7^th International Conference on Epidemiology & Public Health November 14-15, 2018 Tokyo, Japan

Biography:

Su Su Maw is a PhD Nursing student of Okayama University, Japan. She has finished her Master of Nursing Science in Myanmar, and she is learning PhD course in Japan by accepting the Japanese government MEXT scholarship award. Her specialty area is community health nursing, and she has genuine interest in prevention of lifestyle diseases and reducing of communicable diseases for promoting healthy community. After finishing her study, she aims to improve the health care system of her native country as there are many weakness in national health care system of Myanmar.

Abstract:

Biography:

Tassiane Cristina Morais, 34 years old, is pharmacist with qualification in Clinical Analysis and master degree in Basic and Applied Immunology and Parasitology, by Federal University of Mato Grosso (UFMT), Brazil. Currently, she is a Ph.D. student of School of Public Health, University of São Paulo (USP), Brazil. She has published 9 papers in reputed journals and have others articles in development. She works mainly on the following topics: Immunology, Immunomodulation, Maternal-Child Health, Melatonin and Obesity.

Abstract:

Obesity, complex public health problem, is associated with deregulation of circadian rhythms and reductions in the physiological levels of melatonin. The melatonin is secreted mainly by the pineal gland and it plays an essential role in the temporal regulation of biological rhythms and the energy metabolism. Melatonin is present in colostrum and human milk. This fact illustrates the importance of this indolamine for child development. However, the impact of maternal overweight on melatonin levels in colostrum still remains unclear. Therefore, the aim of this project was to analyze the influence of maternal pre-pregnancy overweight on colostrum melatonin levels. It was carried out cross-sectional study, followed by laboratory analysis of human colostrum. The colostrum samples were collected from 14 clinically healthy women, between 48 and 72 hours postpartum in Brazilian public hospital. The women were classified according to pre-gestational BMI into the following groups: normal BMI (18.5 a 24.9 Kg/m2, n=7) and high BMI (≥25 9 Kg/m2, n=7). The melatonin in the colostrum were determined by ELISA kit (IBL). The ANOVA  and Tukey test were used  (p<0.05). Data were expressed as mean ± standard deviation. The melatonin levels in the colostrum were higher in high BMI group (27.2±2.57 pg/mL) than normal BMI group (18.43±4.84 pg/mL), p=0.0014. These results highlight the importance of colostrum melatonin in the pathogenesis of obesity. Thus, the breastfeeding promotion represents a very important way for the developing intervention strategies focused on the prevention of obesity. Financial Support: FAPESP, process n° 2015/01051-3 and 2015/19922-0.

Biography:

Abstract:

Background:

Previous studies have shown that including irrelevant covariates in Propensity Score (PS) methods reduces the effect of treatment. For instance, the simulation study illustrates “including variables that are associated with the treatment but not the outcome will decrease the precision of the estimated treatment effect without decreasing bias.” Therefore, these many individual comorbidities have power to change the cancer treatment effect.

Method:

This study conducts an essential algorithm “Combination of Association and Bias (CAB)” in standardized difference (SD), odds ratio (OR), and relative risk (RR), and effect modification (Bias) compared adjustment to un-adjustment. It rests on the exploitation of information of correlation that is usually untapped and includes a variable selection component to national Medicare patients≥65 years with first primary diagnosis 2007-2011. CAB examines 328 covariates including baseline parameters, patients’ characteristics, empirical factors, and other comorbidities associated with radiation-endocrine treatment (RET) within 6 months of diagnosis and the primary outcome recurrence after 1 year of diagnosis.

Results:

Of 9096 patients have 51% received RET. Selected 135 pre-observational covariates modify the effect of RET and recurrence including 38 correlated to RET, 17 related with outcome. RET (RR: 0.5, 95% CI 0.42-0.58) has significant different effect on recurrence by adjusting the covariates related treatment and outcome. If adjusting non-selections (irrelative) covariates in propensity model, the estimation is significantly increased standard deviation and variance compared to selected covariates.

