Abstract

Clinical Medical Anthropology in Global Public Health and the Need for a Biocultural Approach in the Age of COVID-19 and Beyond

Richard A. Gonzalez, Ph.D.

Doctoral Program in Medical and Health Professions Education, Eastern Virginia Medical School

The biocultural perspective bridges biological mechanisms with the cultural, social, and ecological factors that impact health outcomes at the individual and population level. Medical anthropology facilitates integration of holistic approaches as a means of applying the biocultural perspective. Unfortunately, when it comes to medicine and global public health, there is still a social-natural sciences division that hinders efforts to improve human health.  Yet, it is the human landscape, consumption of goods, mobility patterns, religion, politics, and socioeconomic and ecological factors, that ultimately determine overall epidemiological outcomes and the overall health and well-being of a population.  Research, health policy, and healthcare delivery must consider the lived experiences of a population, especially the embodied vulnerabilities from populations experiencing inequality and marginalization.   Cultural underpinnings and biological consequences can be explored by the ongoing COVID-19 pandemic as a means of educating researchers and healthcare providers to facilitate improved human global health.  This will allow for appropriate healthcare interventions that address the impact of power differentials on health, facilitate community and cross-cultural education for providers, and improved healthcare communication and education to the public.   

Biography

Richard A. Gonzalez, Ph.D. (SUNY-Buffalo 2007) is a broadly trained anthropologist with scholarly and teaching expertise in biocultural and medical anthropology, evolutionary medicine, human identification, clinical anatomy, and medical education. Presently, Dr. Gonzalez is an Associate Professor at Eastern Virginia Medical School where he serves as the Director of the Contemporary Human Anatomy Education Concentration within the Doctoral Program in Medical and Health Professions Education and as Director of the Human Structure Module for the first year of medical education

Abstract

Effect of marijuana on the relationship between periodontitis and diabetes in U.S. adults aged 30 to 59 years: National Health and Nutrition Examination Survey 2009-2014

Karen Raju1, Israel Terungwa Agaku2, 

1School of Dentistry, University of California, San Francisco and 2Department of Oral Health Policy and Epidemiology, Harvard School of Dentistry

Objectives: This study aims to describe the prevalence of periodontitis and DM among marijuana users and examine the effect of marijuana on the relationship between periodontitis and DM status in US adults aged 30-59 years. Methods: Pooled data from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 were analyzed. The primary binary outcome was self-reported diabetes mellitus (DM). Exposure of interest (periodontitis) was defined using the Centers for Disease Control and Prevention/American Academy of Periodontology classification. Regular marijuana users were those who had ever smoked marijuana at least once a month for more than one year. Bivariate and multivariable binary logistic regression models were performed with AIC to examine the effect of marijuana on the relationship between periodontitis and DM. Results: Of 3,179 non-pregnant participants with available periodontitis, DM, and marijuana use, 85.5% were regular marijuana users. Moderate (OR 2.07;1.65,2.61) and severe (OR 3.24;2.48,4.24) periodontitis was significantly associated with marijuana use. No statistically significant difference between the prevalence of DM among marijuana users(P=0.14). Bivariate analysis revealed a positive association between periodontitis and DM irrespective of marijuana use. The fitted multivariable model retained this association. The increasing age, being non-Hispanic whites (aOR 0.36; 0.19,0.67), having Medicaid (aOR 3.04;1.52,6.10), and Medicare insurance (aOR3.87;2.00,7.49) significantly predicts DM. Conclusions/Recommendations: Periodontitis is associated with DM in both Marijuana users and non-users. However, readers should use the results of this study with caution, and further high-quality longitudinal studies are required to elucidate the effect of marijuana on the relationship between periodontitis and DM.

Biography

Dr. Karen Raju is a dentist who is led by her passion for public health. She graduated from the interdisciplinary Master of Public Health program from the University of California, Berkeley in 2019 and the Dental Public Health Postgraduate residency program from the University of California, San Francisco (UCSF) in 2020. She is currently an Associate Specialist at UCSF and serving as chair of CavityFree SF (San Francisco’s local oral health coalition) Children and Youth of Special Health Care Needs workgroup and co-chair of American Association of Public Health Dentistry’s Council of Scientific Information.

Abstract

Dr. Valerie McGaha

Resilience and Hope for Aging PopulationsThe discussion will focus on aging populations.  Participants will identify current biases or problematic mindsets regarding aging populations in health and wellness.  Americans are living longer due to the improvements in medical science and access to affordable healthcare.  American elderly may have more specialized education and learned skills from early adulthood that may be transferred and utilized into later life transitions. The well-being of some elderly populations has included satisfaction of marital relationships, increased family incomes, access to family members, satisfaction of health, positive mental health, and proper nutritional access and intake (Ghimire et al., 2018).  Economic constraints for critically ill patients may pose a risk factor in mental health and social opportunities (LeBorgne et al., 2018). Issues of polypharmacy (e.g., the use of various medications) and the impact of patients physical and mental health continue to rise. Elderly patients are more likely to experience poor mental health such as anxiety, depression, suicide, and low well-being (Parkar, 2015).  The discussion will highlight elderly populations and mental health.  Discussions will address factors of resiliency and increased supportive opportunities for elders. 

Biography

Dr. Valerie McGaha is an Associate Professor of Community Health Sciences, Counseling and Counseling Psychology at Oklahoma State University. She is a Licensed Professional Counselor, Licensed Marriage and Family Therapist, and Licensed Alcohol and Drug Abuse Counselor. Her research interests center around multicultural counseling, psychosocial development, mental and addictive disorders, and suicide prevention and education. In her scholarly work, she has examined individual and collective factors related to academic, personal, and social success of various populations.

Abstract

Survival of Fishes in a Stormwater Retention Pond at the Watershed Nature Center Upper Pond, Edwardsville, Illinois

Manuel Gomez1, Richard Brugam2, and Sharon Locke1

1Department of Environmental Sciences

2Department of Biological Sciences

A study of the Upper Pond at the Edwardsville Watershed Nature Center (WNC) was conducted to discover the potential cause of fish kills in the small stormwater retention pond and to determine how the current populations of bluegill (Lepomis macrochirus), redear sunfish (Lepomis microlophus), common carp (Cyprinus carpio) and largemouth bass (Micropterus salmoides) can survive in the pond based on prevailing environmental conditions. Dissolved oxygen (DO) was measured from June to December 5, 2019 at a site in the center of the open lake (4m deep) and from a dock near the shore (1.1m deep). Water temperature was measured intermittently at both sites from June 19 to November 4. In the open lake, oxygen levels reached a peak of 11.6 mg/L at the surface on July 2. Below 2.5m DO remained less than 1.5 mg/L until Oct. 8 when it slowly began to rise reaching a high of 10.8 on Nov. 20. The dock station also had similar oxygen levels. Temperature varied from a high of 31.2 ○C on July 21 to a low of 6.5 ○C on November 3. The low DO in the pond results from a nearly continuous cover of duckweed (Lemna sps) which prevents interchange of oxygen with the atmosphere. It is likely that the low oxygen levels select for fish species that are psychologically and behaviorally capable of surviving hypoxia.

Biography

Manuel Gomez has completed his Bachelor’s Degree in Global Studies with a concentration of Global Environmental Issues, University of Illinois Springfield, and Professional Science Masters from the Department of Environmental Sciences, Southern Illinois University of Edwardsville. He has been working as an Environmental Health Sanitarian for Madison County Health Department since June 2021. After his master’s completion, he published his graduate research in Transactions Journal of the Illinois State Academy of Science.

Abstract

Topic: The Effects Of Inadequate Maternal Healthcare Systems On Prenatal Health In Low-Middle-Income-Countries (Lmics).

