434 sq miles served by only one Children’s of Mississippi Hospital. In 2016 we ranked 1^st in US with 308,295 adults living with DM prompting our 2017 Mississippi Diabetes Action Plan. This identified disparities in DM prevalence and hospitalization rates for race, education, income and rural vs metropolitan. Our DM patients often return to clinic few if any blood sugar (BG) records or meters. The clinic visit is an optimal time to make DM control recommendations. Hemoglobin A1c (HgbA1c) levels associate with tragic DM complication risks and reflect average BG exposure over previous 2 to 3-month interval. We use point of care (POCT) BG and HgbA1c for individualized DM home care recommendations while awaiting our National Glycohemoglobin Standardization Program (NGSP) certified clinical lab (CENT) HgbA1c levels. Our retrospective Quality Improvement study comparing patient simultaneously obtained POCT and CENT HgbA1c levels indicates our instrumentation can attain HgbA1c standard of care agreement with Total Allowable Error no more than 10%, but POCT HgbA1c 8.5%-10% can at times return CENT HgbA1c 7.5% or less (excellent control). Our UMMC Telehealth is improving individual care beyond clinic visits with remote patient monitoring encouraging 3-4 times daily BG compliance. RPM reduced HgbA1c levels in 16 of 36 patients (44%) and hospital encounters decreased 2.6 to 0.7 per patient per year. We are seeing improved childhood DM control.  

Biography:

Shu Hui Hung, is an associate researcher at NCHC, with experience managing multiple chronic disease care applications implemented across a variety of medical centers, local hospital and clinics in Taiwan, China. She has over a decade years of experience with designing, developing, researching and implementing electronic medical records. She had been focus on few chronic disease informatic management and epidemic control issues. Shu Hui’s mission is to work with all stakeholders in healthcare to transform the healthcare system to improve care and care experience for patients, improve provider productivity and lower costs to create a sustainable health system for all.       
 

Abstract:

Hepatitis C virus (HCV) is ranked as one of high risk chronic disease in Taiwan. HCV can be transmitted by exposure to infective blood mostly, such as injection drug/medical use and other skin touch based devices will also possible cause the epidemic spread. Most HCV infected people do not know they got it. HCV patients were requested to take regular treatment for 48 weeks. Hence, the effectiveness of treatment is slow, and its side effects cause patients give up frequently. Recently, Taiwan government promotes a new treatment with high cure rate.  The purpose of this study is to develop a platform to assist clinics introducing HCV patients, who had dropped or failed the previous treatment result, about  how good the new treatment can do to them, and allows patients to make their own decision whether take it or not. A platform designed and implemented as patients record management and education to be utilized during HCV patients’ decision aids processes from local clinics. Selected target patients with released treatment news with local clinic appointments available date with incentive gifts via text message. While target patients walk-in clinics, the nurse would guide them follow a series of updated HCV education and encourage patients to get HCV blood test. The platform has been recruited 125 patients among 8 clinics to participate within 90 days. 23 out of 125 refused to get the blood test. One-Third of them tested were HCV positive, and decided to accept the new treatment. The platform stimulates HCV patients are more willing to follow new treatment and doctor advice than usual. Among targeted patients who refused to take a test don’t think they have it by comparing HCV symptoms. Yet, they understand HCV can be cured by taking oral medication. It is important providing accurate HCV cure information to public, and also educate us to be aware of how to control HCV in order to promote better living quality.

Biography:

Jing Sun is associate professor of pharmaceutical policy. She received her Ph.D. from the Graduate School of Medical Sciences at the University of Groningen. She is the leader of Pharmaceutical Policy Theme Group of China Core Group of the International Network Rational Use of Drug (INRUD) and the country leader of BRICS Medicines Alliance. Her research areas focus on macro pharmaceutical policy and initiatives to improve the use of medicines. Since 2004, she has been involved in providing technical support to the Chinese government in the pharmaceutical area, and contributed to China’s national health system reform, especially the reforms in the pharmaceutical sector.  