Conclusion:

With large datasets containing many variables, especially cancer studies, the PS theory indicates the most indispensable covariates are those highly correlated with both the selection process of treatment and outcomes. CAB promotes the precision of estimation of treatment effect and limit selection bias.

Keywords: Covariates selection, Propensity Score, Association, Breast Cancer, Treatment Effect

Biography:

Keren Shechter Azulay is the VP General Director of the Southern district at Maccabi Healthcare Services, the second largest HMO in Israel. After a decade of managerial experiences in the private business sector, keren joined the healthcare arena and took care of various positions in the field, as well as, in the headquarters as a Chief Strategic Officer at Maccabi. She holds a BA in Management and Masters in Health Administrations, both from Ben Gurion University. She graduated Wexner senior leaders in Harvard University.

Abstract:

Background:

The OECD estimates that every modern health care system is characterized by:

1. Over-treatment; Up to 30% of the surgery procedures are unnecessary.

2. Hospital-acquired infection (HAI): Over 50,000 inpatients will die from acquired infection diseases that are not related to their primary disease every single year in USA (over 5,000 in Israel).

3. Financial needs are beat the patients' best interests: 25% of the inpatients in the internal units aren’t supposed to be admitted.

4. Revolving doors: 1 out of 12 inpatients will return to the hospital in less that 30 days

5. Choose wisely- cost effective: The "contribution" of the classic health system to life expectancy and wellness is estimated to be less than 10%.

Although the Israeli healthcare system is considered as a miracle and was rated (Bloomberg rate- September 2018), as the sixth most efficiant healthcare system in the modern world, unfortunately the poor outcomes mentioned above, are related to our thriving healthcare system as well, So why does it happen to highly qualified people like us (physitions, managers, nurses, and regulators). How come we stand by and do nothing?

Therefore, we face painful consequences; heavy price of illnesses, deaths, infections, waste and poor health.

It happens because we are use to hear those big four lies/ myths , that are constantly being told to us, and lead to a severe reality of poor efficiency in our public systems;

Lie no.1- Lack of resources: We are dealing with systems that run billions of dollars every single year with over 30% of unnecessary procedures and over treatments.

There is no possibility of any financial shortage.

Lie no.2 - The best interest of the patient first:  There is a built-in financial conflict of interests between hospitals and health funds; 25% of the patients that enter the hospitals shouldn’t be there!! They are exposed to unnecessary procedures and dangerous infections.

Lie no.3- As patients are we safe:  Do we have, as the medical decision makers the whole medical data and information that are needed to see the whole picture. Of course not.

Lie no.4 -The system is being managed:  We surely know how to run separately the links of the healthcare system (hospital, HMO’s, laboratories, pharmacies and so on), but we do not know how to manage it as a whole and a holistic system. Nobody is responsible to the whole patient journey. Although we focus in our great improvements in hospitals, health funds etc. we ignore the real mission; to tie up the loose edges of hospitals, patient- home rehabilitation options, social needs, dead end bureaucracy, which are critical to maximize the treatment and patient health. Who manages that? This is nobody’s mission.

Our goals:

Our goals are to create a simple solution to manage the patient journey via improving the interfaces between the classical links of the healthcare system (hospital-community-home services) by forming an INTEGRATIVE CONTINUITY OF CARE UNIT.

Our KPI’s:

ï‚· Reduce revolving doors by 20 %

ï‚· Reduce Infection cases (reducing the hospitalization time by 10%)

ï‚· Unnecessary procedures (reducing the hospitalization time by 10%)

* camper to the national figures

ï‚· Increase Health outcomes (lower the annual tendency of hospitalizations for complicated patients by 10 %)

ï‚· Increase the rehabilitation activities by 50%

ï‚· Choose wisely - costs and health value (lower the annual tendency of hospitalizations for complicated patients)

ï‚· Increase medical staff and patients’ satisfaction

Our Methods:

Using a rare occasion of opening a new public hospital in our district (It happens ONLY once every 40 years in any modern country).

