Enhancement Program For Couples Adjustment To Failed Assisted Reproductive Technology

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Individual’s Health – Health Care Use & Policy Studies PIH15 Evaluating Community Pharmacists’ Response To Adverse Drug Events Among Women With Pcos: A Simulated-Client Study Mohamed Ibrahim MI, Osman A, Ali S Qatar University, Doha, Qatar

Objectives: The aim of this study was to evaluate the practice and communication, i.e. the structure, content and interaction between clients and pharmacists in response to patients with adverse drug events in community pharmacies.  Methods: Observational descriptive simulated client (SC) method was conducted. Thirty community pharmacies in Qatar were randomly selected and randomized into two groups of 15 (Face to Face, n= 15 and Telephone Calls, n= 15). Two SCs visited all the pharmacies. Pharmacists were presented with a scenario of polycystic ovarian syndrome (PCOS) patient on metformin presenting with bothering diarrhea and requesting the pharmacist assistance. Data collection was through standardized scenario and data collection form which were piloted and refined prior to the study. Primary outcomes included data gathering, labeling, counseling and prescribing practices.  Results: Forty interactions were made with community pharmacists. Majority of pharmacists dispensed medications (90%); antidiarrheal (67.5%) and antibiotics (37.5%). Referral was made by 7 pharmacists (17.5%). Majority of pharmacists did not gather important information from the patient, such as duration of diarrhea and frequency of diarrhea (87.5% and 82.5%, respectively). All pharmacists needed prompting from the SC to discover that this is an ADE from metformin. More than one third of pharmacists did not label any medication dispensed (43.75%). No significant difference was found between groups in data gathering and dispensing (p-value >  0.05).  Conclusions: Community pharmacy practice in Qatar is inconsistent with current guidelines and best practices with poor data gathering, labeling, counseling and prescribing practices. There is an urgent need for professional development and training programs for community pharmacists. PIH16 Pharmacoepidemiological Survey Of Under- Five Antidiarrhea Drugs Utilization In A Tertiary Teaching Hospital In Enugu Metropolis Southeast Nigeria Ogbonna BO, Idoko L Nnamdi Azikiwe University, Awka, Nigeria

Objectives: Diarrhea is a major cause of morbidity and mortality among underfive children in developing countries and consumes reasonable portion of household income. Regular drug utilization studies is essential for auditing of drug use trends in public health facilities for improvement of treatment outcomes and reduction of disease burden.The study assessed diarrheal treatment practices among underfive, and documented information on the level of adherence to standard treatment guideline.  Methods: The study was a retrospective cross sectional analysis of prescriptions in a randomly selected tertiary teaching hospital. It was carried out between January 2016 and February 2017.A total of 350 randomly selected prescriptions with at least one anti-diarrheal agent were used. Eligible prescriptions for under-five children written in English Language between January 2014 and December 2015 were used for the study. Data was summarized using descriptive statistics.  Results: Of the 350 prescriptions studied, 200 (57.1%) were males and 179 (51.1%) came from the urban areas. The mean age was 1.33 ± 0.92 years. Oral electrolyte agents were the most prescribed 388 (50.1%) followed by vitamins and minerals 200(29.7%) while antibiotics were the least prescribed 32 (4.7%). The most used electrolyte agents were oral rehydration salts 338(50.1%) and Zink 184(25.3%) while ringers lactate was the most prescribed parenteral electrolyte solution 50(7.5%). Dextrose water was the least 25(3.7%). Powders were the most prescribed dosage form 388(50.1%) while suspensions were the least 15(2.2%). Generic prescription was 551(81.8%) against the World Health Organization (WHO) recommendation of 100% generic prescription. The average number of drugs per encounter was 4.4 against the recommended 1.6- 1.8.  Conclusions: The study suggested irrational anti-diarrhea use of drugs among under- five and non- adherence to standard treatment guideline. It provides baseline data for further studies at improving anti-diarrhea utilization. PIH17 How Much Sexual Violence Against Women Costs To Brazil? Stutz Klen M1, Fernandes RA2, Gulart A2, Correa JS2, Menezes LP2, Amaral LM2, Vasconcellos JF2, Senna T2 1Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil, 2Sense Company, Rio de Janeiro, Brazil