Abstract:

This study estimated the attributable direct medical economic burden of health care–associated infections (HAIs) in China. Data were extracted from hospitals’ information systems. Inpatient cases with HAIs and non-HAIs were grouped by the propensity score matching (PSM) method. Attributable hospitalization expenditures and length of hospital stay were measured to estimate the direct medical economic burden of HAIs. STATA 12.0 was used to conduct descriptive analysis, bivariate χ2 test, paired Z test, PSM (r = 0.25σ, nearest neighbor 1:1 matching), and logistic regress analysis. The statistically significant level was set at .05. The HAIs group had statistically significant higher expenditures and longer hospitalization stay than the non-HAIs group during 2013 to 2015 (P < .001). The annual average HAI attributable total expenditure, medicines expenditure, out-of-pocket expenditure, and number of hospitalization days per inpatient were (2015 US$) 6173.02, 2257.98, and 1958.25 and 25 days during 2013 to 2015. The direct medical cost savings was estimated at more than 2015 US$12 billion per year in Chinese tertiary hospitals across the country. The significant attributable direct medical economic burden of HAIs calls for more effective HAI surveillance and better control with appropriate incentives.

Biography:

Ho Kim, the first author, is on M.P.H. degree candidates from  Institute for Health Promotion & Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea. He has published 2 papers in Neurosurgery(2015 Apr;76(4):372-80 and 2014 Aug;75(2):124-33).  

Abstract:

Unmet need for medical care in Korea has been increasing due to a lot of reasons such as social, econmic or mental status, which has been associated with health inequalities. Therefore, the aim of this study is to develop predictive models for unmet medical need using both logistic regression model and random forest machine-learning approach. Korea Health Panel data from 2011 to 2013 year, surveyed by Korea Institute for Health and Social Affairs and National Health Insrance Service, were used for this study. There were 38 variables including independent variables such as age, educational level, marital status, economic activity, hosehold income quintile, health insurance type, national pension participation status and others. Dependent variable refered to the experience of an unmet need in using medical service although being needed. Total observations in 12,256 subjects were 30,061 and devided into training (18,037:60%), validation (6,013:20%) and test (6,013:20%). Machine-learning approach with logistic regression model and random forest model were used to predict the unmet need. Overall, 16.2% (n=4,864) of observations experiened unmet need in using medical service even though they wanted or had to use it. The logistic regression model showed area under curve (AUC) as 0.696 and random forest model presented  0.937 AUC in training, validation and test data-set. Conclusivly, prediction result could be different based on which machine-learning approach would be used for unmet need for medical service. And AUC of random forest machine-learning approach is shown to be better than that of logistic regression model. 

Biography:

Ramakuela has completed her PhD at the age of 48 years from The University of Venda She is a Senior Lecturer in the Shool of Health Sciences, Department of Nursing. She has published more than 30 papers in reputed journals and has been serving as an editorial board member of repute. She present papers at national and international conferences where she also chairs sessions.

Abstract:

Menopause for majority of rural women from midlife has become a global health challenge especially coping with the clinical challenges and dietary issues that come with it. Women from the ages of 40 years and above start experiencing clinical manifestations way or another that also impact on their diet. This study adopted a qualitative approach and aimed to explore and describe dietary practices by rural menopausal women of Limpopo Province, South Africa. Four villages with the largest population were purposefully selected. A representative portion of the population of women aged 40 years and above was selected and a convenient sample of 29 women was selected for the study. Purposive sampling was used to select the participants for the focus groups. Sample size was determined by data saturation during the fourth focus group interview. Data were collected through focus group interviews and one central question guided the discussions. Tesch’s eight steps of qualitative data analysis were used. Measures to ensure trustworthiness and ethical issues were observed. Results: Three themes emerged namely:Psycho-social challenges; menopausal age and diet practices, healthy lifestyle and remedies. In conclusions the study recommended that counselling and proper health education regarding healthy dietary practices for rural menopausal women be done.

Biography:

Su-Er Guo currently works at the Colloge of Nursing, Chang Gung University of Science and Technology. Su-Er does research in Allied Health Science and Medicine.

Abstract:

Objectives: Early exercise can promote patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) quickly return to a steady state. However, no previous studies have examined the effects of early Tai-Chi exercise on exercise tolerance and quality of life. The aim of this study was to examine effects of Tai Chi intervention on exercise tolerance and health-related quality of life in hospitalized patients with AECOPD.