Creating an INTEGRATIVE CONTINUITY OF CARE UNIT - This unit is based on multi-disciplinary team; physicians, nurses, physiotherapists, social workers and administrators that share IT systems.

This unit Represent the patient community health services but is located inside the hospital units.

Contacting the patient immediately and proactively once he/ she is admitted to the hospital.

Contacting the hospital doctor / case manager to complete medical info or when approvals are needed to improve patient protocol.

Sharing medical data from the community health services , hospitals, social municipal services, public social insurance, so that the medical decision makers have 360- degree -information to reduce over treatments; for example reduce unnecessary radiation tests , bureaucracy, shorten the patient waiting time for medical procedures if necessary, and close gaps to complete the patient journey.

Making sure that the patient won’t stay more than necessary inside the hospital and coordinate services and facilities at home or rehabilitation solutions to promise the continuity of care , prevent unwanted lose and suffer and increases patient wellness.

Results:

1. High efficiency, revolving doors 35% less

2. Reduce the potential of infection; Inpatient days 43% less

3. Rehabilitation costs are doubled +100%

4. Moving to the safe zone : 1 of every 4 rehabilitation cases gets its care in a safe clean environment :at home

5. Patient satisfaction - medium satisfaction. We haven’t succeeded to achieve a patience full awareness (and appreciation) to the NEW Integrative Unit yet.

6. Medical staff satisfaction - very high satisfaction ( score 6.5 of 7)/ high trust have been reported between community doctors and hospital physicians.

The modern healthcare system has great achievements worldwide when it comes to measuring separately the classical links of the system like hospitals, funds and so on.

However the million dollar question of efficiency which is responsible for: 30% over treatments, high rate of infections, illness etc. is hiding in the interfaces among those links, that no one in the modern healthcare systems is responsible for.

We must change our old habits; hospitals have to break their own walls and show transparency. They have to stop being “factories” that produce surgeries and take responsibility for the rehabilitation of the patients who are released from the hospitals.

The HMOS have to become more proactive and available in the evenings and during the weekends, so that their patients will be released smoothly from the hospitals.

The huge challenge is to improve the interfaces between those links by promising-the continuity of care and maximizing the patient journey is still an unsolved problem worldwide.

Our great challenge is to collaborate and manage the interfaces between hospitals, Community services, and home rehabilitation solutions, as patients experience it. This new INTEGRATIVE CONTINUITY OF CARE UNIT is making a big difference by changing this important mission from nobody’s mission to somebody’s mission. No need for special technology, no great innovation but a new kind of leadership, trust and collaboration to win the financial, guilds, ego interests and focusing on the patient’s best interests. We defiantly want it as our No.1 priority!

Biography:

Su Su Maw is a PhD Nursing student of Okayama University, Japan. She has finished her Master of Nursing Science in Myanmar, and she is learning PhD course in Japan by accepting the Japanese government MEXT scholarship award. Her specialty area is community health nursing, and she has genuine interest in prevention of lifestyle diseases and reducing of communicable diseases for promoting healthy community. After finishing her study, she aims to improve the health care system of her native country as there are many weakness in national health care system of Myanmar.

Abstract:

Biography:

Tassiane Cristina Morais, 34 years old, is pharmacist with qualification in Clinical Analysis and master degree in Basic and Applied Immunology and Parasitology, by Federal University of Mato Grosso (UFMT), Brazil. Currently, she is a Ph.D. student of School of Public Health, University of São Paulo (USP), Brazil. She has published 9 papers in reputed journals and have others articles in development. She works mainly on the following topics: Immunology, Immunomodulation, Maternal-Child Health, Melatonin and Obesity.