Objectives: Brazilian Ministry of Health advocates full and humane treatment for women victims of sexual violence, who must receive psychological care, emergency contraception and prophylaxis for sexually transmitted diseases, HIV, Hepatitis B, among other care measures. In addition to the social impact and intangible costs, sexual violence has a financial impact on the public healthcare system. This study aims to evaluate direct medical costs related to the care of women victims of sexual violence in Brazil, in 2016.  Methods: Data from the most recent Brazilian Public Safety Yearbook show 45,460 cases of rape per year in the country, 89% of which are women (40,459) and reported only in 35% of cases (14,161). Costs of consultations, laboratory examinations and imaging tests came from the Brazilian Outpatient Information System (SIA/SUS) database. Procedures were selected from ICD-10 codes (T74.2, Y05, Z61.4, Z61.5 and Z04.4), only for female. For drugs and vaccine costs, a microcosting was developed based on national guidelines. Costs are presented in Brazilian Real (BRL) for 2016.  Results: Costs of non-pharmacological care were 989,263 BRL. The highest cost (74.99%) was attributed to ICD T74.2 (sexual abuse), including multiprofessional consultation, laboratory and imaging exams. Pharmacological costs included antiretroviral drugs, antibiotics and Hepatitis B vaccine, and totaled 6,303 BRL per patient. This cost was applied to 14,161 patients, generating an impact of 89,267,415 BRL. Estimated total cost for the public healthcare system with acute management of sexual violence against women was

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90,256,678 BRL per year.  Conclusions: Acute care with sexual violence against women generates a significant budgetary impact of more than 90 million BRL for the public healthcare system in Brazil. Costs generated by this analysis are underestimated by low notification rate and low demand for health services by victims. In addition, the real impact should include direct long-term costs as well as indirect and intangible costs. PIH18 Real World Data On Labor Procedures In The Brazilian Unified Health System (SUS). An Eight Years Retrospective Database Study Carmo ÉV Escola de Terapias Orientais de São Paulo, Sao Paulo, Brazil

Objectives: Obstetric practice has undergone significant worldwide changes in the last 20-30 years, with greater emphasis on the promotion of the natural and physiological characteristics of labor. However, there is little information available regarding childbirth procedure characteristics in the Brazilian Unified Health System (SUS). The objective of this study was to address the labor procedures profile in the Brazilian Healthcare System.  Methods: Childbirth characteristics in SUS were analyzed retrospectively from the Brazilian Unified Health System Database, the DATASUS. The study period was defined as January 2008 to December 2015. Procedures utilization was identified in database by identification codes 0310010039 (labor), 0310010047 (high risk labor), 0411010034 (cesarean) and 0411010026 (high risk cesarean) in patient claims. The analyzed variables included reimbursement value authorized, geographical region, assistance level and procedures over time.  Results: From 2008 (n= 1,97 MM) to 2015 (n= 1,98 MM) a total of 15 MM of labor procedures were registered in DATASUS. The regular labor represented 59% (9,1 MM) of procedures while cesarean accounted for 32% (5 MM) in the same period. We also observed and increasing number of high risk labor (R2= 0,8496) and cesarean (R2= 0,924) over the years. Additionally the yearly number of regular labor has dropped down, from 1,2MM to 1MM. The total spending was R$ 9,9BI. Regular labor accounted for 49% (R$ 4,9BI) of the investment, in comparison to regular cesarean: 36% and R$ 3,5 BI, respectively. The average value reimbursed for regular labor (R$ 535), regular cesarean (R$ 711), high risk labor (R$ 785) and high risk cesarean (R$ 1,197) have not changed significantly over the years.  Conclusions: These data reinforces the importance of following the adoption of labor options currently available in Brazil. Besides the observed preference for regular labor and against the worldwide tendency, there is an increasing demand for high risk procedures in SUS. PIH19 Desarrollo De Material Audiovisual Educativo Basado En La Evidencia Para Promover La Salud Materna Y Neonatal Jiménez V1, González L1, Sánchez N1, Prieto L2, Reyes J1, Gómez LM1, Eslava-Schmalbach J1, Páez C2 1Sociedad Colombiana de Anestesiología y Reanimación, Bogotá, Colombia, 2Universidad Nacional de Colombia, Bogotá, Colombia