Abstract

Maternal health is essential for a population to be healthy and productive. However, every day, women die from preventable causes owing to poor maternity care around the world (Dahab & Sakellariou, 2020). According to the World Health Organization (WHO), about 830 women die every day from preventable causes related to pregnancy and childbirth, with developing countries accounting for 99% of all maternal deaths (Alhassan et al., 2019). According to field evidence, most countries' available services are of inadequate quality. Unfortunately, a considerable number of maternal and new-born deaths occur in health facilities that cannot consistently provide effective, safe care while also delivering timely, equitable, integrated, and efficient services (Goyet et al., 2019). Furthermore, LMICs such as Sub-Saharan Africa has been found to have the highest maternal mortality rate in the world, with 542 deaths per 100,000 live births and 28.7 stillbirths per 1000 total births (Wabiri et al., 2016), this is attributable to the low economic income levels, poverty, poor health-seeking behaviour, and weak  health-system links that are all factors contributing to the high number of infant mortalities. The effective delivery of high-quality facility-based neonatal care is hindered by health system shortcomings in LMICs, and the financial impact of inpatient infant treatment on families has received little attention worldwide (Enweronu-Laryea et al., 2018).

Biography

I am a recent Honours Public Health (HPH) graduate from Monash University (SA). I have majored in Epidemiology with the focus on the concepts of epidemiology and their application to the prevention of disease, promotion of health and the development of health interventions and health policy and Applied Biostatistics with the focus on basic concepts in statistics that allowed one to identify and quantify diseases and their associated risks. I have completed research on maternal and infant health with the focus on the association between maternal anaemia in women of child-bearing age (15-49) and low birth weight (LBW) in new-born infants in rural SA. Prior to completing my HPH, I obtained a BA in psychological counselling with the University of South Africa (UNISA) during the time which I was also awarded my six-month theoretical course certificate in HIV/AIDS Care and Counselling (2017). I worked as a volunteer between 2017 and 2018, and as the volunteer team, we worked with children and the old and the frail from one disadvantaged community in Pretoria Gauteng as well as assist the Habitat for humanity building project to build and provide housing for those without proper housing and shelter. I am yet to pursue a Masters in Public Health (MPH) and I plan to continue with my research on maternal and child health with a focus on the improvement of maternal and child healthcare systems.

Abstract

The Necessity of Establishing Kess Waka

Meskelo International Medical Center at Tedda Area in Gonder Ethiopia

Dr. Aderajew Waka Wassie

University of Medicine in Germany  and DRFZ Berlin

Ethiopia is a country with the second highest population in Africa. The estimated total population of the country is more than 115 Million. Out of this estimated population, the youngest generation makes the highest number of the country. In this case establishing new and modern health sectors parallel to the development of the total population all over the country is absolutely mandatory.

In the last few years ago the communicable diseases were the most researched topics in Ethiopia and also in the most African countries. We find only some of Non-Communicable disease in the literature of African studies like Diabetes. But, currently, based on some different studies it shows that not only communicable diseases were and are a big enemy of Africa. Both communicable and Non - communicable disease were/are almost in a similar situation affected/affecting the population.

The Ethiopian health system has hospitals, health centers, health stations/posts, private clinics and very limited laboratories in the big cities. In additions to this there are Pharmacies and Drug stores in limited places. Of course, these all are playing a big role all over the country to disease prevention and for therapy of the patients. But when we compare the total population of the country and the development of health system, it is not sufficient to give an optimal health supply all over the country.

The medical products, medical devices and the medicaments are not enough available all over the country. Its quality and quantity may not well adequate for treatment and distribution of the whole health sectors. It is clear that in the mean time there are different universities with modern Medical Colleges or Medical Faculties with modern referral hospitals and medical personals. However, most referral hospitals are available only in the big cities. Some Medical Laboratories are available only in the capital city Addis Abeba and in some Regional and in a limited way in a very few Zonal Cities. Pharmacies are available in somehow with good medicaments only in the cities. Some drug stores are accessible in different cities and towns. 

The Ethiopian population living way is divided in Rural and Urban areas. The most Ethiopian dwellers are living in the rural area. In this case the accessibility of good health supplies like good medical personals and referral hospitals as well as pharmacies with good medicaments are very few or limited. The accessibilities to modern Medical Diagnostic laboratories with like US, CT, MRI, X-Ray devices and other laboratory diagnosis is very poor.

Therefore, Establishing modern International Medical Centers with International Clinics, International Medical Laboratories and International Clinical Pharmacies in the small towns and also near in the most rural dwellers of the country is a crucial point for the therapy of the patients, prevention of diseases and training purposes for medical as well as paramedical personals which may help the public also for easy access to health sectors. In this case the new establish “Kess Waka Meskelo International Medical Center at Tedda – Gonder Ethiopia „will help and playing a big role in the future to the community also for excellent Health Supply, Education, Research as well as a Training Center in a good and emergency time.

Biography

Biography: Immunologist,Certified Drug Safety Officer,Pharmacovigilance and Clinical Trials Specialist. Completed PhD from Charite’-University of Medicine Berlin, Center for Internal Medicine and Dermatology, Internal Medicine Dept. of Rheumatology and Clinical Immunology; German Rheumatology Research Center Berlin; Institute for Immunology, Center for Infection Medicine of Freie University Berlin. Ambassador of Brain City Berlin for Science and Technology. Ambassador of Tedda Health Science College in Gonder/ Ethiopia. Board Member of Ethiopian Institute of Textile and Fashion Technology EiTEX & Biorefinery Research Center (BRRC of EiTEX) in Bahir Dar University-Ethiopia, Board Member & Co-Founder and General Secretary of International Verein für Gesundheitsförderung in Äthiopien (IVGEFÄ) e.V.

Abstract

Abstract: Future primary care settings will make greater use of community assets as part of place-based approaches to public health promotion locally.

The Premier League Football Community GP Dr Christopher Pritchard, Sunlight Group Practice, Everton in the Community. 

Michael Salla, Director of Health and Sport, Everton in the Community 

Professor Andy Smith, Edge Hill University. 

 Aims/Objectives/Background:

This new service design allowed a GP to work for Everton in the Community (EitC), the official charity of Everton Football Club. Patients often do not engage with the normal medical model of attending healthcare settings. Offering new ways of accessing healthcare in their community through the influence of a sporting organisation is vital to target to those hard-to-reach groups. This is the first programme of its kind in the country with a GP working in a community setting as part of a Premier League Football Club. 

Content of Presentation: EitC has many well-established health-related programmes across the lifecourse. Where appropriate, medical advice and basic intervention was offered from a GP. Further important communication links have been established with the local Primary Care Networks. Drop-in sessions allowed individuals attending to seek help from a GP and other allied support staff. Advertising these sessions was undertaken through the football club’s social media platforms. The work is evaluated with appropriate research methodologies by Edge Hill University as part of placed-based, communitycentred, approaches to health. 

Relevance/Impact: New funded projects have been developed targeting key health inequalities in areas of social deprivation including mental health and diabetes prevention. It has allowed for a funded GP training post to be established and further complement the work already started. This can hopefully allow other deaneries to create similar educational posts. 

Outcomes/Discussion:  Future primary care settings will make greater use of community assets as part of place-based approaches to public health promotion locally. • 

Methods:

EitC delivers 40 projects across Merseyside and Cheshire. The primary base is in the L4 postcode, an area of high socioeconomic deprivation. It includes a total of 32,844 Lower Super Output Areas (LSOA) and is ranked 165th worst for overall IMD scores and 77th worst for Health (IMD 2019) (1).

 • More than 20,000 individuals access the programmes and EitC has worked in collaboration with several primary and secondary providers, including Mersey Care NHS Foundation Trust, Alder Hey Hospital and local Primary Care Networks. Several programmes are evaluated and delivered in collaboration with Edge Hill University. Professor Andy Smith and his team of academic researches use appropriate research methodologies to maximise progarmme impact and ensure these engage the target audience and produce successful outcomes for participants. 