Methods: A quasi-experimental study was conducted. A purposive sampling of 31 patients with AECOPD (experimental group, n = 17 and control group, n = 14) was selected from hospitals in two cities of Midwest Taiwan. The generalized estimating equations were used to examine the effects of Tai Chi training intervention.

Results: The experimental group had better exercise tolerance than control group（P = 0.01）one week after discharge and (P = 0.01) six months after discharge. The experimental group had better quality of life than control group（P = 0.04） 3months after discharge.

Conclusions: Early exercise with Tai Chi intervention during hospitalization can enhance exercise tolerance and health-related quality of life. The findings can be seen as references for professional healthcare providers to promote early exercise in the future.

Key Words: Early exercise, Chronic obstructive pulmonary disease (COPD), tai chi, Exercise tolerance. 

Biography:

Daniega took her BS Pharmacy (1991-1995) and Doctor of Medicine( 1995-1999) in the University of Santo Tomas, Manila Philippines. She also holds a degree of Master in Health Professions Education from the National Teachers Training Center-University of the Philippines .She served as department head of the Health Services of Mapua University in Manila for 8 years and has been teaching Bioethics, Anatomy and Physiology, Pharmacology, Occupational Health and Safety since 2002  in several universities in Manila. She is pursuing her Doctor in Public Health Nutrition in the University of the Philippines at present and is a certified Physician examiner for US Veterans Compensation and Pension benefits.  
 

Abstract:

Objective: One of the natural products found to have anti-diabetic properties is Allium cepa, commonly known as garden onion. Thus, this review paper will go through some researches which have been done to illustrate the anti diabetic property of Allium cepa.

Results: Quercetin, a major phenolic content in onion, inhibits the liberation of D-glucose from oligosaccharides and disaccharides by inhibiting a-glucosidase, resulting in delayed absorption of glucose from the intestine and is thereby considered responsible for controlling blood glucose levels. In several animal studies, the administration of oral juice of Allium cepa significantly decreased the blood sugar levels in drug-induced diabetic rats. Ether extract of the fresh bulb, administered to pancreatectomized dogs and rabbits by gastric intubation, was active. Ether extract of the fresh bulb, administered intragastrically to rabbits at a dose of 250 gm/kg, was active. A dose of 10.0 mg/kg, administered orally to rabbits, was active. A drop in blood sugar of 15 mg relative to inert treated controls indicated positive results. These results indicated that the different extracts using different agents do not affect the activity of the anti-diabetic effects of the components of allium cepa. Although, further studies have to be done in order to establish the most appropriate dosage for its maximal hypoglycemic control without causing any harm to the animals of study, Allium cepa shows promising evidence as a possible food supplement in the management of diabetes mellitus.

Conclusions: Studies have demonstrated the potential benefit of Allium cepa in lowering  the blood sugar levels among drug-induced diabetic rats

Biography:

Nurfazlinda Md Shah obtained her MBBS from International Islamic University, Malaysia in 2002. She has since been practicing as a medical and health officer in government hospitals and clinics in Malaysia. She obtained her Master of Public Health (MPH) degree from University of Malaya in 2011 and enrolled into the Doctor of Public Health (DrPH) program in 2014. She is currently in the final year of her study. Her doctoral thesis focused on stress and eating behavior among the adolescents. She is also currently a practicing medical officer and a part time lecturer in Universiti Teknologi MARA, Malaysia.

Abstract:

