Scientific Program | Primary Healthcare-2016 | Dubai | UAE | Health Care Conference

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Day 22 : May 9, 2016

Track 10: Primary Care Nurse Practitioner
Track 11: Public Health Concepts
Track 12: Dental Primary Care

Location: The Oberoi Dubai, Dubai

Chair

Gustavo H. Marin

UNICEN, Argentina

Co-Chair

Nick Richards

SEHA Dialysis Services, Abu Dhabi

Aim: The aim of the study is to examine the health promoting behavior among adolescents through the adolescent friendly center services initiated at school campus. This study also wanted to investigate the receptiveness and perception of adolescent friendly services by parents, teachers and adolescents. Methodology: Through the process of Triangulation the research design was formulated and applied to suit the concept of the study (survey, one group pretest and posttest design was used). Data collection procedure: The data collection was done for a period of 9 months in 3 phases. A 5 point likert scale was used to assess the perception and receptiveness of parents, teachers and adolescents on adolescent friendly services at school. The multi-dimensional student life satisfaction scale was used to assess various aspects of adolescent’s life including family, friends, school, environment and self-esteem. The data were collected from 269 adolescents, 160 parents and 21 teachers. Findings: The study reported that students were benefitted by the adolescent friendly services. The students, parents and teachers had positive perception regarding the adolescent friendly services. The students, parents and teachers gave a positive feedback regarding the services. Majority (51.7%) of adolescents perception is that the parent is the suitable person to provide guidance and counseling to them. Parents (76.3%) perceive that Principal/teacher as the best person to provide guidance and counseling to adolescents, while the teachers (71.4%) feel that health care person is the suitable person to provide guidance and counseling to adolescents. The perception of the 3 group of people differs significantly, thus denoting each group has different opinion on the same issue from their own point of view. The results of the study revealed that the component of the MSLSS scale “self” has a significant (at 0.01 levels) difference in the mean scores of the adolescents, obtained before and after the initiation of the adolescent friendly center service at school. Conclusion: The study brings to attention the need for professional counseling and help related to awareness of adolescent friendly services and ways to solve issues regarding adolescent health.

Break: Networking & Refreshments 10:40-11:00 @ Foyer

Dybesh Regmi

United Arab Emirates University, UAE

Title: Motivational interviewing- A necessity in medical education

Time : 11:00-11:20

Time : 12:40-13:00

Biography:

Amna Khalifa Alhadari has graduated from Sheffield University–collage of medicine, Nephrology. She is now working as a Specialist Consultant in Nephrology department in Dubai Hospital.

Abstract:

Prevalence of end-stage renal disease (ESRD) has been rising steadily, chronic kidney disease is a silent killer, being silent is responsible for its late diagnosis. When the disease is silent (asymptomatic), it is usually detected by primary health care physician on routine testing or incidentally while testing for other problems. It is expected that a growing number of asymptomatic CKD patients will be managed in the primary care setting. There are simple steps to diagnose the disease, and its stages. Some factors such as controlling blood sugar in diabetics and blood pressure in hypertensives may delay the progression of the disease, avoiding nephrotoxins such as nonsteroidal anti-inflammatory pain killers may also help delay the needs for renal replacement therapy. These reversible factors could be tackled in primary health care and the time is defined when the care should be shared with the nephrologist. Complications of CKD starts and the symptoms appears with GFR being <30ml/min although it might start earlier in diabetics, this is the stage where the patients should be referred to the nephrologist to attend the pre dialysis educational clinics and to plan their further treatment under the supervision of the expertise and also to meet others who have similar problems. These support groups can be of great help psychologically, being gone through the same steps. Recently, predialysis educational clinics providing information about kidney disease, options for the management of CKD prior to dialysis (including pharmacological and dietary management) and the options for renal replacement therapy, proved to improve outcomes in management of CKD. Similar clinic has been initiated in Dubai hospital with great results.

Break: Lunch Break 13:00-13:40 @ Foyer and Panel Discussion

Duric N S

Helse Fonna Hospital, Norway

Title: ADHD children and adolescents: Long-term randomized controlled study

Abstract:

Background: Maps show well the spatial configuration of information. Considerable effort is devoted to the development of Geographical Information Systems (GIS) that increase understanding of public health problems and in particular to collaborate efforts among Clinicians, Epidemiologists, Ecologists, and Geographers to map and forecast disease risk. Objectives: Small populations tend to give rise to the most extreme disease rates, even if the actual rates are similar across the areas. Such situations will follow the decision-makers attention on these areas when they scrutinize the map for decision making or resource allocation. As an alternative, maps can be prepared using P-values (probabilistic values). Materials & Methods: The statistical significance of rates rather than the rates themselves are used to map the results. The incidence rates calculated for each village from 2000 to 2009 were used to estimate Î», the expected number of cases in the study area. The obtained results are mapped using Arc GIS 10.0. Results: The likelihood of infections from low to high is depicted in the map and it is observed that 5 villages namely, Odanthurai, Coimbatore Corporation, Ikkaraiboluvampatti, Puliakulam, and Pollachi Corporation are more likely to have significantly high incidences. Conclusion: In the probability map, some of the areas with exceptionally high or low rates disappear. These are typically small unpopulated areas, whose rates are unstable due to the small number of problems. The probability map shows more specific regions of relative risks and expected outcomes.

Track 1: Primary Health Care
Track 2: Primary Care Medicine

Location: The Oberoi Dubai, Dubai

Chair

Jay Kalra

University of Saskatchewan ,Canada

Co-Chair

Andrew W. Gottschalk

Ochsner Health System, USA

Alcohol has an association with intoxication and violence. Hazardous drinkers may be caight up in the criminal justice system as there is a relationship between alcohol and violence. For example, the risks of violence and offending behaviour increase with alcohol intoxication. A number of offences have been linked with hazardous drinking, including, criminal damage, theft, drunk and disorderly, violent assault, grievious bodily harm, domestic violence, sexual offences, drink drving, drug-related offences and public disorder and there are health risks too. An entry into the criminal justice system occurs with arrest and detention within a police custody suite. With regards to alcohol-related offences, depending on the time of the arrest e.g., evening or during the night or the previous day would mean being charged with a court appearance the next day. Whilst there has been limited research to date concerned with reducing alcohol consumption amongst offenders arrested and/or detained in police custody suites, such settings offer a number of advantages integrating the UK National Health Service primary health care workers. Successfully delivered interventions within these settings have potential to interrupt hazardous drinking earlier than those that are offered later in the cycle of offending, such as within probation settings, police custody and magistrate courts as well as better health outcomes.

Ingrid Schusterova

Children University Hospital, Slovakia

Title: Importances of cardiovascular disease in primary healthcare

Time : 11:40-12:00

Biography:

I Schusterová is an Associated Professor and the Head of the Department of Paediatrics and Adolescent medicine, Children University Hospital, P J Š University in Košice, Slovakia. At the same time, she is the Head Physician in the tertiary center for valvular and congenital heart defects, Eastern Slovak Institute of Cardiac and Vascular Diseases. She took specialization exam from Adult and Pediatric Cardiology at National Institute of Cardiac and Vascular Diseases in Bratislava, Slovak Republic. After Graduation, she took part in Fellowship Training at Ottawa Civic Hospital, and later on performed research work in the area of cardiology at University of Ottawa in Canada. In the period from 11/1999 till 7/2004, she completed her training at Cardiologic department, II. Internal Medicine Clinic, General hospital, Vienna under supervision of Professor Dr Gerald Maurer. Later in 2005, she broadened her professional knowledge and skills at Cardiac Surgery Clinic, Kardiocentrum Universitätsklinik in Bad Oyenhausen, Germany. Her research interests focus on preventive cardiology, obesity, and disorders of lipid metabolism, atherosclerosis and their prevention in the pediatric age group.

Abstract:

The process of atherosclerosis begins already in childhood and its relationship to the presence and intensity of the known cardiovascular risk factors has been already proved. Expert panel on integrated guidelines for cardiovascular reduction in children and adolescents highlighted early identification of risk factors and their elimination, as they plays a key role in the prevention of CVS diseases. AHA definition of “CVS health” encompasses these parameters: tobacco use, BMI adjusted to the gender and age of a child, physical activity, score of healthy food, total cholesterol, blood pressure, fasting glycaemia. As an important part of primary prevention we perform screening program, examining the serum concentration of total cholesterol in 11 and 17 years old children and adolescents allover Slovak Republic by primary paediatricians. In case, total cholesterol level are higher than 5.4 mmol/l patients are refered to the specialist outpatient care department – pediatric cardiologist and endocrinologist. Selective screening is provided in population with high risk of CVS disease (with positive family history of CVS diseases, concentrations of cholesterol higher than 6.2 mmol/l, etc.) in specialised terciary centers for lipid metabolism disorders and preventive cardiology. Markers of subclinical atherosclerosis, increased Carotid Intima-Media Thickness (CIMT) assessed with ultrasound, endothelial dysfunction (reduced arterial dilation), and increased left ventricular mass with cardiac ultrasound are examined in the pediatric centers of preventive cardiology. The identification of children and adolescents with high risk and effective management of identified risk factors represents the key point in prevention of future CVD.