• A Health Education England (HEE) funded pilot for 12 months involved a GP working with EitC. This is a new and innovative post which is the first of its kind. The GP provides medical support and infrastructure to established and new programmes. The GP attends EitC one day a week for face-to face work for 12 months. The GP was also available during the rest of the week for any medical or health related queries involving any participants. Assessment of physical health parameters such as blood pressure, pulse, weight and also mental health screening were undertaken. No prescribing of medications is involved and there is limited information relating to patient’s medical records. 

• One of the first new projects created involved a diabetes pilot screening undertaken in November 2019. This involved identifying individuals who may have undiagnosed pre-diabetes or diabetes using a point of care testing analysis kit on fans attending a football match day screening event.

 Results:

• A well-being Wednesday service was available to local residents who were able to drop in and seek medical support and advice. Several case reports involved people seeking crisis help for their own mental health and being directed onto EitC programmes. 

• The results of the diabetes pilot demonstrated that 50% of those screened were either pre-diabetic or diabetic. Individuals were given appropriate advice and directed to seek further medical interventions regarding this from their own GP provider. 

• A screening programme addressing blood pressure, pulse and BMI screening programme for participants involved with the Blue Base projects and Everton Veterans Hub was provided. These identified several people with high blood pressure, a raised BMI and one new diagnosis of atrial fibrillation. Individuals were directed towards their own GP for further medical support and given health and lifestyle interventions from a health coach. 

• EitC offer current and future primary care providers with an opportunity to individuals who do not access healthcare through the normal medical models. These people are hard to reach and offer suffer from a number of underlying health comorbidities. Using the power of the football club provides an alternative route to engaging those with health problems and enhance long-term sustainability in allowing patient advocates to have greater roles in projects. 

Conclusions :

• Doctors working in these community settings need to adapt in terms of public health promotion and prevent chronic illnesses from developing especially in areas of socioeconomic deprivation. Greater emphasis needs to be placed on diet and lifestyle measures and the role of poor mental health. These new skills can then be translated back into their everyday clinical practice and help develop the roles of future GPs. 

• A new GP training post has now been created and developed with guidance from the RCGP. This commenced in August 2021 and involves a 12 month pilot of two GP trainees working in a community setting for separate 6 month rotations as part of their overall three year development. This post is the first of its kind in the country. It is hoped that this will lead to further training posts which involve doctors gaining experience in similar community settings. 

• A 12 month diabetes screening and lifestyle intervention programme has been funded by North West Coast networks following the successful results of the initial EitC pilot scheme. This involves identifying those members of the community who are hard to reach and have failed to engage with or complete the National Diabetes Prevention Programme (NDPP). 

• Further opportunities for match day screening using point of care testing to identify underlying metabolic disorders in football fans are available. Individuals are offered a 12 week diet, lifestyle and holistic support programme and are monitored by the GP, GP trainee and Programme Co-ordinator. Funding has been obtained to undertake work looking at Atrial Fibrillation screening within community settings. This is one of the key Impact Factor Targets for Primary Care Networks in 2022. A mental health programme looking at supporting new dads will also take place in the next 12 months. . On the Front Foot, The Doctor Magazine January 2020 (2). 

Biography

Professor of Sport and Physical Activity at Edge Hill University, UK. × Biography Professor of Sport and Physical Activity at Edge Hill University, UK. × Biography Andy Smith is Professor of Sport and Physical Activity at Edge Hill University, Lancashire, UK. He has worked with Everton in the Community for over eight years, including on the award-winning Tackling the Blues programme which was cited as a model of good practice in the 2017 UK Health Select Committee Suicide Prevention report. His research focuses on developing mental health awareness and literacy (alongside suicide prevention) in children and young people, schools and local communities, as well as in professional sport. Andy contributed to the government’s independent Duty of Care in Sport review, works with a range of sports organisations on mental health and suicide prevention, and led the UK’s first research project into mental health in the sport and physical activity workforce.

Abstract

Abstract: Future primary care settings will make greater use of community assets as part of place-based approaches to public health promotion locally.

The Premier League Football Community GP Dr Christopher Pritchard, Sunlight Group Practice, Everton in the Community. 

Michael Salla, Director of Health and Sport, Everton in the Community 

Professor Andy Smith, Edge Hill University. 

 Aims/Objectives/Background:

This new service design allowed a GP to work for Everton in the Community (EitC), the official charity of Everton Football Club. Patients often do not engage with the normal medical model of attending healthcare settings. Offering new ways of accessing healthcare in their community through the influence of a sporting organisation is vital to target to those hard-to-reach groups. This is the first programme of its kind in the country with a GP working in a community setting as part of a Premier League Football Club. 

Content of Presentation: EitC has many well-established health-related programmes across the lifecourse. Where appropriate, medical advice and basic intervention was offered from a GP. Further important communication links have been established with the local Primary Care Networks. Drop-in sessions allowed individuals attending to seek help from a GP and other allied support staff. Advertising these sessions was undertaken through the football club’s social media platforms. The work is evaluated with appropriate research methodologies by Edge Hill University as part of placed-based, communitycentred, approaches to health. 

Relevance/Impact: New funded projects have been developed targeting key health inequalities in areas of social deprivation including mental health and diabetes prevention. It has allowed for a funded GP training post to be established and further complement the work already started. This can hopefully allow other deaneries to create similar educational posts. 

Outcomes/Discussion:  Future primary care settings will make greater use of community assets as part of place-based approaches to public health promotion locally. • 

Methods:

EitC delivers 40 projects across Merseyside and Cheshire. The primary base is in the L4 postcode, an area of high socioeconomic deprivation. It includes a total of 32,844 Lower Super Output Areas (LSOA) and is ranked 165th worst for overall IMD scores and 77th worst for Health (IMD 2019) (1).

 • More than 20,000 individuals access the programmes and EitC has worked in collaboration with several primary and secondary providers, including Mersey Care NHS Foundation Trust, Alder Hey Hospital and local Primary Care Networks. Several programmes are evaluated and delivered in collaboration with Edge Hill University. Professor Andy Smith and his team of academic researches use appropriate research methodologies to maximise progarmme impact and ensure these engage the target audience and produce successful outcomes for participants. 

• A Health Education England (HEE) funded pilot for 12 months involved a GP working with EitC. This is a new and innovative post which is the first of its kind. The GP provides medical support and infrastructure to established and new programmes. The GP attends EitC one day a week for face-to face work for 12 months. The GP was also available during the rest of the week for any medical or health related queries involving any participants. Assessment of physical health parameters such as blood pressure, pulse, weight and also mental health screening were undertaken. No prescribing of medications is involved and there is limited information relating to patient’s medical records. 

• One of the first new projects created involved a diabetes pilot screening undertaken in November 2019. This involved identifying individuals who may have undiagnosed pre-diabetes or diabetes using a point of care testing analysis kit on fans attending a football match day screening event.

 Results:

• A well-being Wednesday service was available to local residents who were able to drop in and seek medical support and advice. Several case reports involved people seeking crisis help for their own mental health and being directed onto EitC programmes. 

• The results of the diabetes pilot demonstrated that 50% of those screened were either pre-diabetic or diabetic. Individuals were given appropriate advice and directed to seek further medical interventions regarding this from their own GP provider. 

• A screening programme addressing blood pressure, pulse and BMI screening programme for participants involved with the Blue Base projects and Everton Veterans Hub was provided. These identified several people with high blood pressure, a raised BMI and one new diagnosis of atrial fibrillation. Individuals were directed towards their own GP for further medical support and given health and lifestyle interventions from a health coach. 

• EitC offer current and future primary care providers with an opportunity to individuals who do not access healthcare through the normal medical models. These people are hard to reach and offer suffer from a number of underlying health comorbidities. Using the power of the football club provides an alternative route to engaging those with health problems and enhance long-term sustainability in allowing patient advocates to have greater roles in projects. 