The concurrent increasing prevalence of reported stress and obesity among adolescents worldwide has been attributed to urbanization and changes in lifestyle. This study aims to explore the impact of stress on eating behavior among adolescents. A cohort study was conducted among 797 multi-ethnic Malaysian adolescents. Data were collected at two time points six month apart; during the 2 weeks prior to final-year national school examination and during normal school days. Stress level was assessed subjectively using a validated questionnaire and objectively by using saliva cortisol level of a subsample of 261 participants. Eating behaviours were explored using a validated self-reported questionnaire. Linear regression and Pearson’s correlation analyses were applied. No significant difference of perceived stress level was observed between near exam period and normal school days. However, saliva cortisol level was significantly higher during the near exam period. Adolescents with high perceived stress had significantly higher scores for emotional eating pattern and food responsiveness. Strongest significant positive correlation was observed during the near exam period between perceived stress and emotional overeating (r₀=0.30); stronger among female (r₀=0.31), urban (r₀=0.32), underweight (r₀=0.34) and adolescents with moderately perceived stress (r₀=0.24). No significant correlation was found between perceived stress and saliva cortisol or between saliva cortisol and eating behaviour. Stress and obesity are significant problems among adolescents and school examinations are an important stressor needs to be addressed. Perceived stress level affects the emotional eating and external eating patterns of adolescents and therefore obesity prevention programmes should be designed taking these issues into account.  

Biography:

Masoud Mohammadnezhad was awarded his PhD in Public Health from Flinders University, Australia, in 2014. Dr Mohammadnezhad has more than 15 years of experience in teaching undergraduate and postgraduate courses in various university settings. He is currently teaching a variety of public health courses at Fiji National University (FNU), where he is an Associate Professor of Public Health (Health Promotion) in the School of Public Health and Primary Care, along with being the program coordinator for the health promotion discipline. Dr Mohammadnezhad is very interested in doing research in different areas of health issues such as non-communicable diseases (NCDs), global health issues, health risks and determinants of said risks.

Abstract:

Introduction: From an intern nurse to a registered nurse is a phase of transition. The transitional phase requires intern nurses to assimilate in to the nursing culture, develop clinical expertise through gaining clinical skills and knowledge through new experiences. The transitional experiences can be perceived as a phase of new discoveries, frustrations, happiness and accomplishments which moulds how the intern nurses will work when they become registered nurses. The main aim of this study is to explore the experiences of intern nurses at Labasa Hospital.

Method: This qualitative study is conducted among 20 intern nurses who were currently employed at Labasa Hospital, Fiji. A non‒probability method using convenience sampling was used to select the sample. After ethical approval has been sought, data was collected using semi‒structured interviews. The content of the interview was transcribed and the data was coded, sorted and categorized into themes.

Results:  The results of the study showed array of challenges including; lack of knowledge and confidence, meeting the physical demands of shift work, adapting to new roles/relationships and accepting professional accountability.

Conclusion: The results of this study showed the challenges for intern nurses transition into the workforce at Labasa Hospital in Fiji. Further knowledge will enable management to create better experiences for all intern nurses and for capacity building for future nurses in Fiji.

Key Words: Intern nurse, transitional experience, challenges, Fiji

Biography:

Masoud Mohammadnezhad was awarded his PhD in Public Health from Flinders University, Australia, in 2014. Dr Mohammadnezhad has more than 15 years of experience in teaching undergraduate and postgraduate courses in various university settings. He is currently teaching a variety of public health courses at Fiji National University (FNU), where he is an Associate Professor of Public Health (Health Promotion) in the School of Public Health and Primary Care, along with being the program coordinator for the health promotion discipline. Dr Mohammadnezhad is very interested in doing research in different areas of health issues such as non-communicable diseases (NCDs), global health issues, health risks and determinants of said risks.

Abstract:

Background: Diabetes, a global health emergency, is the number one cause of morbidity and mortality in Fiji. Despite advancement in diabetes management, a lot of diabetics in Fiji are still suffering from preventable complications and dying prematurely. This study is conducted to determine poor glycaemic control proportion and its associated factors among T2DM adults attending clinics at Suva health centres in 2011 – 2016.

Methodology: This quantitative study was conducted at three Suva health centres on sample size of 338 adult T2DM patients registered on August 1, 2011 – August 1, 2017 for the quantitative study and 18 health care workers working at the same diabetes clinics purposively selected for three focus group discussions.  Data analysis included logistic regression analysis using SPSS version 22.0. P-value less than 0.05 was considered as the significant level.

Results: Out of the 338 participants, 261 (77.2%) had poor glycaemic control (HbA1C<7%). Patients had a mean age of 56 years, 59% were female, mean duration of diabetes was 4.7 years, 23.7% were treated with insulin and 70.7% were in overweight & obese categories. Patients who had poor RBS (AOR = 7.43, 95% CI 2.46 – 22.45) and poor FBS (AOR = 9.76 CI 3.11 – 30.58) had high odds of poor glycaemic control.