Abstract:

Obesity, complex public health problem, is associated with deregulation of circadian rhythms and reductions in the physiological levels of melatonin. The melatonin is secreted mainly by the pineal gland and it plays an essential role in the temporal regulation of biological rhythms and the energy metabolism. Melatonin is present in colostrum and human milk. This fact illustrates the importance of this indolamine for child development. However, the impact of maternal overweight on melatonin levels in colostrum still remains unclear. Therefore, the aim of this project was to analyze the influence of maternal pre-pregnancy overweight on colostrum melatonin levels. It was carried out cross-sectional study, followed by laboratory analysis of human colostrum. The colostrum samples were collected from 14 clinically healthy women, between 48 and 72 hours postpartum in Brazilian public hospital. The women were classified according to pre-gestational BMI into the following groups: normal BMI (18.5 a 24.9 Kg/m2, n=7) and high BMI (≥25 9 Kg/m2, n=7). The melatonin in the colostrum were determined by ELISA kit (IBL). The ANOVA  and Tukey test were used  (p<0.05). Data were expressed as mean ± standard deviation. The melatonin levels in the colostrum were higher in high BMI group (27.2±2.57 pg/mL) than normal BMI group (18.43±4.84 pg/mL), p=0.0014. These results highlight the importance of colostrum melatonin in the pathogenesis of obesity. Thus, the breastfeeding promotion represents a very important way for the developing intervention strategies focused on the prevention of obesity. Financial Support: FAPESP, process n° 2015/01051-3 and 2015/19922-0.

Biography:

Maria Elizangela Ramos Junqueira is Assistant Professor at the University of the State of Bahia, Brazil and Public Health, University of São Paulo, Brazil.

Abstract:

Background: Cesarean section has been associated with development of leukemia.

Objective: To review systematically studies conducted on the association of cesarean section and acute lymphoblastic leukemia (ALL) in children and adolescents.

Methods: Eligible studies were sought in Pubmed, Lilacs, Scielo, Scopus, CINAHL until April 30th, 2018. Inclusion criteria: case-control studies published in English, Spanish and Portuguese with children and adolescents aged 0-19 years from all world geographic regions. Exclusion criteria: studies without data on cesarean section, and studies with animals, in vitro and reviews. Data from identified studies were examined by two investigators, who reported the odds ratios (OR) and corresponding 95% confidence intervals (95% CI). Analyses were performed separately with the entire sample of studies and with the set of studies without subjects with Down syndrome, because it is a risk factor for leukemia. Random-effects models were used to calculate summary effect estimates. Analyses were conducted using Stata Statistical Software, version 14.

Results: Seventeen case-control studies (N=19211 cases/56339 controls) and nine case-control studies (N=9396 cases/25367 controls) without subjects with Down syndrome were included. Cesarean section was associated with increasing risk of ALL in the entire sample of studies [OR 1.075, 95% CI 1.000-1.157]. For studies without subjects with Down syndrome, cesarean section was also associated with ALL [OR 1.063, 95% CI 0.928-1.216].

Conclusion: Cesarean section presented a discreet increased risk for LLA. However, considering the high cesarean rates in some parts of the world, this factor may be relevant for the incidence of ALL in children and adolescents.

Biography:

Josy Xi Zhou, PhD. Research associate and biostatistician and statistician at Lineberger Comprehensive Cancer Center, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Abstract:

Many researchers summarized different methods of selecting covariates (e.g., forward and backward selection, high-demission proxy adjustment) to reduce bias in epidemiological studies. However, as the lack of a combinational statistical method and an effective programming perform for covariates selection, misclassifying, misadjusting, or missing covariates on fixed treatment comparisons or predicted the outcome is still a primary issue. For example, some covariates that are predictive of the outcome but have no influence on treatment status are often adjusted to balance treatment. As known, adjustment for such covariates can increase bias. The study conducts an essential algorithm called “Combination of Statistical Methods (CSM)” regarding the relation of variables to address the complex issue of limiting the number of potential covariates to a large number of covariates for adjustment in order to compare the causative effects of treatments.