Conclusions :

• Doctors working in these community settings need to adapt in terms of public health promotion and prevent chronic illnesses from developing especially in areas of socioeconomic deprivation. Greater emphasis needs to be placed on diet and lifestyle measures and the role of poor mental health. These new skills can then be translated back into their everyday clinical practice and help develop the roles of future GPs. 

• A new GP training post has now been created and developed with guidance from the RCGP. This commenced in August 2021 and involves a 12 month pilot of two GP trainees working in a community setting for separate 6 month rotations as part of their overall three year development. This post is the first of its kind in the country. It is hoped that this will lead to further training posts which involve doctors gaining experience in similar community settings. 

• A 12 month diabetes screening and lifestyle intervention programme has been funded by North West Coast networks following the successful results of the initial EitC pilot scheme. This involves identifying those members of the community who are hard to reach and have failed to engage with or complete the National Diabetes Prevention Programme (NDPP). 

• Further opportunities for match day screening using point of care testing to identify underlying metabolic disorders in football fans are available. Individuals are offered a 12 week diet, lifestyle and holistic support programme and are monitored by the GP, GP trainee and Programme Co-ordinator. Funding has been obtained to undertake work looking at Atrial Fibrillation screening within community settings. This is one of the key Impact Factor Targets for Primary Care Networks in 2022. A mental health programme looking at supporting new dads will also take place in the next 12 months. . On the Front Foot, The Doctor Magazine January 2020 (2). 

Biography

Dr. Christopher Pritchard is a GP at Sunlight Group Practice, Wirral. He has worked with Everton in the Community since 2019 as part of a ground breaking initiative which was the first of its kind in the country to have a GP working as part of a Premier League Football Club’s Foundation. Dr Pritchard is now supervising further doctors as part of their GP training who are working with the charity. This enables the existing physical and mental health programmes to have an additional layer of support. Dr Pritchard graduated with a degree in medicine from the University of Liverpool and had previously undertaken a degree in Applied Biochemistry. Dr Pritchard had previously established the first sports medicine society and national conference during his undergraduate training. He now is the mental health lead for his local federation and primary care network. He is the clinical lead for the first primary care ADHD led service in the country. Dr Pritchard is also a GP trainer and appraiser.

Abstract

Abstract: Future primary care settings will make greater use of community assets as part of place-based approaches to public health promotion locally.

The Premier League Football Community GP Dr Christopher Pritchard, Sunlight Group Practice, Everton in the Community. 

Michael Salla, Director of Health and Sport, Everton in the Community 

Professor Andy Smith, Edge Hill University. 

 Aims/Objectives/Background:

This new service design allowed a GP to work for Everton in the Community (EitC), the official charity of Everton Football Club. Patients often do not engage with the normal medical model of attending healthcare settings. Offering new ways of accessing healthcare in their community through the influence of a sporting organisation is vital to target to those hard-to-reach groups. This is the first programme of its kind in the country with a GP working in a community setting as part of a Premier League Football Club. 

Content of Presentation: EitC has many well-established health-related programmes across the lifecourse. Where appropriate, medical advice and basic intervention was offered from a GP. Further important communication links have been established with the local Primary Care Networks. Drop-in sessions allowed individuals attending to seek help from a GP and other allied support staff. Advertising these sessions was undertaken through the football club’s social media platforms. The work is evaluated with appropriate research methodologies by Edge Hill University as part of placed-based, communitycentred, approaches to health. 

Relevance/Impact: New funded projects have been developed targeting key health inequalities in areas of social deprivation including mental health and diabetes prevention. It has allowed for a funded GP training post to be established and further complement the work already started. This can hopefully allow other deaneries to create similar educational posts. 

Outcomes/Discussion:  Future primary care settings will make greater use of community assets as part of place-based approaches to public health promotion locally. • 

Methods:

EitC delivers 40 projects across Merseyside and Cheshire. The primary base is in the L4 postcode, an area of high socioeconomic deprivation. It includes a total of 32,844 Lower Super Output Areas (LSOA) and is ranked 165th worst for overall IMD scores and 77th worst for Health (IMD 2019) (1).

 • More than 20,000 individuals access the programmes and EitC has worked in collaboration with several primary and secondary providers, including Mersey Care NHS Foundation Trust, Alder Hey Hospital and local Primary Care Networks. Several programmes are evaluated and delivered in collaboration with Edge Hill University. Professor Andy Smith and his team of academic researches use appropriate research methodologies to maximise progarmme impact and ensure these engage the target audience and produce successful outcomes for participants. 

• A Health Education England (HEE) funded pilot for 12 months involved a GP working with EitC. This is a new and innovative post which is the first of its kind. The GP provides medical support and infrastructure to established and new programmes. The GP attends EitC one day a week for face-to face work for 12 months. The GP was also available during the rest of the week for any medical or health related queries involving any participants. Assessment of physical health parameters such as blood pressure, pulse, weight and also mental health screening were undertaken. No prescribing of medications is involved and there is limited information relating to patient’s medical records. 

• One of the first new projects created involved a diabetes pilot screening undertaken in November 2019. This involved identifying individuals who may have undiagnosed pre-diabetes or diabetes using a point of care testing analysis kit on fans attending a football match day screening event.

 Results:

• A well-being Wednesday service was available to local residents who were able to drop in and seek medical support and advice. Several case reports involved people seeking crisis help for their own mental health and being directed onto EitC programmes. 

• The results of the diabetes pilot demonstrated that 50% of those screened were either pre-diabetic or diabetic. Individuals were given appropriate advice and directed to seek further medical interventions regarding this from their own GP provider. 

• A screening programme addressing blood pressure, pulse and BMI screening programme for participants involved with the Blue Base projects and Everton Veterans Hub was provided. These identified several people with high blood pressure, a raised BMI and one new diagnosis of atrial fibrillation. Individuals were directed towards their own GP for further medical support and given health and lifestyle interventions from a health coach. 

• EitC offer current and future primary care providers with an opportunity to individuals who do not access healthcare through the normal medical models. These people are hard to reach and offer suffer from a number of underlying health comorbidities. Using the power of the football club provides an alternative route to engaging those with health problems and enhance long-term sustainability in allowing patient advocates to have greater roles in projects. 

Conclusions :

• Doctors working in these community settings need to adapt in terms of public health promotion and prevent chronic illnesses from developing especially in areas of socioeconomic deprivation. Greater emphasis needs to be placed on diet and lifestyle measures and the role of poor mental health. These new skills can then be translated back into their everyday clinical practice and help develop the roles of future GPs. 

• A new GP training post has now been created and developed with guidance from the RCGP. This commenced in August 2021 and involves a 12 month pilot of two GP trainees working in a community setting for separate 6 month rotations as part of their overall three year development. This post is the first of its kind in the country. It is hoped that this will lead to further training posts which involve doctors gaining experience in similar community settings. 

• A 12 month diabetes screening and lifestyle intervention programme has been funded by North West Coast networks following the successful results of the initial EitC pilot scheme. This involves identifying those members of the community who are hard to reach and have failed to engage with or complete the National Diabetes Prevention Programme (NDPP). 

• Further opportunities for match day screening using point of care testing to identify underlying metabolic disorders in football fans are available. Individuals are offered a 12 week diet, lifestyle and holistic support programme and are monitored by the GP, GP trainee and Programme Co-ordinator. Funding has been obtained to undertake work looking at Atrial Fibrillation screening within community settings. This is one of the key Impact Factor Targets for Primary Care Networks in 2022. A mental health programme looking at supporting new dads will also take place in the next 12 months. . On the Front Foot, The Doctor Magazine January 2020 (2). 