Conclusions: Majority of patients had poor glycaemic control. Patients with poor random and fasting blood sugars were likely to have poor glycaemic control. Regular RBS monitoring could be a cost-effective way of monitoring glycaemic control in the absence of HbA1C testing.

Keywords: Type 2 diabetes mellitus, Determinants, Mixed method study, Fiji 

Biography:

Rasyad Khalifah is a 4^th year medical student in the Faculty of Medicine, University of Indonesia. He is highly passionate to contribute in macro scale health-improving policies through extensive and systematical population-based studies. He also currently active in several organizations whose focuses are on to sustainable community development programs and emergency medical response volunteerings. The very gist of liberal arts education is the foundation to his constructive and analytical thinking. He believes this characteristic will lead him to be a mindfulness practitioner. Lastly his quest in life is to bring the utmost quality in health services for a better humanity.

Abstract:

Background: Zinc is one of the essential micronutrients for human body. Zinc deficiency could lead to smaller head circumference and late of cognitive development. Objective: This study is aimed to seek the relationship between serum zinc level with head circumference and cognitive development in children. Method: This study used cross-sectional model in 97 subjects that suitable to the criteria. Variables are then analysed with Kolmogorov-Smirnov test. Correlation between serum zinc level and head circumference is analysed with Pearson correlation formula, and relation between serum zinc level and cognitive development is analysed with T independent formula (significant correlation if p<0.05). Result: The average of plasma zinc serum is 65,45 mcg/dL, head circumference is 43,7 cm, and the prevalence of cognitive development in suspect category is 6,3% Through bivariate analysis was found that correlation between serum zinc level with either head circumference and cognitive development had insignificant correlation statiscally (p=0,636 and p=0,178 respectively). Discussion: In conclusion, relation between serum zinc level with either head circumference and cognitive development in  8-10 months children in Central Jakarta were positive with insignificant correlation.

Biography:

Jean-Pierre Marissal works as a health economist at the Catholic Institute of Lille, and the depending hospital structures. He gives lectures on microeconomics at the same academic institution.

Abstract:

Context: There is a growing political will to link hospital payments not only to the severity and complexity of the cases treated, but also to the ability of a structure to meet some objectives regarding public health or cost cuts. One possible and legitimate objective appears to be the performance as regards the prevention of nosocomial infections. Objectives: We analyse the ability of DRG-based payment systems to help defining financial incentives or penalties, as regards both their economic and statistical feasibility. Material: We assess the theoretical and empirical evidence for the possibility of payment / reward systems aimed at reducing the incidence of nosocomial infections, based on an analysis of the costs involved by such infections for hospitals in both terms of productivity and opportunity losses or gains. We use the case of Clostridium difficile infections as an illustration of the dilemma involved in the task of incentivizing hospitals to prevent nosocomial infections.

Results: There is room for the definition of payment / reward systems based on the definition of criteria related to the productivity gains / losses, based on DRG-payment systems and the estimation of opportunity costs involved. However, we show that the main problem we are facing is related to the assessment of the impact of the nosocomial infection on the duration of hospital stay at the individual level. Conclusion: The methodological stalemate involved in the definition of payment / reward systems, as shown by the analysis of a particular situation with general implications, calls for the definition of some academic consensus or common minimum standard of estimation of such a crucial data that is the measurement of the individual extra lengths of hospital stay.

Biography:

Amal Farahat Mohamed Allam is an acting Dean of medical Research Institute, Alexandria University she is also the Vice Dean of community service and environmental affairs & Professor of Parasitology in Parasitology Department. She published her papers in many international Journals. She participates in many national health education campaigns and help in the treatment of poor population.

Abstract:

Objective: To compare the performance of urine circulating cathodic antigen (CCA) cassette test and real time PCR cycle threshold values in cases of Schistosomaisis mansoni of different infection intensities.

Methods: Stool and urine samples were collected from 110 school children after obtaining the consent of school guardians and children’s parents. Stool samples were microscopically examined using double Kato slides (41.7 mg each). Midstream urine specimens were tested for S. mansoni by using CCA and were tested for S. haematobium by filtration technique  . Part of each stool sample was kept at -20 °C and further processed by SYBR Green PCR.