Gustavo H. Marin

National University of Central Buenos Aires (ESCS-UNICEN), Argentina

Title: Proposal to improve Primary Health Care effectiveness

Time : 12:00-12:20

Biography:

Gustavo H Marin is Doctor in Medicine; Magister in Public Health; Magister in Health Economics; Magister in Political Sciences; Post-doc in Public Health Assistance, Paris, France. He is the Former Director of Primary Health Care of Buenos Aires; Director of Scientific Research Commission, Buenos Aires, Argentina; PAHO Health International Leadership Fellowship; Head Professor of Health, National University of Central Buenos Aires, UNICEN, Argentina. He is the Author of more than 150 papers and books in Public Health Research.

Abstract:

Primary Health Care (PHC) has been an excellent theoretical strategy however, in practice, after more than 30 years from the proposal, health’s results and indicators are not the one expected. From Alma Ata to our days, the epidemiological approach of diseases has changed. Chronic illnesses such as hypertension and diabetes mellitus have replaced the infectious diseases as the major causes of morbidity and mortality worldwide. Our group has focused the absence of nominal responsibility and customization of the practices by the health team as one of the major drawbacks of the lack of success with PHC strategy. To demonstrate this point, we examined the impact of nominal and customized health care model in patients with diabetes and hypertension. 2,400 patients were included in a randomized study. Patients were assigned to a control group or to an intervention. Both groups received medication prescribed by health professional for free, but “control” group received the treatment on demand; while in the "intervention" group, a weekly regular contact by one of the member of the health team. A nominal responsibility of the patient was being then assigned to that team’s member. After 24 months of running this health care model, results showed 46% reduction in cardiovascular events and 62% decrease in hospital admissions due to events related to these diseases. We conclude that PHC strategy showed a substantial improvement of the goals when a nominal responsibility is assigned to a member of the health team in order to provide this care practices.

Muhammad Ajmal Zahid

Kuwait University, Kuwait

Title: Prevalence of psychiatric morbidity in the primary health clinic attendees in Kuwait

Time : 12:20-12:40

Biography:

Muhammad Ajmal Zahid has done his MBBS from King Edward Medical College, Lahore. He is working as a Professor; Faculty of Medicine in Kuwait University, Kuwait. He has attended many international conferences and organized many workshops. He has published nearly 30 abstracts in many reputed journals. He is an invited speaker to many conferences.

Abstract:

Background: A substantial proportion of primary clinic attendees suffer from psychiatric disorders and many of them are neither recognized nor adequately treated by primary clinic physicians. Objectives: To determine the point prevalence of, and identify risk factors for, depression, anxiety and somatisation disorder in the primary health clinics in the country. Method: The Physical Health Questionnaires (PHQ-SADs) were administered to a randomized sample of 1046 primary clinic attendees in all the five governorates of the country over a 5-month period. The descriptive data were computed with chi-square tests while the association of demographic characteristics with psychiatric disorders was determined with the logistic regression test. Results: 42.7% of our patients suffered from psychiatric disorders including depressive (22.9%), anxiety (17.7%), and somatisation (33.4%) disorder. Comorbidity between the three disorders was found in 20.4% of the sample; 11% had two and 10.4% had all three disorders. The Kuwaiti nationals, female gender, older age group subjects and those with lower level of education were more likely to suffer from psychiatric disorder. Limitations: The inter-rater reliability may have affected the results as a large number of physicians were responsible for administering the questionnaires. Moreover, the study did not include eating and substance-abuse disorders and the findings were limited to detection of somatisation, depression and anxiety disorders. Conclusions: In order to ensure timely provision of appropriate treatment, the primary care physicians need adequate information on different forms of presentation, and basic front line treatment, of the common mental disorders at the primary care level.

Litty Varghese

Seha Ambulatory Healthcare Services, UAE

Title: Barriers to adult immunizations and strategies to improve coverage

Time : 12:40-13:00

Biography:

Litty Varghese (RN; MSN) is working as A/Head of Nursing Education, AHS/SEHA, UAE. She has 34 years of experience in the field of PHC, UAE and has expertise as JCIA chapter lead and tracer team member, quality improvement coordinator, diabetic clinic project coordinator, community program organizer, nurse educator, newsletter editor and researcher. She holds Master’s Degree in Community Nursing, Post Graduate Diploma in Nursing Administration and obtained certification in Principles of Epidemiology and Biostatistics from CDC, Atlanta. With her continuance in excellent professionalism, she won the First Seha Best Employee Award 2012, the 3rd Best Abstract Award at The Pan Arab Hypertension Conference in Abu Dhabi Feb. 5-9, 2000 and actively participated in winning the following Awards: 2009 Arab Health Award for PHC Chronic Disease program; 2010 Arab Health Award for Nursing HR development.

Abstract:

Vaccination against childhood communicable diseases through the Expanded Program on Immunization (EPI) is one of the most cost-effective public health interventions available. Most causes of vaccine preventable illness among children are relatively uncommon due to high rates of vaccination and very effective vaccines. Adult vaccination is one of the most important tool for reducing morbidity and mortality not just in the elderly but in other members of the society by increasing herd immunity, reducing severe clinical outcome and helping in eradication of the disease. The immunization program overall has been very successful with kids. We are not doing so well with adults. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations and other considerations. Although provider recommendation is a key predictor of vaccination, more often clients report not receiving vaccine recommendations at healthcare provider visits. Other barriers for vaccinating adults include the cost of providing vaccination services, inadequate or inconsistent payment for vaccines and vaccine administration, and acute medical care taking precedence over preventive services. Despite these challenges, a number of strategies have been demonstrated to substantially improve adult vaccine coverage, including patient and provider reminders and standing orders for vaccination. Providers are encouraged to incorporate routine assessment of their adult patients' vaccination needs during all clinical encounters to ensure patients receive recommendations for needed vaccines and are either offered needed vaccines or referred for vaccination.

Break: Group Photo & Lunch Break 13:00-13:40 @ Foyer

Tim Carr

Maharishi Ayurveda Association of Australia, Australia

Title: Personalized diet and lifestyle prescription in primary health care

Biography:

Tim Carr has completed his Medical degree from the University of Sydney in 1976 and Postgraduate studies at the MIU Institute of Ayur-Vedic Studies, Iowa, USA and the Gujarat Ayur-Veda University, Jamnagar, India in 1984-85. He has authored and co-authored several articles on the clinical applications of Maharishi Ayurveda. He was appointed as Expert Adviser on Ayurveda to Complementary Medicines Evaluation Committee, Therapeutic Goods Administration from 2002 to 2009. He is currently the President of the Maharishi Ayurveda Association of Australia.

Abstract:

Diet and lifestyle are recognized as the primary determinants of major chronic diseases. Primary health care physicians are ideally placed to advise patients about primary and secondary preventive measures. Compliance, however, is largely dependent on patientsâ€™ motivation. This can be improved by personalizing preventive advice, so that the recommended measures are more relevant to and compatible with the patient. Maharishi Ayurveda, the reconstruction of the ancient Vedic system of medicine, offers a systematic approach to adapt preventive advice to the patient. Central to this approach is the determination of the patientâ€™s mind/body type and digestive capability. This is assessed through a short questionnaire and simple clinical examination. The mind/body type is indicative of the patientâ€™s metabolic type and responsiveness to different food groups, exercise programs and daily routines. Knowing the patientâ€™s digestive capability, however, is the first step in formulating the dietary advice. It is known that the products of digestion can alter gut flora and the integrity of the gut lining and in turn influence the bodyâ€™s immunological and endocrinological responses. Dietary manipulation of the digestive function therefore can have a major impact on health outcomes. In this approach the patient also learns to monitor the effects of dietary and lifestyle changes and to modify them accordingly â€“ and is thereby empowered to take more responsibility for his or her health. Clinical experience confirms that by personalizing diet and lifestyle prescriptions in this way and educating the patient to self-monitor the results, compliance with preventive advice is greatly enhanced.

Brendan Mitchell

Gold Coast University Hospital, QLD, Australia

Title: Medication adherence one month after hospital discharge in medical inpatients

Time : 11:35-11:55

Biography:

Brendan Mitchell completed a Bachelor of Science at the University in Queensland in 2010, and subsequently a Doctor of Medicine at the University of Melbourne, graduating in 2014. He is currently working as a resident medical officer at Gold Coast University Hospital in Queensland, Australia.