Biography

Michael is the Director of Health and Sport at Everton in the Community, the official charity of Everton Football Club. Michael leads a team to deliver a range of community-based programmes to tackle health inequalities and improve health outcomes across some of the most deprived communities in the Liverpool City Region in North-West England. Reaching 20,000 people each year, who are at-risk of premature mortality and a poorer quality of life, Michael’s work provides life-course provision supporting various population groups including those living with dementia, cancer, diabetes, obesity and other non-communicable diseases. Michael’s work has shown to generate £14.74 of societal value for every £1 invested. Separate to Michael’s role at Everton in the Community, he is a Trustee at Liverpool Charity and Voluntary Services (LCVS), which has a focus on supporting the voluntary sector and making improvements in the areas of health, education and employment.

Abstract

Primary Contact: Janvier MUNGARULIRE , MCSP Rwanda Kigali , Rwanda

 All Authors: Janvier MUNGARULIRE, MCSP Rwanda (Primary Presenter) 

Evariste KAYITARE, Rwanda Biomedical Center 

Pascal MUSONI, MCSP Rwanda 

Beatrice MUKAMANA, Rwanda Biomedical Center 

 Title: Integration of PPFP counselling in ASMs’ home visit to pregnant mother’s families to strengthen PPFP uptake 

Significance/background:

 In 2009, Rwanda adopted a National Community Based Maternal and Newborn Health Care Program (CBMNH) to increase access to Antenatal Care (ANC) and Postnatal Care(PNC) services, focusing on essential interventions for pregnant women, mothers and newborns. In 2016, the Ministry of Health of Rwanda (MoH) updated the CBMNH guidelines and protocols for consistency with the 2013 WHO recommendations on postnatal care of the mother and newborn. CBMNH evolved with new components added such as postpartum hemorrhage (PPH) prevention and kangaroo mother care (KMC). This was an opportunity to integrate postpartum family planning (PPFP) counseling during home visits, both the 3 rd visit during pregnancy as well as PNC visits, carried out by Animatrices de Santé Maternelle (ASMs, one of Rwanda’s Community Health Worker [CHW] cadres). ASMs follow-up with family planning (FP) clients at the community level to offer counseling, resupply contraceptive methods after initiation at health facility and refer clients experiencing negative side effects. Though the Government of Rwanda (GoR) has put a strong emphasis on birth spacing, FP uptake has not registered significant increases in recent years. To address this issue, the GoR has prioritized PPFP integration into ANC, maternity and PNC services (HSSP4, 2018). 

Program intervention/activity tested: 

Since 2016, the Maternal and Child Survival Program (MCSP) has supported the revision of protocols, training materials and implementation tools in Rwanda. From April 2015 to June 2017, MCSP supported the implementation of high impact interventions across the country in collaboration with MoH by conducting five-day training for a total of 4,136 ASMs in nine districts using revised CBMNH program materials. Note that in the same period, 8,655 both ASMs and Binomes CHWs also received a two-week training on community based provision (CBP) of FP methods. From the last above CBP training, one third of ASMs got both trainings.

 Methodology : 

The objective of the integration of PPFP into CBMNH was to ensure that all pregnant women are aware of benefits of healthy timing and spacing of pregnancies, safety of contraception during breastfeeding and the postpartum period and to encourage decision-making with partners and uptake of PPFP. Data from the “Systeme d’information sanitaire” (SIScom, the community health information system) and Health Management Information System (HMIS) from the nine districts were included in the analysis. Districts selected were the ones in which ASMs were trained on CBMNH with integrated PPFP. MCSP also received MOH concurrence to train providers at health facilities to track pre-discharge PPFP uptake in codes and margins of existing registers. MCSP then collected this data quarterly. This analysis also uses PPFP uptake data from this parallel system. Using a dataset combining the above databases, we calculated monthly averages, minimums and maximums to showcase trends in the use of FP methods. 

Results/key findings: 

From January to December 2017, trained ASMs in nine districts conducted PPFP counselling to an average of 17,307 pregnant women each month through home visits in the antenatal period and an average of 6,190 mothers per month in the postnatal period (SIScom). In total, ASMs identified and visited a total of 66,566 new pregnant women in that period (SIScom). The number of FP new users increased from 26,100 in quarter two (January-March 2017) of fiscal year (FY)17 to 29,248 in quarter one of FY18(HMIS); while at the same time the number of PPFP clients also increased by 53% from 4,688 in quarter two FY17 to 7,174 clients in quarter one FY18 (MCSP parallel system, 2018). Before the integration of PPFP in CBMNH, ASMs were mobilizing pregnant women to go back to health facility at six weeks for immunization of their babies, but also to initiate a FP method. The above number of PPFP users are pregnant women that started a contraceptive method immediately after delivery. 

Program implications/lessons learned: 

Findings suggest that training ASMs on the new CBMNH program with integrated PPFP counselling may lead to increased adoption of immediate PPFP services among postpartum women. Tools such as a well-designed counseling cards, reporting registers, supervision checklist, etc. can also help ASMs counsel pregnant women and their families about PPFP, allow pregnant women to choose a method before giving birth and accompany them throughout the postnatal period. PPFP counselling during ASM home visits can also contribute to the conversation between a pregnant woman and her health providers during PPFP counselling at the health facility because it increases the awareness of pregnant women about this service. It also facilitates early decision-making in consultation with husbands and other family members who have a great role in decision-making in Rwandan culture. Therefore, discussing family planning in the early stage of pregnancy gives the family enough time and information to make an informed choice about which contraceptive method best meets their needs. While trends suggest an additive effect of ASM providing PPFP advice in the home, our analysis could not attribute increasing trends solely to that interventions as other efforts, such as clinical mentorship, were taking place at facility levels. However, scaling up CBMNH integrating PPFP in other districts may contribute to the increase of modern contraceptive prevalence rate by addressing missed opportunities in postpartum. We have shown that this approach is acceptable and feasible for both ASMs and families.

Biography

Janvier MUNGARULIRE, MPH, is a public health professional with more than 19 years of clinical and programmatic experience related to community health programs, reproductive, maternal, newborn, and child health and Malaria. Janvier has extensive experience in implementation, monitoring and evaluation, and scale up of high impact community health interventions and health system strengthening initiatives, with ministry of health (MOH), implementing partners and United Nations agencies. Currently serve as Malaria Specialist at Ingobyi Activity/IntraHealth International where he supports Rwanda’s malaria control program to implement malaria prevention and control interventions at all levels. Prior to this role, Janvier worked for national and international organizations such as UNICEF, Chemonics International, Save the Children International, JHPIEGO, Partners in Health, Rwanda Biomedical Center (RBC) and Kanombe Military Hospital where he supported development, implementation, and evaluation of community health interventions. Led the design and implementation of new approaches based on community engagement principles which were adopted by RBC as innovations in community health. These are Quality Improvement for Community Health Workers (CHWs), community health mentorship, CHW’s curriculum, CHW’s e-learning courses among others. Janvier holds master’s in public health from University of Rwanda and a bachelor’s degree in social sciences from Kigali Independent University.