Results: All the examined cases were negative for S. haematobium. In spite of the high prevalence of S.mansoni , the majority of children had light infection intensity (64.3%) as estimated by Kato- Katz. The highest infection rate of S. mansoni was detected by real time PCR (82.7%), followed by CCA test (60%) while the lowest infection rate was diagnosed by Kato-Katz (50.9%). The three tests showed similar performance in moderate and heavy infections. On the contrary, among the 54 negative schistosomiasis individuals after Kato-Katz, real time PCR diagnosed higher positive cases (70%)  in comparison to CCA (22%). Cycle threshold values higher than 25, suggest the absence of heavy infection.

Conclusion: Real time PCR was the most detector  of positive S. mansoni cases missed by  Kato- Katz and CCA test and it would enhance the effectiveness of surveillance and control programs of schistosomiasis. To detect low infection intensity and missed cases after Kato- Katz, it is recommended to increase the cycle threshold during application of real time PCR to 40 cycles.  

Keywords: Schistosoma mansoni,  Kato-Katz, circulating cathodic antigen (CCA) cassette test, SYBR Green, real-time PCR.

Biography:

Su-Er Guo currently works at the College of Nursing, Chang Gung University of Science and Technology. Su-Er does research in Allied Health Science and Medicine.

Abstract:

Biography:

Abstract:

         Taiwan promoted the ICF system in 2012 and ICD-10 system in 2016 as the national health insurance coverage for medical expenses. ICD-10 A system of diseases categorized according to the rules and expressed in a coded way. The ICF classification system provides a unified framework for classifying the functional states and disability that make up the health component. The ICF describes the etiology of medicine as a neutral word, focusing on the functional status of an individual rather than a disorder or condition. In addition, the ICF is a health classification tool that considers cross-cultural, age-and-gender variables, which makes the ICF classification system suitable for operation in different demographic contexts. The ICF classification system complements the WHO's (ICD-10) deficiencies because the ICD contains only information on disease diagnosis and health conditions, but no functional status description. The ICD and ICF are currently the core classification system in the World Health Organization's International Classification Family (WHO-FIC). This article explores the accessibility, convenience and safety of patients with mental and behavioral problems through the promotion of two systems and from 2008 to 2016 statistics. Our study found that the number of mental hospitals increased by 122%, the number of psychiatrists increased by 250% and the number of nursing staff increased by 248% between 2008 and 2016. These data show that the Taiwanese government needs more resources to promote long-term care policy and pay attention to the medical needs of potential patients with mental and behavioral disorders.

Biography:

Ho Kim, the first author, is on M.P.H. degree candidates from  Institute for Health Promotion & Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea. He has published 2 papers in Neurosurgery(2015 Apr;76(4):372-80 and 2014 Aug;75(2):124-33).  

Abstract:

Unmet need for medical care in Korea has been increasing due to a lot of reasons such as social, econmic or mental status, which has been associated with health inequalities. Therefore, the aim of this study is to develop predictive models for unmet medical need using both logistic regression model and random forest machine-learning approach. Korea Health Panel data from 2011 to 2013 year, surveyed by Korea Institute for Health and Social Affairs and National Health Insrance Service, were used for this study. There were 38 variables including independent variables such as age, educational level, marital status, economic activity, hosehold income quintile, health insurance type, national pension participation status and others. Dependent variable refered to the experience of an unmet need in using medical service although being needed. Total observations in 12,256 subjects were 30,061 and devided into training (18,037:60%), validation (6,013:20%) and test (6,013:20%). Machine-learning approach with logistic regression model and random forest model were used to predict the unmet need. Overall, 16.2% (n=4,864) of observations experiened unmet need in using medical service even though they wanted or had to use it. The logistic regression model showed area under curve (AUC) as 0.696 and random forest model presented  0.937 AUC in training, validation and test data-set. Conclusivly, prediction result could be different based on which machine-learning approach would be used for unmet need for medical service. And AUC of random forest machine-learning approach is shown to be better than that of logistic regression model.