Abstract:

Background: The rate of medication non-adherence has been consistently reported to be between 20-50%. The majority of available data comes from international studies, and we hypothesized that a similar rate of adherence may be observed in Australian patients. Aims: To determine the rate of adherence to medications after discharge from acute general medical hospital admission, and identify factors that may be associated with non-adherence. Methods: A prospective cohort study of 68 patients, comparing admission and discharge medication regimens to self-reported regimens 30-40 days after discharge from hospital. Patients were followed up via telephone call and univariate and multivariate binary logistic regression used to determine patient factors associated with non-adherence. Results: A total of 27 of 68 patients (39.7%) were non-adherent to one or more regular medications at follow up. Intentional and unintentional non-adherence contributed equally to non-adherence. Using multivariate analysis, presence of a carer responsible for medications was associated with significantly lower non-adherence (OR 0.20 (0.05-0.83), p=0.027) when adjusted for age, comorbidities, chemist blister pack and total number of discharge medications. Conclusions: Non-adherence to prescription medications is suboptimal, and consistent with previous overseas studies. Having a carer responsible for medications is associated with significantly lower rates of non-adherence. Understanding patientâ€™s preferences and involving them in their healthcare may reduce intentional non-adherence.

Trish Morison

Universal College of Learning, New Zealand

Title: When pregnancy is no longer the issue

Time : 14:40-15:00

Biography:

Trish Morison has completed a Masterâ€™s degree in Public Health. Her research was published in the New Zealand Journal of Primary Health Care. She has lectured in Anatomy, Physiology and Pharmacology for the last 14 years.

Abstract:

The rate of sexually transmitted infections amongst midlife and older heterosexual women in New Zealand is rising. Popular culture celebrates a heightened sexuality for this population group. However, depictions of sexually savvy â€˜cougarsâ€™ are at odds with reality for many women. International literature highlights that these women are often ill-equipped to negotiate safer sex and condom use, instead focusing on pleasing men and attributing their silence to spontaneity. The study aimed to explore the enablers and barriers to safer heterosexual sex as perceived by midlife and older New Zealand women, who are re-partnering or in casual relationships. This qualitative study utilized Interpretive Phenomenology Analysis, supported by the theory of gender and power, to examine the gender-normative assumptions and behaviors in womenâ€™s accounts of unprotected sex. Eight single women aged 40-69 participated in individual, in-depth interviews. Analysis indicated that these women held misconceptions about STI transmission but had not sought educational material, nor discussed their sexual health with clinicians. Results highlighted womenâ€™s ambivalence about prioritizing safer sex, preferring to comply with partnersâ€™ wishes, particularly when under the influence of alcohol. Women described valuing their own pleasure and their distaste for condom use, but data emphasized that women predominantly aligned their choices with menâ€™s preferences. This study highlights that midlife women are both ill-informed and vulnerable with regards to sexual health. Primary healthcare clinicians are well placed to provide education and sexual health advice.

Haw-Yueh Thong

Shin Kong Wu Ho-Su Memorial Hospital ,Taiwan

Title: Experience of Photopneumatic Therapy in Taiwanese Acne Patients

Time : 15:00-15:20

Biography:

Haw-Yueh Thong is Chief of the Cosmetic Center at Shin Kong Wu Ho-Su Memorial Hospital in Taipei, Taiwan ROC. After graduating from National Taiwan University College of Medicine, she completed an Internship in National Taiwan University Hospital. Her Residency was in dermatology at National Taiwan University Hospital and her Fellowship was in cosmetic dermatology at the University of California, San Francisco. She had worked closely with Professor Howard Maibach at UCSF. She is also a Graduate of Stanford University with a Masterâ€™s degree in management science and engineering, focusing on medical decision analysis. She has published numerous articles in professional journals and serves on many advisory boards and committees. Her interest in dermatology include acne vulgaris, cosmetic dermatology and filler injections

Abstract:

Acne is a disease of the pilo-sebaceous unit affecting both teenagers and adults. The treatment of acne is sometimes frustrating due to the emergence of antibiotic resistance, skin irritation and lack of novel therapy. Light and vacuum devices, also known as photo-pneumatic therapy, have been shown promising as a generally well-tolerated adjunctive treatment of acne vulgaris. We conducted a clinical study using such device to assess the efficacy and safety as an adjunctive treatment of acne in Taiwanese patients. Twenty patients received six sequential treatments every one to two weeks in the facial region. A 4Ã—4 cm2 area on cheek was chosen as a control area and was not treated with photo-pneumatic device. Safety parameters and adverse events were recorded. VISIA Complexion Analysis System was used for image analysis on the improvement of four parameters, namely, pigmentation, pore reduction, redness and porphyrin levels. There was an overall improvement in pigmentation, pore size, redness and porphyrin levels on treatment areas. The treatment areas showed statistically significant improvement (p<0.05) in pigmentation and pore sizes compared with the control areas using paired samples T-test. Mild and self-limiting localized adverse events, mostly focal petechiae or mild irritation, were reported. Our study has demonstrated that photo-pneumatic therapy is an effective, safe and relatively well-tolerated procedure in Taiwanese acne patients.

Salwan Tariq Al-Ani

UIT Arctic University of Norway, Norway

Title: Symptoms, signs and biomarkers during exacerbations of asthma and COPD in primary care: Which findings are most strongly related to a drop in lung function?

Time : 15:20-15:40

Abstract:

Objective: The aim of this study was to determine the knowledge and attitudes among women in a high-income developing country regarding pregnancy and antenatal care. Methods: Women who participated in the study were asked to complete a questionnaire. The questionnaire enquired about age, level of education, internet use, marital status and employment. It also included questions regarding their knowledge of ultrasound, the effects of sexual activity and other exercise during pregnancy, breast feeding and premature delivery. The collected data were subjected to statistical analysis using SPSS. Results: The total number of women included in this study was 205. A total of 115 women (56.1%) thought that the most important benefit of ultrasound was to discover fetal abnormalities. Only 75 (36.6%) thought that regular exercise was not harmful during pregnancy. Of the total respondents 116 (56.6%) of 205 thought that sex during pregnancy was harmful to the fetus or did not know. Age (P=0.001), marital status (P=0.001) and working status (P=0.005) were found to significantly affect their knowledge. Conclusion: Knowledge about pregnancy among Emirati women is low. There is a need for effective prenatal classes that focus on educating women about issues related to pregnancy and antenatal care.

Galya Ghalib Al Ghalib Alsharif

King Abdulaziz University Hospital, Saudi Arabia

Title: The benefit of pre- and post-operative instructions

Time : 17:25- 17:40

Biography:

Jawahar Jay Kalra, an educator, researcher, and quality health care advocate, is a Professor of Pathology in the University of Saskatchewan and has served as Head of the Department of Pathology and Laboratory Medicine. He is recognized for his many contributions as a clinical scientist, academic leader, and health system administrator. He has been a pioneer in establishing guidelines for thyroid-function testing, quality assurance program and contributed nationally and internationally in the area of total quality management. He has published extensively and is the author of the book â€œMedical Errors and Patient Safety: Strategies to reduce and disclose medical errors and improve patience safety.â€

Abstract:

Disclosure of an adverse event is an important element in managing the consequences of a medical error. We have previously reported the Canadian provincial initiatives encouraging open disclosure of a critical event and have suggested its integration into a â€˜no-faultâ€™ model. We reviewed and compared the various medical error disclosure initiatives across the globe (USA, Australia, New Zealand, and United Kingdom) to analyze the progress made in this area. In Australia, disclosure policy integrates the disclosure process with risk management analysis towards investigating the critical events. In New Zealand, in any adverse event, patients are rehabilitated and compensated through a no-fault state funded compensation scheme. The United States Joint Commission on Accreditation of Healthcare Organizations mandated an open disclosure of any critical event during care to the patient or their familiesâ€™. Effective communication between health care providers, patients and their families throughout the disclosure process is integral in sustaining and developing the physician patient relationship. The Canadian provincial initiatives, though similar in content, remain isolated because of their non-mandatory nature on disclosure. In conclusion, the designing of an error disclosure policy requires integration of various aspects including bioethics, physician-patient communication, quality of care, and team-based care delivery. The complexities of medical error disclosure to patients present ideal opportunities for medical educators to probe how learners are balancing the ethical complexities involved in error disclosure. We suggest that a uniform policy centered on addressing errors in a non-punitive manner and respecting the patientâ€™s right to an honest disclosure be implemented.

Track 5: Primary Care Services
Track 6: Primary Care Pediatrics

Location: The Oberoi Dubai, Dubai

Chair

Tochi Iroku-Malize

Hofstra Northwell Health School of Medicine, USA

Co-Chair

Brian Littlechild

University of Hertfordshire, UK

Session Introduction

Kaye Ervin

The University of Melbourne, Australia

Title: Care giver distress in dementia in rural Victoria

Time : 10:15-10:35

Biography:

Kaye Ervin has been a registered nurse for over thirty years, practicing predominantly in rural Victoria. Her passion is aged care and the focus of her research interests for the past 6 years. She is a member of the rural health department, the University of Melbourne. She has published 20 papers in international peer reviewed journals and regularly presents her research at National and International forums.