Abstract

Implementation of IHR (2005) in the Context of Emerging and Reemerging Infectious Diseases: Case of Monkey Pox in Nigeria by Ojo, Olubunmi Eyitayo 

The International Health Regulation (IHR, 2005) came to force in 2007 and was designed to strengthen, maintain, and ensure rapid detection, verification, and response to public health risk among member countries. The mandate of this international law is legally-binding on 196 countries and gives each country the obligatory role to systematically notifying potential public health events of international emergency concern using the decision instrument. The Regulations also infer each member state to designate a National Focal Point as a national liaison center between member states and the World Health Organization (WHO). However, there has been a significant fault or gap in IHR (2005) across certain sphere of crosscountry borders, Africa (Nigeria) most especially has suffered greatly from information sharing and support among member states which defeats the purpose of IHR (2005). Furthermore, the reemergence of the Human Monkeypox Virus, in 2017 after 39 years as a case study, continues to prove the lack of cooperation and support binding the IHR member states. In 2017 and 2018, Nigeria experienced exportation of cases to the UK and USA respectively. Only UK collaborated with the Nigerian government in ensuring surveillance investigative process and early reporting of the disease; while the US reluctantly did not share database with Nigeria, firmly proving the ineffectiveness of the IHR (2005). There are also increasing concerns as to the global implication for countries like South Africa for instance who acted on the IHR obligatory roles to report and inform the international community of the detection of the first case of Omicron strain of COVID 19 and consequentially faced series of scrutiny and travel ban restrictions, further portraying double standardization in the system

Biography

Ms Olubunmi Eyitayo Ojo, M.Sc. She is a retired pioneer Director, Surveillance and Epidemiology and responsible for implementation of International Health Regulations (IHR, 2005) at the National Public Health Institute, Nigeria Centre for Disease Control which also serves as the IHR National Focal Point. A seasoned Public Health Professional with experience spanning over three decades. She has led numerous National assignments including leading the National technical delegation on the West Africa Regional Technical Committee on Ebola Virus Disease (2014), coordination of the Nigeria Joint External Evaluation of International Health Regulations (IHR) Core Capacities in June 2017 and the National Action Plan for Health Security (2017/2018). She also coordinated the West African Health Organisation (WAHO) supported Simulation Exercise (SIMEX) of Yellow Fever Outbreak in Lagos in 2018 A graduate of the 1st cohort of IHR (2005) Implementation Course in 2010. She is a listed expert on World Health Organization IHR roster of experts and has served on various committees in that capacity. She is presently an independent Public Health Consultant.

Abstract

Reducing oral health disparities globally: the role of the public health practitioner.

Globally, there has been an increased level of oral health awareness, yet there appears to be a disproportionate utilization of these services. Oral health improvements are not being experienced evenly across the population. The poor, low-income, uninsured, members of certain racial/ethnic minority or rural populations, institutionalized elderly people, and other groups do not have adequate access to dental care. Failure to understand the barriers to care and address them adequately will result in limited success in enhancing access to dental care for underserved populations. How do these barriers directly affect oral health access, and will control of these disparities improve health care outcomes? 

The purpose of this presentation was to highlight the oral health needs of a remote fishing community in sub-Saharan Africa.

Methods: A descriptive cross-sectional study was carried out to assess the periodontal status of adults in Jamestown, a peri-urban area in Ghana. Data acquisition was by using a structured questionnaire, and periodontal examination. Information obtained consisted of demographic data (age, sex, education, and occupation category) oral hygiene practices (type of teeth cleaning materials, methods of tooth cleansing, frequency of dental visits and reasons for the visit), and periodontal clinical parameters (Plaque Index, and Community Periodontal Index of Treatment Needs).

In conclusion, the study found inhabitants of the fishing community of Jamestown to have a generally unsatisfactory periodontal status, but worse for the fisherfolk in the community.

Biography

Dr. Harold Nii-Aponsah is a trained dentist by profession, and also holds a masters degree in public health. He is currently pursuing his doctoral studies in health sciences and teaches biostatistical applications in public health at the Northern Illinois University in the United States. He currently serves on numerous boards in various capacities and has won numerous honors and awards in public health. He also serves as the vice-chair of the Illinois Public Health Association- Academia Section. He is passionate about general health disparities, and his research focuses on advancing health equity, eliminating health inequalities, and health disparities as applicable to oral health outcomes. In his leisure, he enjoys reading, reading, working out, road-tripping, and playing tennis. He is passionate about volunteering and hopeful to leave a positive impact in this world through service.

Abstract

Big Ideas and New Strategies in E-health

Precious Olayinka

Abstract

According to the World Health Organization (WHO), e-health is the cost effective and secure use of information and communication technologies, to support health and health-related fields including healthcare, health surveillance and health education, knowledge and research. E-health simply means the use of information and technologies in healthcare. E-health can be used for diverse things- treating patients, conducting research, tracking diseases, educating the health workforce, Monitoring Public Health, amongst many others. It is imperative to give account of the new possibilities the internet is opening up, to the area of healthcare. The internet creates new opportunities every day and it is ultimately smart, for healthcare to join the train, to proffer solutions, for health. Many countries have started programmes, centred on e-health, to improve overall wellbeing of populations. There are different subsets of e-health, like - Digital Health, Electronic Health Records (EHR), Telehealth, Telemedicine, etc. Some of the ideas that birthed the provision of services, provided through e-health are: Telepathology, Vital Signs Monitoring, Telesurgery, Electronic Prescription, Teleradiology, Teleconsultation, Treatment and care, Hospital management, Ubiquitous Health, amongst others. This approach to healthcare progressively being harnessed in geographically extended areas, where there is low availability of healthcare or even non-existent. Also, when fittingly qualified medical personnel are available only in centralized locations. Computers are now fundamental, in most clinical practices. Through the Electronic Medical Record (EMR) innovation, computer generated prescriptions have been of so much help and comes with many benefits including links to software that highlights risks from drugs and drug-drug combinations. Another example is the fact that the National Cancer Institute in the USA had developed an Internet-based program that allows the physician or counsellor to input clinical information relevant to breast cancer risk, including family history and previous breast pathology. The health professional then gets this information, in form of a relative risk. The internet is now used, to deliver DNA tests directly to consumers. There is also the Diabetes e-heath ecosystem, which was defined by the Association of Diabetes Care & Education Specialists (ADCES), as the use of information and communication technologies for health. The e-health ecosystem includes personal health devices like the physical activity and sleep trackers, smart home assistants, smart implantables, data management platforms, cloud-connected monitoring systems, telehealth services, digital education, mobile apps and digital therapeutics.  A great part of the e-health innovation is the fact that the internet has been essential for educating patients, families and the community at large, and this helps people to increase their comprehension of what can be complex issues to their wellbeing.  

Biography

Precious Olayinka graduated recently, with a B.sc in Public Health. She had her internship with Monitor Healthcare Limited, a health NGO, whose present focus is to reduce the burden of Breast Cancer in Nigeria. She has anchored sensitization programmes on the risk factors and prevention of Non-Communicable Diseases. She has concentrated most of all in Community Health, Epidemiology and Health Promotion. She has also developed a profound interest in Global Health and Research for public policy. She has a research paper that has been accepted by the American Journal of Preventive Medicine, for Publication. She has participated actively in community and volunteer services and she is currently volunteering with APIN Public Health Initiatives, a health NGO that works to reduce the burden of HIV/AIDS in Nigeria. She loves Public Speaking and she is an active member of the Toastmaster’s club. She is determined to pursue postgraduate studies in Public Health, to heighten her contribution to the health of the society, assume positions with high level of responsibility in education and program planning and translate

Abstract

Leveraging technology to encourage Key Health behavior change among patients in India Despite advances in medicine and healthcare at large, the last mile experience for those in rural India continues to be filled with challenges. Noora health’s remote engagement digital service is designed to meet people where they are at by leveraging technology and whatsapp to give anyone access to information about their health long after they leave the hospital or are discharged from the hospitals and return back to their communities. On signing up to the service, users receive daily push messages that promote healthy practices and health seeking behaviors by providing continued care. Noora Health’s clinicians, consultant specialists, service designers, health behavior change specialists, user experience designers and tech experts create culturally appropriate message content, flows, and overall experience to deliver health messages when families need them the most. It also contains an interactive live chat component that provides a novel avenue for patients with otherwise poor access to care, to ask qualified providers pressing clinical questions. The service does not diagnose or prescribe medicines. The service is live in 6 Indian States, in 5 languages and in the following clinical conditions: Cardiology, Antenatal Care, PostNatal Care and General Inpatient health area. We have on-boarded 1,00,000 + users till date, shared over 15l individual messages to people who opted to use the service and resolved 25,000 health questions from individuals.On top of wider coverage across India, Whatsapp offers advantages that other digital technologies like short message services and interactive voice response systems do not.