CSM by standardized difference, bias, and odds ratio to declare the association of each covariate and select confounding covariates from a large number of observed variables (i.e., demographics, empirical, baseline-identifier, and measured potentially hidden covariates during the study window) and model adjustment as well. It is neither limited sample size nor the number of covariates. Moreover, CSM can further help researchers to discover important confounders that the previous studies ignored. In a word, CSM provides an efficient, convenient, and timesaving computing platform on selecting covariates for adjustment based on the association of each covariate in a summarized table, and generates effects or the evidence that limitation of adjusted preferred covariates in empiricism.

Biography:

Abstract:

Biography:

Kamolthip Vijitsoonthornkul has completed her B.Nursing, M.S and Ph.D in Dermatology from Mahidol University. At present she is the Head of Thai Behavioural Risk factor Survey (Thai BRFSS).

Abstract:

Background

Thailand has passes through the demographic and epidemiologic transition since the beginning of the 1960s¹.  Nowadays, three out of four died from non-communicable diseases and of those 55% was premature deaths before age of 70 years. Non-communicable diseases become the highest  burden diseases. To formulate effective intervention and guideline for non-communicable disease prevention and control as well as to education people on health turn into the key components of  strategies to decrease non-communication diseases. The information of monitoring and assessment of behavioral risk factors of non-communicable diseases, as well as availability of health services, is needed for such effective strategies. Thailand initiated the establishment of the Thai Behavioral Risk Factor Surveillance System (Thai BRFSS) since 2005. The system aims to set up collection data on basic health status and behavioral risk factors by regular periodic survey. The health survey with multi-stages sampling in general population aged 15-79 years has conducted every three years. Over ten years period, the health data-based has accumulation four rounds survey data. The objective of the study is to monitor trends in major behavioral risk factors by Thai Behavioral Risk Factor Surveillance System data between 2005 and 2015.      

Methodology 

 This study uses the four round survey datasets between 2005 and 2015 from Thai Behavioral Risk Factor Surveillance System. The information was collected by face to face interview with the same standard questions every round. In addition to weight and height were measured during the survey. The NCD surveillance indicators followed to USA Center of Disease Control and World Health Organization were analyzed with 9.3 SAS Program (Statistical Analyses System). The prevalence, age adjusted prevalence and relative percentage change were performed to monitor trends.   

Results

The results showed the estimated prevalence had highest increased in obesity (BMI >30.0 Kg/m²) from 3.0 to 7.5. After adjusting age adjusted prevalence, the percentage difference was 155%. While prevalence of overweight (BMI > 25.0 – 29.9 Kg/m²) had raised from 16.1 to 30.5 over this period and the percentage difference was 94%. In addition, the estimated prevalence trends of current alcohol drinking were from 37.4 to 36.2, and the percentage difference was 1.6%. The same as binge drinking prevalence slightly increased from 14.0 to 13.6 and the percentage change was 2.9%. While the rest alcohol consumption indicator had been quite different or higher increasing as heavy drinking was from 3.6 to 7.3 or the percentage difference was 97.4%. For adequate physical activity prevalence had declined from 91.5 to 82.2 with decreasing the percentage change - 9.9%.  Over this period, the current smoke prevalence slightly declined from 22.3 to 21.3 and the percentage change decreased -1.4%. The adequate fruit and vegetable consumption prevalence (or average greater than 5 serving per day in the past 7 days) increased from 17.4 to 24.3 and the percentage change was 40.1%.          

Discussion

Our analysis show that the trends of risk factors reflect to overall progresses in implementation of preventive measures. Increasing obesity and overweight are of public health concern. Public policies on unhealthy diet, physical inactivity had been endorsed immediately. Considering, the multisectoral policy response required to address risk factors reduction is essential strategy. As the result of the WHO Framework Convention on Tobacco Control was forced for tobacco control in the past two decades². The impacts of the tobacco measures display the trend of tobacco use in slow progress.  

Recommendation           

This finding suggests that it is essential to monitor and evaluation changing risk factors continuously. Accordingly, there is a need for development of national strategy in non-communicable disease surveillance in appropriate and useful direction, as well as enhancement of comprehensive knowledge and understanding in using indicators for accurate identification of risk factors and detect changes over time.