Abstract:

Aim: The aim of this study was to explore the levels of stress, anxiety and depression of informal carers caring for someone with dementia in a rural setting. The study also sought to determine carer’s primary source of stress and their use of dementia specific services. Methods: Carers of people with dementia were recruited to complete a survey that incorporated the Depression, Anxiety Stress Scales (DASS) to measure carer emotional well-being. The survey also included the Neuropsychiatric Inventory Questionnaire (NPI-Q), which assesses the presence and severity of behavioural and psychological symptoms of dementia (BPSD) of care recipients and their effect on the carer. They were also asked through an open ended question what they found most stressful in their caring role and what services they utilised. Results: A total of 39 carers completed surveys. Almost half of the respondents reported levels of stress and depression in the moderate to severe range as measured on the DASS. BPSD exhibited by care recipients, such as agitation, anxiety, aggression and nocturnal disturbance, showed a relationship to the level of stress reported by the carer as measured with the NPI-Q. Despite 84.6% reporting use of the Aged Care Assessment Service and 61.5% reporting provision of printed information on the services available, less than half of the carers utilised commonly available support services. Only 46.2% received financial compensation for their carer role. The predominant source of stress reported was the unremitting burden experienced when caring for someone with dementia.

Mariely Lima

Escola Superior de Educacao de Paula Frassinetti, Portugal

Title: Dogs on the front line of care: Timely information for family physicians

Time : 10:35-10:55

Biography:

Mariely Lima completed her degree in Speech Therapy and PhD in Biomedical Sciences. She is an invited Professor at two Universities in Portugal, where she lectures Post-Graduate and Master’s courses and supervises academic research. She is a founding member of ÂNIMAS, a Portuguese association, accredited by the Assistance Dogs International, which implements dog-assisted interventions and educates assistance dogs. She has been responsible for a number of dog-assisted activities and therapy programs for individuals with different diagnoses. She has attended different conferences as an invited speaker and published a number of scientific papers in peer-reviewed journals with good impact factor.

Abstract:

Recent years have witnessed a surge of interest in the relationship between dogs and human health with a concurrent emergence of new and exciting ‘medical’ roles for these animals. Not only studies show that owning a pet dog can have prophylactic and therapeutic value, but that incorporating these animals into clinical practice, can have a number of benefits for different types of patients. Dogs can also fill the role of assistants for people with disabilities, bringing important physical, psychological and social positive effects for their handlers, and even be trained to alert to seizures in epileptic patients and to changes in blood sugar levels in diabetics. In light of this, a significant “push” is currently being made by a number of researchers to integrate dogs into mainstream healthcare, notably through family medicine. Data, however, suggest that family physicians do not explicitly enquire their patients about dog ownership and feel uncomfortable to discuss the benefits of acquiring assistance or alert dog, and recommend dog-assisted interventions. In this communication, a timely and comprehensive update on the scientifically stronger evidence supporting the positive effects of dogs for human health will be provided. With it, one aims at calling for the attention of family care practitioners on the clinical potential of pet dogs, namely as motivators for adherence to treatment plans and on the importance of ensuring their patients knowledge about the possibility of engaging in dog-assisted interventions and/or acquiring an assistance or alert dog.

Break: Networking & Refreshments 10:55-11:10 @ Foyer

Naser Salihu

University Clinical Center of Kosovo, Kosovo

Title: Unusual orbital trauma

Time : 11:10-11:30

Biography:

Naser Salihu finished his residency in Medical Faculty in Ljubljana. He has completed his PhD in Medical Faculty at University of Prishtina. His interests in ophthalmology are anterior segment surgery, oculoplastic surgery and ocular trauma. He has published a lot of papers in International Journals. He also is the president of Kosovo Association of Ophthalmologists and head of trauma department in Eye Clinic, University Clinical Center of Kosovo.

Abstract:

Every orbital trauma represents a serious condition, because in most of the cases is associated with face and head trauma. We represent an unusual case of 12 years old boy with multiple face trauma associated with bilateral globe avulsion and optic nerve transection. He was involved in a tractor accident while driving it. The first signs to be notice as a serious condition from the GP are bilateral globe luxation and acute loss of vision. In this situation we have to pay attention about these signs as they may be caused by fracture of midface and orbit. Because of the closely related anatomy between orbit and midface with brain and blood vessels, this kind of injury may be life threatening. This situation is an emergency which needs multidisciplinary approach. This case should raise awareness on preventing injuries caused by driving agriculture machines from children, especially in developing countries where these injuries are more often.

Belinda Pustina

University Clinical Center of Kosovo, Kosovo

Title: Life threatening eyelid infection after minor trauma

Time : 11:30-11:50

Time : 12:30-12:50

Biography:

Duric N S is Child and Adolescent Psychiatrist and Clinical Researcher at Helse Fonna Hospital in Norway. She obtained her Medical degree from the University of Sarajevo in 1980 after which she pursued specializations in ear, nose and throat from the Clinical University Center of Sarajevo (1988) and child and adolescent psychiatry from Mental Health Clinic Kristiansand, Norway (2001). She completed her PhD from the University of Bergen. She has published many articles in prestigious journals and has served as a scientific reviewer of repute. She has a long engagement as a member and leader of charity work.

Abstract:

Maysoun Al Rushood

Kuwait University, Kuwait

Title: Anaphylaxis management: Knowledge and practice among pediatricians

Time : 12:50-13:10

Biography:

Maysoun Al Rushood is an Assistant Professor at the department of pediatrics in Kuwait University. After graduating from Kuwait Medical School, she joined the pediatric residency program in McGill University in Montreal, Canada. She did further training in the specialty of pediatric allergy and clinical immunology in McGill University, Canada. She has the following certificates: The American Board of Pediatrics, The Canadian Board of Pediatrics and The Canadian Board of Allergy and Clinical Immunology. She is a member in many medical associations in the field of pediatrics and allergy and immunology, such as The American Academy of Pediatrics and The American Academy of Allergy, Asthma and Immunology. Her special interests are primary immunodeficiency and various allergic diseases as well as medical education. She is actively involved in research and teaching at the Faculty of Medicine besides her clinical work in the hospital.

Abstract:

Anaphylaxis is a serious allergic reaction that is rapid in onset and might cause death. It is fatal in around 1% of cases. Studies have shown that there is underuse of intramuscular epinephrine as a first-line treatment despite the international guidelines. It has been demonstrated that many pediatricians have difficulties in anaphylaxis diagnosis and management. My personal observation is that there is delay or failure to use IM epinephrine, which is lifesaving, in cases of anaphylaxis. This is the first study on anaphylaxis in Kuwait. The aim of which is to assess the knowledge on anaphylaxis management among pediatricians and pediatric emergency physicians and factors influencing their practice. The ultimate goal is to be able to provide appropriate tools (updated ER protocol, scientific days, and workshops) to improve patient care and outcome. This is a survey questionnaire that will cover aspects on management based on the international guidelines. The study population is going to be pediatricians in the wards, clinics, ER or PICU, where they might encounter anaphylactic reactions.

Ghada Mohammad Abu Shosha

Zarqa University, Jordan

Title: Perceived challenges of mothers having a child with Thalassemia major: A phenomenological study

Time : 13:10-13:30

Biography:

Lamia K Alsenaidi is a 6th year Medical student in United Arab Emirates University/College of Medicine and Health sciences. The expected date of her graduation is May 2016. She has published 2 papers in reputed journals and she is currently working in a new research about cancer awarness

Abstract:

Thalassemia is a genetic blood disorder that requires a life-long treatment of blood transfusion and chelating drugs. It poses a range of stressors and challenges for patients, their families, and health care team. Mothers are the primary caregivers and therefore, understanding their perceptions of having a child with thalassemia is very important. This study aimed to explore challenges of having a child with thalassemia major as perceived by Jordanian mothers. A descriptive phenomenological approach was used. Twenty three Jordanian mothers were selected purposefully from two major thalassemia treatment clinics in Jordan to participate in this study. Semi-structured, face-to-face interviews were used to obtain the participants' perspectives. Interview sessions were transcribed verbatim, and translated from Arabic to English. Data were analyzed using Colaizzi’s process of descriptive phenomenology. The study revealed that thalassemia has a significant impact on mothers' lives. Many forms of challenges associated with rearing children with thalassemia were illustrated using four major themes: “Psychosocial problems"," Financial problems", "Inadequate information", and “Disease consequences". Participants expressed their worries and fear resulting from the complications of the disease and its treatment. They voiced their needs for more information about the disease and managing the side effects of treatment. Therefore, nurses are advised to address the needs of mothers caring for children with thalassemia and to provide psychosocial support and sufficient information about the child's disease and its treatment.