Biography

Dr. Neelima (MBBS) is a Medical Design Strategist at Noora Health, where she leverages her knowledge in medicine and her understanding of design and applies it to the healthcare space to create a transformational experience for the end user. She works across health condition areas (maternal and child health, inpatient, oncology, cardiology, tuberculosis, and COVID-19) to set medical content strategy for in-person and digital services at Noora Health. Her experience in the field across various condition areas have led her to understand the value design brings to global health and incorporates it into her work

Abstract

Leveraging technology to encourage Key Health behavior change among patients in India Despite advances in medicine and healthcare at large, the last mile experience for those in rural India continues to be filled with challenges. Noora health’s remote engagement digital service is designed to meet people where they are at by leveraging technology and whatsapp to give anyone access to information about their health long after they leave the hospital or are discharged from the hospitals and return back to their communities. On signing up to the service, users receive daily push messages that promote healthy practices and health seeking behaviors by providing continued care. Noora Health’s clinicians, consultant specialists, service designers, health behavior change specialists, user experience designers and tech experts create culturally appropriate message content, flows, and overall experience to deliver health messages when families need them the most. It also contains an interactive live chat component that provides a novel avenue for patients with otherwise poor access to care, to ask qualified providers pressing clinical questions. The service does not diagnose or prescribe medicines. The service is live in 6 Indian States, in 5 languages and in the following clinical conditions: Cardiology, Antenatal Care, PostNatal Care and General Inpatient health area. We have on-boarded 1,00,000 + users till date, shared over 15l individual messages to people who opted to use the service and resolved 25,000 health questions from individuals.On top of wider coverage across India, Whatsapp offers advantages that other digital technologies like short message services and interactive voice response systems do not.

Biography

Victoria comes from a clinical and community social work background and has a strong passion to serve the society. She is a relentless problem solver. At Noora Health, she helps manage. WhatsApp bots that give users a space to learn and interact with the nurses in order to help change their behaviors and keep them healthy. Being a design strategist with a social work background helps her understand the end users better to strategize solutions using technology

Abstract

The role of Knowledge, Attitude and Practice (KAP) in the prevention of Diabetes mellitus (DM) and Hypertension (HT) in Indonesia. 

Authors: Omar Aljawair  

Mohsin Khan 

Majed Kazim 

 Ahmed Alsaif 

Supervisor: Jaap Koot  Dr. Jaap Koot Majed Kazim, Student number: S3203735 The role of Knowledge, Attitude and Practice (KAP) in the prevention of Diabetes mellitus (DM) and Hypertension (HT) in Indonesia. 

 Introduction:

 n Indonesia, the burden of Diabetes Mellitus (DM) and Hypertension (HT) is increasing significantly1 . According to the Indonesian Sample Registration System, DM and HT are within the top 10 most common diseases in Indonesia; with a prevalence of 12.9% and 6.7% respectively2 . Compared to the younger Indonesian population, there is in general a higher mortality rate among the middle aged people (40 - 50 year olds). As a result, there is a reduction in the proportion of the older Indonesian population that survive beyond the age of 50 years3,4. It is widely accepted that Non Communicable Diseases (NCDs) are the cause of this, inclusive of DM and HT. In light of this, it becomes of utmost priority to facilitate prevention of risk factors for NCDs, such as unhealthy eating habits, lack of physical exercise and obesity. This will help reduce the prevalence of NCDs in Indonesia . 

Previous studies have suggested that knowledge and attitude of individuals towards health can be associated with NCDs1,2,5. Nevertheless to-date, no study has been conducted to investigate the roles of knowledge and attitude of the Indonesian population in the increasing prevalence rates of DM and HT. To fill this gap, a Scaling-Up NCD Intervention in South-east Asia (SUNI-SEA) research project was initiated. The aim of this was to facilitate cost-effective scaling-up strategies based on evidence-based prevention and management programmes for DM and HT6 . More than half of the affected Indonesian population fail to receive adequate treatment for DM and HT5 . The situation is rendered even more dire when considering the substantial number of undiagnosed cases related to DM and HT. 

This bachelor thesis explores the following research question: to what extent does Knowledge, Attitude and Practice (KAP) contribute to the prevention of HT and DM in Indonesia? To answer this question, our study attempts to answer the following questions: 

● Do Indonesians living with DM and HT have better Knowledge, Attitude and Practice (KAP) of these diseases compared to their healthy counterparts? 

● Do significant differences in KAP exist across different age groups of the Indonesian population? 

● Are there significant differences in KAP between Indonesians who live in urban and rural areas?

 Any significant findings will then be used to promote disease prevention nationwide. Methods and Results Methods To determine the role of KAP in the Indonesia population, a cross-sectional study was conducted with the use of KAP questionnaires taken from the SUN-SEA project in Indonesia6 . Ethical approval obtained by Sebelas Maret University in Indonesia as can be seen in Appendix 1 . A total of 3877 participants were included in the study (1861 screened for diabetes and 2016 screened for hypertension). Among these, 216 Dr. Jaap Koot Majed Kazim, Student number: S3203735 The role of Knowledge, Attitude and Practice (KAP) in the prevention of Diabetes mellitus (DM) and Hypertension (HT) in Indonesia. 3 were previously diagnosed with DM and 512 with HT. 

The participants were chosen from geographic areas near the SUNI-SEA project. These geographic areas were further categorized as either urban or rural areas. Questionnaire Design A Knowledge, Attitude, Practice (KAP) questionnaire was developed by the team of Sebelas Maret University and employed in Indonesia by enumerators that were trained in administering the questionnaire. The KAP questionnaire consisted of 2 main parts; DM and/or HT. Furthermore, questions pertaining to each of these diseases were categorised into Knowledge (K), Attitude (A) and Practice (P). These included questions related to personal information, current illnesses, the use of health application, evaluation of current knowledge/health literacy, attitude and practice. The “K” category was made up of a total of 34 items (18 for DM and 16 for HT) and prompted participants to provide information relevant to the knowledge of risk factors, symptoms, treatment and complications of the DM and HT. For “A”, a total of 12 items (6 for DM and 6 for HT) were used to gather information related to the participants. Finally, 30 items for “P” (15 for DM and 15 for HT) were used to obtain details of lifestyle behaviours. 

Statistical Analysis The data collected from patients with DM and HT were merged and prepared for analysis using version 27 of the Statistics Package for Social Science (SPSS). Continuous variables (such as age of the patients) were displayed as mean (+/- SD), whereas categorical variables (such as education level) were shown as integers (and percentages). As a part of the descriptive statistics, patient characteristics were both tabulated and also described with the help of graphs, pie charts and frequency distributions generated in R. Logistic regression analyses were performed in SPSS using each set of KAP items from the DM questionnaire as response variables with the 3 predictor variables; current illness, area and age. This was then repeated for each set of KAP items from the HT questionnaire as response variables with the same three predictor variables as mentioned above. Cases and controls for each condition were statistically analysed with the Mann-Whitney test. A significance threshold of P = .05 was used to define statistical significance. 

Biography

Passionate about innovative E-health solutions that could add a significant value to preventive medicine. Hoping to become an active member of a health entrepreneurship initiative and making a real impact on humans’ lives.Majed is a person who have came a long way to study medicine in the hope of helping people. However, he realized that he can help more people at a much broader spectrum. Especially that Doctors are not the ones saving lives; what is saving lives is the System meaning that ensuring a reliable health care system and stable security is more significant than becoming a mere doctor. Hence, his dream goal is to finally find the right team members that will engineer a whole new revolutionary health vision which will ensure an equal easily accessible health care system benefiting all humans from all different socio-economic levels. For what is the benefit of treating individual cases while we could have prevented them in the first place and didicated these wasted reaources to others in desperate need for it!

Abstract

Internalized Stigma and its correlates amongst patients with Common Mental Disorders. - Priyanka Manghani Abstract Introduction: Mental Health is a crucial component of Sustainable Development Goals. Common Mental Disorders are an umbrella term inclusive of mood disorders, neurotic, stress-related and somatoform disorders according to International Classification of Diseases and Related Health Problems-10 (ICD-10). Internalized stigma in psychiatric patients not only impacts their self-esteem and quality of life but also influences the individual’s treatment and health seeking behaviour. Thus, stigma presents a major barrier and is influenced by a variety of socio-demographic and clinical variables. This study explored the level of internalized stigma perceived by patients and the association between self-stigma with socio-demographic and clinical profile of the patient. Materials and Methods: A structured socio-demographic and morbidity proforma along with the Internalized Stigma of Mental Illness (ISMI) Scale was administered to 119 patients above 18 years with different Common Mental Disorders as per ICD-10 criteria. In this crosssectional study, patients from the OPD service of a tertiary care hospital were included. Patients with epilepsy, intellectual disability, organic mental disorders, and those requiring hospital admissions were excluded. Results: A mild to moderate level of stigma was reported in patients with common mental disorders. The mean scores across the domains of alienation, discrimination, social withdrawal, and stigma resistance were highest in patients with obsessive compulsive disorders. Age, age of onset of disease, history of suicidal ideation and attempt were significant predictors of self-stigma. Strong correlations were found between various domains of stigma. Conclusion: Stigma can act as a barrier in addressing the burden of global mental health, influencing treatment and health seeking behaviour. Knowledge of self-stigma and its contributing factors will help us understand the extent of internalized stigma present in patients, aiding in interventions to reduce internalized stigma

Biography

Dr. Lorelei E. Walker (she/her) is an experienced public health professional, community advocate, policymaker, labor leader, and science educator. Her interdisciplinary focus fuels community-centric action enabling systematic change for the greater good. Dr. Walker earned a PhD in Public Health and MPH from the University of Washington’s School of Public Health, Institute for Public Health Genetics. Her work focused on allostatic load, stress response programming, environmental toxicants, epigenetic adaptation, health equity, and community organizing. She is currently the Director of Public Health Training for the Social Safety Initiative and lives in Issaquah, WA with her feisty 7-year-old daughter and her family.

Abstract

Understanding the impact and experiences of COVID-19 on healthcare worker wellbeing: A case study of the Vhembe district, Limpopo province

 Abstract:

The COVID 19 pandemic imposed a significant strain on healthcare delivery, resulting in stress among frontline healthcare workers caring for COVID 19 patients and taking a toll on these workers' mental health. Prior to the COVID-19 pandemic, the South African healthcare system was overburdened and under severe strain due to a lack of resources, personnel, and critical facilities, as well as many patients living with HIV, tuberculosis, malnutrition, and diabetes. HCWs are more likely to experience psychological difficulties such as anxiety, depression, fear, distress, poor coping mechanisms, and insomnia. Thus, safeguarding HCWs' mental health and well-being is critical during the COVID-19 pandemic. The study aims to understand and assess job strain, job satisfaction, burnout and wellbeing of Healthcare workers during the COVID 19 pandemic .

The study will use mixed method approach which focuses on collecting, analyzing and mixing both quantitative and qualitative data in a single study. The study will use triangulation design wherein qualitative and quantitative data will be collected and analyzed, the results will be merged to compare, interrelate or validate results to provide a general equal emphasis on both data forms. Accordingly, this study will be conducted in two phases. Phase 1a will employ a quantitative methodology, Phase 1b will utilize a qualitative methodology A measure of psychological wellbeing will be done using the General Health Questionnaire (GHQ), the perceived stress scale will be used to measure stress and the job content questionnaire (JCQ) will be used to assess job strain and decision latitude. The data analysis will be conducted with the use of the Statistical Package for Social Sciences (SPSS) version 2. The framework analysis will be used to analyse qualitative data

Biography

Name : Lisa Wadzanai Kashiri 1. BSc Biokinetics (UNIVEN) 2.Post Graduate Diploma In primary healthcare and district health management (UNIVEN) 3.Masters of Public health (UNIVEN) Currently studying PhD Public health Medicine (University of Kwazulu natal,South Africa )

Abstract

The Use Of Computed Tomography For Detecting COVID-19 Pneumonia: 

Rapid Evidence Review

Abstract

Background: The nucleic acid test or genetic sequencing (RT-PCR ) serves as the gold standard method for confirmation of COVID-19 infection, yet several recent studies have reported false-negative results of RT-PCR. Thus, several countries are looking at the role of chest imaging for the diagnostic workup of patients with suspected or probable COVID-19 disease and to inform clinical management of COVID-19. Therefore, this rapid evidence review provides the best available evidence on the use of Computed Tomography (CT) for the detection of COVID-19 Pneumonia.

Methods: The researcher searched in PubMed, Cochrane Library, JBI Library, Epistemonikos, and Evidence aid databases. The searching was based on identified population, concept and context with respect to the objective of the review from December 01, 2019 to June 12, 2020. Seven relevant systematic reviews identified that provide evidence about the effectiveness CT imaging role in COVID-19 pneumonia. The methodological quality of the included systematic reviews were appraised using AMSTAR. 

Results: Use of CT as a first-line diagnostic or screening tool in COVID-19 is not beneficial. Nevertheless, for patients with suspected COVID-19 pneumonia but false negative RT-PCR, cross checking with CT and repeated RT-PCR is essential in order to avoid misdiagnosis. Chest CT offers the great sensitivity for detecting COVID-19 pneumonia among symptomatic individuals, especially in a severe situation. As well, it serves for evaluating potential complications, disease severity and progression of COVID-19 pneumonia. The imaging features of CT findings differ at early, intermediate and later stage of COVID-19 pneumonia. The most common chest CT findings were patchy and Ground glass opacities. On the other side, the diagnosis of CT in children is difficult.

Conclusions: Computed tomography is not used for primary screening and diagnosis of COVID-19. But, it has very high detection in later time and can be used for evaluation of COVID-19 pneumonia. For patients with suspected COVID-19 pneumonia but false negative RT-PCR, cross checking with CT and repeated RT-PCR is essential in order to avoid misdiagnosis. 

Authors

Samson Mideksa, PhD, Yoseph G/yohannes, PhD Fellow, Firmaye Bogale, MPH. Dagmawit Solomon, MPH, Tsegaye Getachewu, MPH, Ermias Wolde, MPH, Zelalem Kebede, MPH

Sabit Ababor, MPH, Desalegn Ararso, MPH, PhD Fellow , Getachew Tolera, PhD 

Acknowledgments

The researcher would like Dr. Gemechu Geleto (MD, Consultant Radiologist, Radiology department Head and Instructor at Negelle Arsi General Hospital and Medical College) reviewed the document and provide technical assistance.

Biography

I obtained my doctoral Degree in Public Health emphasis on Preventive Health Care. I also finished MPH with two emphases namely Health Promotion and Nutrition. As well, I have the background of Nursing, and Rural Development and Family Science at an undergraduate level. Moreover, I have more than six years of experience working as chief registrar and teaching in College, Ethiopia, and more than five years’ experience in teaching graduate school, being consultant, journal editor, and researcher in different organizations both in Ethiopia and outside of the country. I spoke in `moral recovery` for Dasmarinas city Jail officers, and conducted several presentations in the community and scientific community, including poster presentation in the Philippines. As well. I taught MPH students at the Asia-Pacific International University in Thailand. Then, I joined Health System and Reproductive Health Research Directorate at Ethiopian Public Health Institute (EPHI) as Technical Assistant to coordinate research projects. Currently, I am working at Knowledge Translation Directorate (KTD) at EPHI with Researcher position. As I am working at KTD in EPHI, We generate more than 18 evidence synthesis including Evidence-Informed Policy Brief, Executive Summary, Policy Dialogue Report, Health Technology Assessment, Issue Brief, Rapid Evidence Review, and Evidence Summary.