Break: Lunch Break 13:30-14:10 @ Foyer

Rosa Gimenez-Garcia

Hospital Rio Hortega, Spain

Title: Photodistributed hyperpigmentation induced by antihypertensive drugs: Two case reports

Biography:

Rosa Gimenez-Garcia is working as a Clinical Assistant in Hospital Universitario Rio Hortega, Valladolid, Spain and Associate Professor as Faculty of Medicine in Valladolid Spain. She done her residency 1981-1985. Hospital Clinico UNiversitario de Valladolid, DEPARTMENT OF DERMATOLOGY. Worked as Consultant Dermatologist in Hospital Clinico Valladolid and its area of health May 1985-Novembre 1987. Post of Clinical Assistant .Hospital Virgen Blanca" de LeÃ³n (Obtained through public competitive examination) 04-11-87 y el 06-11-90. Post of Facultativo Especialista de Ãrea (Clinical Assistant) (obtained through public competitive examination) "Hospital Rio Hortega" Valladolid 06-11-90- present.

Abstract:

Introduction: Drug-induced skin pigmentation is estimated to account for 10-20% of all cases of acquired hyperpigmentation. Antihipertensive drugs induced hyperpigmentation has been rarely described. Calcium channel blockers are commonly prescribed cardiovascular agents and have been associated with skin reactions in sun-exposed areas. No case of cutaneous hyperpigmentation associated with lercanidipine has been formally reported up to date. We present two cases of photo distributed hyperpigmentation induced by telmisartan- hydrochlorothiazide combination and lercanidipine. Case Reports: Case 1: A 79-year-old man was referred to us for evaluation of hyperpigmented lesions. He had been given telmisartan 80 mg and hydrochlorothiazide 12.5 mg daily for essential hypertension for 3 years and he has noticed hyperpigmentation and pruritus on sun exposed areas a few months after starting therapy. Discontinuation of the drug caused gradual reduction of photo distributed pigmentation. Case 2: A 68-year-old woman, with personal history of frontal fibrosing alopecia, presented to us with a 4 months history of photosensitivity (during the previous summer) and increasing pigmentation on her face. She had been given lecardinipine for essential hypertension for approximately 4 years. Physical examination revealed a dark-brown reticulated pigmentation on the malar area and superior eyelids. A skin biopsy specimen showed interface changes with vacuolar degeneration and pigmentary incontinence. Discussion: Drug-induced hyperpigmentation has been associated with many different types of medications, including anti-malarials, amiodarone, cytotoxic drugs, tetracyclines, heavy metals or psychotropic drugs (phenothiazines and imipramine). Clinical features are very variable with a large range of patterns, colors and distributions. The interval from the initiation of treatment through the onset of hyperpigmentation is markedly longer (even several years) than the intervals for other types of drug eruption. Antihypertensive drugs are very commonly prescribed. Photodistributed hyperpigmentation associated with diltiazem, a calcium channel blocker widely used in the treatment of cardiovascular disease, has been described. Oral mucosal and cutaneous hyperpigmentation associated with amlodipine, and telmisartan induced hyperpigmentation have been reported. Conclusions: Drug-induced cutaneous pigmentation, in particular with antihypertensive medications, must be considered in unexplained pigmented lesions, especially in the elderly. Cessation of the suspicious drug typically results in a gradual fading of the rash, although in some cases it never completely resolves.

Litty Varghese

Ambulatory Healthcare Services-SEHA, UAE

Title: Barriers to adult immunizations and strategies to improve coverage

Biography:

Litty Varghese; RN; MSN is working as A/Head of Nursing Education, AHS/SEHA, UAE. She has 34 years of experience in the field of PHC, UAE and has expertise as JCIA chapter lead and tracer team member, quality improvement coordinator, diabetic clinic project coordinator, community program organizer, nurse educator, newsletter editor and researcher. She holds Masterâ€™s Degree in Community Nursing, Post Graduate Diploma in Nursing Administration and obtained certification in Principles of Epidemiology and Biostatistics from CDC, Atlanta. With her continuance in excellent professionalism, she won the First SEHA BEST EMPLOYEE Award 2012, the 3rd Best Abstract Award at The Pan Arab Hypertension Conference in Abu Dhabi Feb. 5-9, 2000, and actively participated in winning the following Awards: 2009 ARAB HEALTH AWARD FOR PHC Chronic Disease program; 2010 ARAB HEALTH AWARD FOR Nursing HR development.

Abstract:

Vaccination against childhood communicable diseases through the Expanded Program on Immunization (EPI) is one of the most cost-effective public health interventions available. Most causes of vaccine preventable illness among children are relatively uncommon due to high rates of vaccination and very effective vaccines. Adult vaccination is one of the most important tool for reducing morbidity and mortality not just in the elderly but in other members of the society by increasing herd immunity, reducing severe clinical outcome and helping in eradication of the disease. The immunization program overall has been very successful with kids. We are not doing so well with adults. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Although provider recommendation is a key predictor of vaccination, more often clients report not receiving vaccine recommendations at healthcare provider visits. Other barriers for vaccinating adults include the cost of providing vaccination services, inadequate or inconsistent payment for vaccines and vaccine administration, and acute medical care taking precedence over preventive services. Despite these challenges, a number of strategies have been demonstrated to substantially improve adult vaccine coverage, including patient and provider reminders and standing orders for vaccination. Providers are encouraged to incorporate routine assessment of their adult patients' vaccination needs during all clinical encounters to ensure patients receive recommendations for needed vaccines and are either offered needed vaccines or referred for vaccination.

Mariamma Kuriakose

Malankara Orthodox Syrian Church Medical College, India

Title: Can Insects Transmit Hepatitis B virus?

Abstract:

Galya Ghalib Al Ghalib Alsharif

King Abdulaziz University Hospital, Saudi Arabia

Title: The Benefit of pre- and post- operative instructions

Biography:

Galya Ghalib Al Ghalib Alsharif has completed her MBBS from King Abdulaziz University Hospital. She is currently a medical intern.

Abstract:

Millions of people each year undergo surgery. Despite the development in the surgical field; patients remain in fear of the complications that may take place. 140 patients were randomly selected from the clinics at King Abdulaziz University Hospital, in Jeddah. A questionnaire was used to test their knowledge of the instructions before and after a surgery; ear nose and throat specialty in particular. Another questionnaire was given after educating the patients of the instructions in one of the surgical operations in this specialty. The aim is to educate the patients about these instructions in the event of undergoing any future operations. The result was: 64% of patients knew the existence of instructions before and after operations, while 36% didnâ€™t know the existence of such instructions. The most known instruction by 86% was: to stop eating at midnight on the night of the operation. And the least known by 34% was: to stop taking Aspirin 7 days before the operation. The benefit rate from the explained instructions was 100%. 54% of these patients received only verbal instructions, while 10% received both verbal and on paper instructions, and the remaining 18% of patients didnâ€™t receive any instructions.

Kaye Ervin

The University of Melbourne, Australia

Title: Care giver distress in dementia in rural Victoria

Time : 10:15-10:35

Biography:

Abstract:

Aim: The aim of this study was to explore the levels of stress, anxiety and depression of informal carers caring for someone with dementia in a rural setting. The study also sought to determine carerâ€™s primary source of stress and their use of dementia specific services. Methods: Carers of people with dementia were recruited to complete a survey that incorporated the Depression, Anxiety Stress Scales (DASS) to measure carer emotional well-being. The survey also included the Neuropsychiatric Inventory Questionnaire (NPI-Q), which assesses the presence and severity of behavioral and psychological symptoms of dementia (BPSD) of care recipients and their effect on the carer. They were also asked through an open ended question what they found most stressful in their caring role and what services they utilized. Results: A total of 39 carers completed surveys. Almost half of the respondents reported levels of stress and depression in the moderate to severe range as measured on the DASS. BPSD exhibited by care recipients, such as agitation, anxiety, aggression and nocturnal disturbance, showed a relationship to the level of stress reported by the carer as measured with the NPI-Q. Despite 84.6% reporting use of the Aged Care Assessment Service and 61.5% reporting provision of printed information on the services available, less than half of the carers utilized commonly available support services. Only 46.2% received financial compensation for their carer role. The predominant source of stress reported was the unremitting burden experienced when caring for someone with dementia.

Symposium on Preventive cardiology and obesity, dyslipidemia

Location: The Oberoi Dubai, Dubai

Chair

Gillian Hood

Queen Mary, University of London, UK

Co-Chair

Marc Matthews

Mayo Clinic, USA

Session Introduction

Schusterova I

P. J. Å afÃ¡rik University in Kosice, Slovakia

Title: Universal screening for hypercholesterolemia in children at 11- and 17 years of age: unique in Slovakia for 17 years

Time : 13:40-14:25

Biography:

Schusterová I is an Associate Professor and the Head of the Department of Paediatrics and Adolescent Medicine, Children University Hospital, P J Š University in Košice, Slovakia. At the same time, she is the Head Physician in the Tertiary Center for Valvular and Congenital Heart Defects, Eastern Slovak Institute of Cardiac and Vascular Diseases. She took specialization exam from Adult and Pediatric Cardiology at National Institute of Cardiac and Vascular Diseases in Bratislava, Slovak Republic. After Graduation, she took part in Fellowship Training at Ottawa Civic Hospital, and later on performed research work in the area of Cardiology at University of Ottawa in Canada. In the period from 11/1999 till 7/2004, she completed her training at Cardiologic Department, II. Internal Medicine Clinic, General Hospital, Vienna under supervision of Professor Dr Gerald Maurer. Later in 2005, she broadened her professional knowledge and skills at Cardiac Surgery Clinic, Kardiocentrum Universitätsklinik in Bad Oyenhausen, Germany. Her research interests focus on preventive cardiology, obesity, and disorders of lipid metabolism, atherosclerosis and their prevention in the paediatric age group.

Abstract:

Atherosclerosis begins in childhood. In adults, elevated non-HDL-cholesterol concentrations, low HDL-cholesterol concentrations, hypertension, smoking, diabetes, and obesity are associated with advanced atherosclerotic lesions and increased risk of clinically manifest atherosclerotic disease. These risk factors also are associated with early atherosclerosis in young persons. Control of these risk factors is the major strategy for preventing atherosclerotic disease. The current recommendations for the primary prevention of cardiovascular diseases in Slovakia include universal nation screening for hypercholesterolemia: national programmed routine examination of 11- and 17 years old children by primary pediatricians. The national universal screening in Slovakia was introduced gradually, and the referral rate to the tertiary institution reached its expected level only in 1998. Screening was gradually implemented throughout the whole country, reaching an estimated majority of 11 and 17-years-old children, approximately 1 million from 2004 until now. Data for the efficacy of a national universal screening for detection of familiar hypercholesterolemia are lacking. The universal screening for hypercholesterolemia together with familiar history and premature cardiovascular complicationidentified a disease- causing variant for familiar hypercholesterolemia. The long-range prevention of atherosclerosis and its squeal by control of the risk factors for adult coronary artery disease should begin in adolescence and young adulthood. Primary pediatricians play an important role in primary prevention of cardiovascular diseases, detection of familial hypercholesterolemia in a cohort of children with hypercholesterolemia. Clinic for preventive cardiology and lipid metabolism disorders focus on management and treatment of children with positive screening test result.

Tohatyova A

P J Å University in KoÅ¡ice, Slovakia

Title: Childhood obesity and obesity reduction program

Biography:

Alzbeta Tohatyova is currently a PhD student at Medical Faculty, P J Safarik University in Kosice, Slovakia. Her research interests focus on pediatric cardiology and preventive cardiology.

Abstract:

Over the past three decades the prevalence of overweight and obesity has increased substantially. Childhood obesity is an important public health problem and is of particular interest because of possible long-term associations with adult body weight status and morbidity. Obesity is associated with a shortened life expectancy mainly because of increased risk for cardiovascular disease and obesity related cardiomyopathy. However, a third of obese individuals never develop CV disease; and this group is called the metabolically “healthy” obese. Recent evidence suggests that not all obese persons are negatively affected by their body weight and that weight loss does not necessarily always improve health. Obese youth will live a longer portion of their life as obese and with chronic health conditions. Moreover, although weight loss in obese youth is associated with improved metabolic outcomes, weight management goals for this age group are more ambiguous than in adults. In our Children Faculty Hospital, the management of obesity includes hospitalization to exclude secondary causes of obesity, spa treatment and outpatients programs. Our highly specialized Clinic for preventive cardiology and lipid metabolism disorders, focus on individual and group outpatient therapy for obesity, and also on cardiovascular risk stratification in children and adolescent. Highly organized team of specialists is working on interdisciplinary outpatient program- “Obesity reduction program, School of Obesity”. This program is focused on the same sex groups of children and adolescent who are in the same range of ages. The goal of this program is to win the fight against obesity- prevention of cardiovascular disease associated with obesity, and treatment of childhood obesity by new ways. We confirmed that group outpatient therapy for children and their parents had significantly better results in body weight loss (p<0.05) compared to individual therapy during the childhood.

Break: Pleanary Session Continues

Schusterova I

P J Å University in KoÅ¡ice, Slovakia

Title: Obesity and heart: Cardiologistâ€™s view

Biography:

Abstract:

Obesity causes chronic volume overload (increased preload) and dilation of the left ventricle (LV) of the heart. Hypertrophy LV itself as an adaptation to expanded intravascular volume determines the damage of the diastolic function LV especially by influencing later diastolic passive infilling. For persistent obesity they may of course result in systolic dysfunction and manifest heart failure while damaging the function of the myocardium correlates with body mass index and the duration of obesity. The clinical picture of the consequences of cardiomyopathy depends on the severity of the emerging cardiac changes, age, duration and severity of the obesity, as well as on associated diseases, which often accompany obesity (arterial hypertension, disorder in the metabolism of lipids and glucose, ischemic heart disease, sleep apnea syndrome, etc.). Studies of obese child patients indicate, initial signs of cardiomyopathy – changes of indices of diastolic and systolic functions, though they are clinically silent. Early structural and functional changes in the myocardium of obese children and overweight children represent a higher risk of clinical manifestation of this cardiomyopathy in early adulthood, and therefore they require increased vigilance of the pediatricians and pediatric cardiologists. In one of our study, we confirmed differences not only in LVM (p<0.001) and LVM index body height2.7 (p<0.05) but as well as the differences in left ventricle size (IVS (p<0.01), LVEDD (p<0.005), LVESD (p<0.05), PWTh (p<0.001)) and volumes include stroke volume (p<0.05) in spite of normal preserved systolic function in obese and overweight children. Increased LV mass in obese individuals is also a result of the increased amount of epicardial fat and fat infiltration of the myocardium. The thickness of epicardial adipose tissue (EAT) as measured by echocardiography represents an independent predictor of visceral adiposity. A very good positive correlation was found between echocardiographic measurements of EAT and MRI measurements, which represent the gold standard for assessing visceral fat mass. We confirmed significantly higher thickness of echocardiography EAT was found in overweight and obese adults and children (p<0.001). However, it requires the creation of a standardized examination methodology for children age, as well as the creation of certain reference values while considering the growth and development of children.

Track 7: Community Primary Care
Track 8: Primary Healthcare Management
Track 9: Primary Care Epidemiology

Location: The Oberoi Dubai, Dubai

Chair

Fahad Alkherayf

University of Ottawa, Canada

Co-Chair

Brian Littlechild

University of Hertfordshire, UK

Session Introduction

Gulnaz Karatay

Tunceli University, Turkey

Title: Effect of scenario-based school based prevention program to the abilities of students to say

Time : 14:10-14:30

Biography:

Gulnaz Karatay is an Associate Professor in Public Health Nursing in the Tunceli University Health High School in Turkey. She completed her Master and Doctorate program from Hacettepe University Faculty of Health Science in Ankara, Turkey. Her academic background and work experience as a Nurse-Researcher has enabled her to develop a range of skills. Accordingly, she has been in Prato Hospital in Italy-Florence for 3 months and US-Wisconsin Madison University for 3 months. Her research focuses on motivational interviewing for smoking cessation, improving cognitive function of the elderly, prevention of substance use in adolescent period and women health.

Abstract:

Objective: To develop students' ability to say "No to Substances" in order to prevent substance use. Method: A pre- and post-test study design was used with a single group. All of the 8th graders (n=282) in 3 schools located in an Eastern Province of Turkey were included in the study; however, the study was completed with n=249 students, who responded to both pre- and post-tests. The scenario-based training, developed by the researchers, was applied school counselors for 4 weeks. For this purpose, a teaching booklet was prepared for the teachers as well as a supportive material in a comic book format for students. The scenarios were to improve adolescents' abilities to say "No" to substance offers, to prevent addictive substances, and to call for help if needed. The pre-test of the study was applied in November 20-25, 2015, and the post-test was applied in January 4-8, 2016. The data of the study were collected using personal information form, self-efficacy scale in protection against substance abuse for adolescents, and Rosenberg self-esteem inventory (ROSE). The obtained data were assessed using percentages, Chi-square, t-test and F-test in the SPSS software. Results: The average age of the students was 13.53±0.57. Of the students, 8.5% stated they tried smoking, and 25% stated that they used alcohol. The mean score in the self-efficacy scale in protection against substance abuse for adolescents was found to increase significantly (103.20±20.00) after the training compared to the situation before the training (92.11±17.08) (t=6.374, p=0.001). Similarly, the mean Rosenberg self-esteem inventory score was increased after the training (1.51±0.85) compared to the pre-training score (1.29±0.79), and the difference was statistically significant (t=2.828, p= 0.005). Conclusion: Short-term outcomes of the class-based scenario training were observed to be effective in the development of self-efficacy for substance abuse prevention.

Rosa Gimenez-Garcia

Hospital Rio Hortega,Valladolid,Spain

Title: Photodistributed hyperpigmentation induced by antihypertensive drugs: Two case reports

Time : 14:30-14:50

Biography:

Rosa Gimenez-Garcia is working as a Clinical Assistant in Hospital Universitario Rio Hortega, Valladolid, Spain and Associate Professor in the Faculty of Medicine in Valladolid Spain. She has completed her residency during 1981-1985 at Hospital Clinico Universitario de Valladolid. He worked as Consultant Dermatologist in Hospital Clinico Valladolid and its area of health from May 1985-November 1987. He obtained the Post of Clinical Assistant at Hospital Virgen Blanca" de León and at "Hospital Rio Hortega" Valladolid from 06-11-90 to present.

Abstract:

Manjula A Rao

Kasturba Medical College, India

Title: Assessment of emotional problems faced by people living with HIV/AIDS (PLWHA) and to study the need for family support to manage the emotional problems

Time : 14:50-15:10

Biography:

Manjula A Rao has completed her MPhil in Social Work from Coimbatore University and PhD scholar from the same University. She is working as a Counselor in Kasturba Medical College, Mangalore. She has 20 years experience in HIV field. She has presented 15 scientific papers in national and international conferences. She has published papers on HIV and received Best Paper Award in Practitioner Category. She is the Director of RUDES and ADHAR charitable trust. She is a national level master trainer for different organization and member of many organizations which works in welfare of the community.

Abstract:

HIV/AIDS is one of the most alarming social challenges faced by the people in the Universe. It has been described as the “most devasting epidemic humanity has ever known”. Human immunodeficiency virus (HIV) is a lentivirus that causes the infection and acquired immunodeficiency syndrome (AIDS). As on today the disease is fatal, but it is totally preventable. AIDS is the end result of a viral infection, caused by a group of viruses known as Human Immunodeficiency viruses. UNDP 2010 reports that India had 2.39 million people living with HIV at the end of 2009. The present study highlights the effect of emotional problems faced by the person with HIV and AIDS. HIV infection has a major impact on the mental health of the person which has a chance of causing cognitive impairment, mood and anxiety disorders, and even psychotic manifestations. Various psychological issues leading to manifestations among PLWHAs are acute-stress reactions, anxiety disorders, depression, mania, psychosis and neuro-psychiatric manifestations of HIV associated neurological illness. Testing for HIV is itself evokes a lot of anxiety. It is very general that most of them take lot of time to muster up courage to undertake the test. Not all will react in a positive way. The first reaction is anger, depression and failure to cope up with life. Suicidal thoughts will occur. At this time there is a need for proper counseling. Appropriate counseling or absence of any other social support can devastate an individual. They experience a lot of stress mentally as many emotional problems occur to them. To cope up with these stressors there should be a need for social support for which the PLHWHA could be able to tell them about the sero-status for moral, emotional and psychological support. Majority of our study population included males (52.2%) and rest are females (37.8%). Majority of them had primary (58.6%) and secondary (37.8%) level of education. 99.1% are infected through sexual contact. 38.7% of respondents receive support from spouse, and secondary family members. 95.5% respondents are satisfied with the support they get from family members. Most of our respondents (41.4%) always and sometimes (55.9%) get financial support for their medication, only 2.7% will never get support. 94.6% of respondents feel they have someone to listen their feelings and thoughts. 41.4% respondents get reminder to take ART medication from their family members. 81.1% of the respondents felt that they can always participate in family function. The present study highlighted the fact that adherence of ART treatment is better when family support is high.

Madhusudan B Jani

Gujarat Adani Institute of Medical Sciences, India

Title: Rhythmic inversion exercise techniques: Healthier approach to hypertension

Time : 15:10-15:30

Biography:

Abstract:

Inversion therapy has been around from a long time – inversion has been talked about since 400 BC when Hippocrates, the father of modern medicine, monitored patients being hung from a ladder in the interests of their health. Very recently, there has been a little interest in the West, in objectively documenting the effects on health, especially for the more advanced or esoteric practices, such as inversions. Inversion can act positively on the cardiovascular system, as blood flow in some parts aided and in other parts challenged, which can lead to a mild cardiovascular workout. Regular inversion can have a positive effect in fighting varicose veins, and, as blood helps to infuse the brain, the increased oxygen it carries may have positive impact on maintaining brain function in later years. Those that swear by inversion and its benefits say that inversion therapy helps in correcting the imbalances affected by gravity. Because we spend most of our life sitting or standing, blood is pulled down into our lower body and our circulation progressively grows sluggish. Hanging upside down, reverses the blood flow temporarily, which allows more blood and oxygen to reach the brain. Pre and post rhythmic inversion exercise, on floor and under water, blood pressures were registered and concluded as healthier ways to control hypertension.

Essam Mahran

Cairo University, Egypt

Title: NSAIDs which of which?

Time : 15:30-15:50

Biography:

Essam Mahran has completed his MD degree in April, 2010 from Cairo University. From that date, he is working as lecturer of Anesthesia and pain therapy in National Cancer Institute, Cairo University. He has published more than 5 papers in reputed journals and has active participation in many conferences including ESA, 2012 in Paris, European Congress of Airway Management, 2013 in Istanbul, WIP, 2014 in Mastricht and AOSRA, 2015 in Bangkok.

Abstract:

None Steroidal Anti-Inflammatory Drugs (NSAIDs) are analgesic, antipyretic and anti-inflammatory drugs. NSAIDs are commonly used drugs with more than 13 millions chronic users in USA with direct cost more than 2 billion dollars per year. They have serious side effects up to mortality representing 15th commonest cause of death in USA. The NSAIDs are present in the 3 steps of the WHO step ladder analgesic pattern. NSAIDs are classified according to their degree of selectivity on cyclo-oxygenase enzyme into non-selective drugs and newer Cox 2 selective NSAIDs. They vary in their potency, duration and elimination. Because of their CVS risks both Roficoxib and Valdicoxib are withdrawn from the market. GIT risks of gastric erosion and peptic ulcer are more with non selective NSAIDs. Renal side effects result mainly from vasoconstriction of afferent arteriole. Other side effects include allergy and prolonged labor. NSAIDs choice should be tailored to each patient according to his/her age and medical status. In hepatic patients paracetamol can be used in mild to moderate impairment with reduction of the maximum daily dose. In renal impairment NSAIDs, dose adjustments are made according to creatinine clearance. NSAIDs during pregnancy can result in early closure of fetal ductus arteriosus and preterm birth, So NSAIDs are contraindicated in 3rd trimester in France and their FDA approval is category D in third trimester and category C in first and second trimester. During lactation paracetamol, ibuprofen and diclofenac are safe. They vary in their pediatric doses. Celecoxib has also anti-cancer effect.

Anil Kumar Chhotalal Mithani

Omdurman Teaching Hospital, Sudan

Title: PHC Sudan- Knowledge exchange to improve primary healthcare outcomes from a Urologistâ€™s perspective in Sudan

Time : 15:50-16:10

Biography:

Anil Kumar Chhotalal Mithani completed his MBBS from Alexandria University and obtained MD from China. He is carrying over 30 years of clinical experience and also worked as the Director of Government Hospitals. Currently, he is working as an Associate Professor at University of Bahri and Head of Urology at Omdurman Teaching Hospitals which has 600 beds and treat the maximum number of patients in Sudan. He attended Urological Conferences in Iraq, Egypt and many other countries. Also, he is the Treasurer of the Sudan Urology Association and the President of the Indian Community in Sudan.

Abstract:

Abstract:

Electrical muscle stimulation (EMS) is just following the steps and evolution of exercise: one of the enormous accumulations of evidence about its possible medical benefits and high safety and feasibility profile. EMS is nearing inclusion at contemporary essential guidelines for health maintenance, primary and secondary prevention and rehabilitation, with a range of actions extending from healthy people to various categories of chronic patients. It appears to exert regenerative and reparatory effects on the endothelium, to mobilize endothelial progenitor cells; to favorably affect the microcirculation; to induce mesenchymal stem cell potentiation; to exert multilevel beneficial immune, metabolic and endocrine actions related to cytokine, hormonal, neural, anti-inflammatory and anti-oxidant modifications. By these pleotropic pathophysiologic mechanisms, it is evidenced that, EMS improves cardiovascular fitness and overall health; prevents ICU- acquired weakness or sarcopenia, pressure ulcers and venous thromboembolic disease; decreases pathological cardiac remodeling in heart disease, and sympathetic activity; alleviates dyspnea in malignancy or COPD; improves glucose metabolism in metabolic syndrome or diabetes patients; reinforces post injury neuroregeneration; improves spasticity, urinary/fecal incontinence, pelvic floor dysfunction, and chronic pain syndromes; enhances tissue perfusion; and assists in muscle reeducation. Further emerging applications relate to psychological health (such as depression); to post-surgical prevention of atelectasis and cough reinforcement; and to dysphagia in stroke or anorexia nervosa patients. Many applications of this endless list are FDA approved already. EMS needs to be considered as part of numerous medical conditions, and any health-care professional needs to be aware of its indications.

Break: Panel Discussion

Track 2: Primary Care Medicine
Track 3: Family Medicine and Primary Care
Track 4: Quality in Primary Care

Location: The Oberoi Dubai, Dubai

Chair

Gillian Hood

Queen Mary, University of London, UK

Co-Chair

Ingrid Schusterova

Children University Hospital, Slovakia

Session Introduction

Brendan Mitchell

Gold Coast University Hospital, Australia

Title: Medication adherence one month after hospital discharge in medical inpatients

Time : 14:25-14:45

Biography:

Abstract:

Introduction: Patients’ awareness plays an important role in the early diagnosis and control of many diseases including hypertension. We aimed to estimate the level of awareness among the relatives of medical students by assessing the prevalence of undiagnosed and uncontrolled hypertension. Methods: In this cross-sectional designed study, a certain group of medical students were invited to interview their respective adult first-degree relatives for risk factors and take measurement of their blood pressure in adequate conditions. According to the absence or presence of hypertension in their history, relatives who were measured with elevated blood pressure were analyzed as undiagnosed or uncontrolled hypertension, respectively; while those who were measured with normal values of blood pressure were analyzed as normal or controlled hypertension, respectively. Comparative analysis of different parameters was carried out between these subgroups. Results: We included 770 relatives of 82 (57.7%) total students’ participations. The prevalence of undiagnosed hypertension in the total study population was 14.4% (111 cases). Among participants diagnosed previously with hypertension, 61.9% were uncontrolled at the time of the study. Predictors for undiagnosed hypertension were aged below 40, working at the present time in either governmental or private sectors, current smoking, absence of diabetes and cardiac diseases; while none of the investigated factors showed to be a significant predictor for uncontrolled hypertension. Conclusions: There is insufficient level of awareness among the family members of medical students, as demonstrated by the high prevalence of both undiagnosed and uncontrolled hypertension. The typical profile associated with the lowest awareness level is that of the young smoking employee with no history of diabetes or cardiac disease.

Break: YRF Session

Natalia Alexeeva

Stanford Graduate School of Business, USA

Title: Virtual primary care-new models for guideline adherence, efficiency and access

Time : 16:40-16:55

Biography:

Abstract:

Virtual primary care is the fastest growing market segment in health care. It is projected to reach 42% this year. This is compared to 7% growth of the Urgent Care and 14% growth for retail clinics. The market says it all consumers, physicians and healthcare organizations all over the world see the value in more efficient ways to deliver high quality care. There are two major models in delivering health over electronic medium: Synchronous (video and phone) and asynchronous (model that does not require real time interaction). Synchronous models have been shown to be effective in mental health and clinician to clinician communications. However, it delivers limited efficiency, since the time taken to assess someone’s health via a video visit is almost identical to the time needed to do the same in the office (23 minutes vs. 25 minutes average). Asynchronous healthcare delivery, on the other hand, creates efficiency as well as increases access and convenience. It relies on latest evidence based guidelines to collect information from the patient using sophisticated computer algorithms and then serves it to the physician, so that they can access non-critical cases using clinical marginal capacity. Friendly is the market leader in asynchronous communication. The unique approach is showing an average doctor visit reduced by a factor of 10. Physician documentation is reduced by 50%. Patient loyalty and satisfaction is much higher as compared to in-person visit.

Alzbeta Tohatyova

Pavol Jozef Å afÃ¡rik University, Slovakia

Title: Ad36 infection can lead to overweight and obesity?

Time : 16:55-17:10

Biography:

Alzbeta Tohatyova is currently a PhD student at Medical Faculty, P J Safarik University in Kosice, Slovakia. Her research interests focus on pediatric cardiology and preventive cardiology.

Abstract:

Introduction: Ad36 is the first human adenovirus reported that causes obesity in experimentally infected animals and shows association with obesity in humans. More human studies, all over the world, are related to the relationship between Ad36 infection and obesity, and till now have not been explanatory, studies show contradictory results. Aim: The main aim of our study is to assess the association between Ad36 infection and obesity in high-school students from Eastern Slovakia. Methods: Two hundred and twenty-four randomly selected students (17.72±1.20 years of age, 120 female) from 7 high-schools in Kosice were included in the study. Subjects with secondary causes of obesity were excluded and none were taking medications or had a history of cardiovascular disease. In 224 healthy students, anthropometric parameters, fasting plasma glucose and insulin were measured. Ad36 antibody was detected by ELISA test. Results: No significant differences were found between Ad36 positive and Ad36 negative high-school students in prevalence of obesity (chi-kv: 1.91, p=0.16). Study found no significant differences between high-school students with and without IR in prevalence of Ad36 positivity (chí-kv: 0.66, p=0.41). We confirmed significant differences between Ad36 positive and Ad36 negative in normal weight high-school students (p<0.05, U=2221.50). We also confirmed the high prevalence of overweight and obesity in healthy high-school students (23.66%). Conclusion: The current study shows a possible association between Ad36 infection and the risk of development of obesity in normal weight children and adolescents. Our results do not support that any Ad36 adipogenic adenovirus effect on body composition is operating in human through an insulin-resistance-related mechanism. Further studies in different age groups of children and adults are required to elucidate this biological mechanism of such complex relationship.

Lamia K Alsenaidi

United Arab Emirates University, UAE

Title: Womenâ€™s knowledge and attitude towards pregnancy in a high-income developing country

Time : 17:10- 17:25

Biography:

Abstract:

Galya Ghalib Al Ghalib Alsharif

King Abdulaziz University Hospital, Saudi Arabia

Title: The benefit of pre- and post-operative instructions

Time : 17:25- 17:40

Biography:

Galya Ghalib Al Ghalib Alsharif has completed her MBBS from King Abdulaziz University Hospital. She is currently a medical intern.

Abstract:

Millions of people each year undergo surgery. Despite the development in the surgical field; patients remain in fear of the complications that may take place. 140 patients were randomly selected from the clinics at King Abdul-Aziz University Hospital, in Jeddah. A questionnaire was used to test their knowledge of the instructions before and after a surgery; ear nose and throat specialty in particular. Another questionnaire was given after educating the patients of the instructions in one of the surgical operations in this specialty. The aim is to educate the patients about these instructions in the event of undergoing any future operations. The result was: 64% of patients knew the existence of instructions before and after operations, while 36% didn’t know the existence of such instructions. The most known instruction by 86% was: to stop eating at midnight on the night of the operation. And the least known by 34% was: to stop taking Aspirin 7 days before the operation. The benefit rate from the explained instructions was 100%. 54% of these patients received only verbal instructions, while 10% received both verbal and on paper instructions and the remaining 18% of patients didn’t receive any instructions.

Vijayalakshmi Gopalan Nair

University of Nizwa, Oman

Title: Influence of balanced diet on the nutritional status of the children between 1 to 3 years

Time : 17:40- 17:55

Biography:

Vijayalakshmi Gopalan Nair is a registered Nurse and Midwife with Master’s in Community Health Nursing Specialty in 2000. She has completed a Post-graduate diploma in Computer Application and pursuing PhD. She is currently working as Lecturer at College of Pharmacy & Nursing, University of Nizwa, Sultanate of Oman.

Abstract:

Break: Panel Discussion

Rajni Nair(Video Presentation )

Metro-North Hospital Health Services, Australia

Title: Home is where health is

Time : 17:55-18:05

Biography:

Rajni Nair has completed her Master’s in Health Care Research from Griffith University, Australia and has publications related to "Extent and application of patient diaries in Intensive care unit in Australia". She has been the guest speaker in various conferences, like the Australian College of Critical Care Nurses and the Australian and New Zealand Intensive Care Society. She is the Nursing Director of Hospital in the Home service, in the Metro-North Health Services in Queensland. She has done extensive work in this sector, where active research is being conducted in “Hospital in the Home” and how the model would be effective to assist in patient journey in the field or Rehabilitation, Delirium, and more.

Abstract:

Hospital in the Home (HITH) involves the provision of acute, sub-acute treatments by health care professionals at a patient’s usual place of residence as a substitute for inpatient care received at a hospital. Patients are considered to be inpatient with preservation of medical governance. Most states and territories in Australia have HITH programs under which admitted patients are provided with hospital care in the home. The drive for HITH care in Australia has been due to rising health care costs increasing the need to reduce inefficient health care expenditure; growth in the demand of inpatient care in the context of limited public hospital bed supply; shifting demographics and population growth, hospital access issue, increased responsive to consumer preferences; and the development of portable hospital technologies, drugs delivery devices. The Metro-North HITH model of care has incorporated 4 tertiary hospitals, with care provision provided to patients in varied diagnosis related groups (DRG), with intravenous antibiotics, fluid management, wound management, blood transfusion, peritoneal dialysis and rehabilitation. Studies have shown that HITH is more beneficial when access block to hospitals is interjected, in Emergency Department. A pilot project conducted in one of the tertiary hospitals showed that the presence of a HITH nurse within the Emergency Department proved to be very effective and efficient in referring patients onto the HITH services. Other than the lesser waiting time for patient, outcomes were predominantly the portrayal of the efficiency in health services, cost savings, patient satisfaction, further referrals and less representation back to hospital.