Objectives: Diseñar 12 videos educativos basados en la evidencia y consenso de expertos, para la trasferencia del conocimiento (KT) sobre el cuidado materno y neonatal.  Methods: Estudio con 3 fases: 1. Revisión sistemática de la literatura sobre efectividad de diferentes formatos audiovisuales como estrategia (KT); 2. Definición preliminar de los temas a incluir en cada video, mediante la revisión de la evidencia de guías de práctica clínica de salud materna y neonatal; 3. Consenso formal bajo la metodología Delphi con 10 expertos especialistas en neonatología, pediatría, psicología, seguridad del paciente, educación del paciente, ginecología y obstetricia.  Results: En cuanto a la revisión de formatos: los videos en formato 3D muestran mejores niveles de conocimiento y recordación que los videos 2D; incluir y resaltar palabras clave en el video aumenta los niveles de recordación; se debe evitar incluir muchos estímulos que interfieran entre sí, música de fondo o imágenes sobresaturadas pueden interferir con la comprensión; videos con voz humana que hable directamente al televidente aumentan el aprendizaje. Respecto al consenso de expertos, se encontró que es clave mostrar la importancia de consultar al médico ante cualquier señal de alarma en el embarazo, rechazar la automedicación y promover el contacto piel a piel y lactancia materna.  Conclusions: Al construir estrategias audiovisuales para KT puede ser efectivo incluir voces con acepto neutro que hablen directamente al televidente mientras se muestran palabras que refuercen las ideas clave del tema. El material educativo para maternas debe hacer énfasis la importancia de consultar al médico, ir a controles periódicos y evitar la automedicación. PIH20 Enhancement Program For Couples Adjustment To Failed Assisted Reproductive Technology Chegedekova S1, Khismetova Z1, Turgambayeva A2 1Semey State Medical University, Semey, Kazakhstan, 2Astana Medical University, Astana, Kazakhstan

Objectives: Men and women use a variety of coping strategies to manage stress associated with infertility. This study is aimed to research the effect of counselling on couples adjustment to failed assisted reproductive technologies (ART).  Methods: Study was based on Semey Region of Kazakhstan. The sample was consisted of 85 couple: failed cases 46 and success cases 39. Tools used for data collection consisted of FertiQoL tool and Ways of Coping Questionnaire, follow up card and EX-PLISSIT model for counselling program. Sociological survey included both filling in the questionnaire and interview with respondents. For relevant statistical analysis Excel and SPSS tools were used.  Results: Results revealed that couples included in the study ranged between 23-48 years, with a mean age of 32.14±2.896 years for women and 36.98±3.526 years for males. 68.1% of female were the cause of infertility, and 89.9% of couples had a previous trials of ART. In relation to coping strategy, for women at least, taking direct action appears to be effective if it is associated with some degree of acceptance of one’s position. For males, the picture is less clear, though direct action and acceptance again appear to be effective coping strategies. Males scores

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were significantly lower than before counselling with regard to passive avoidance strategy with t= 2.16, and females scores were significantly higher than before with regard to meaning-based strategy with t= 3.96.  Conclusions: The study identified key gender differences in how men and women cope with infertility and counselling effective on couples’ adjustment to failed ART. The establishment of educational programs help to answer their questions and different coping strategies with failed ART trials.

air pollution, and breast cancer, was observed in seven of the 12 articles selected. In particular, the effect of pesticides on the risk of developing breast cancer was found in half of the eight articles.  Conclusions: The studies analyzed favor an understanding of the determinants of breast cancer incidence and mortality and reaffirm that genetic/hereditary, endocrine/reproductive factors, in addition to age, explain a great part of the risk of developing breast cancer, however, its association with socioeconomic and environmental determinants are essential to better understand disparities in disease development.

PIH21 Epidemiology Of Healthcare Registered As Sexual Abuse Against Women In Brazil Gulart A1, Fernandes RA1, Stutz Klen M2, Correa JS1, Amaral LM1, Vasconcellos JF1, Senna T1, Menezes LP1 1Sense Company, Rio de Janeiro, Brazil, 2Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

Objectives: To evaluate the epidemiological data on health care recorded as sexual abuse against women in Brazil in 2016.  Methods: Healthcare registered as sexual abuse against women came from the Brazilian Outpatient Information System (SIA/ SUS) database. Procedures were selected from ICD-10 codes (T74.2, Y05, Z61.4, Z61.5 and Z04.4), only for female, for 2016. In order to compare information from database, a gray literature search was performed to find other sources of rape or sexual violence numbers against women in Brazil.  Results: In 2016, 11,389 outpatient procedures were registered with the selected ICDs. The most commonly affected age groups accounted for 29.28%, 16.93%, 10.77%, 10.33% and 10.27%, represented by 10-14 years, 15-19, 6-9, 20-24 and 0-5 years, respectively. For the geographical division, the North region was responsible for the larger number of visits (26.74%), followed by South (25.29%), Southeast (23.21%) and Central West (6.68%). The state with the largest participation was Tocantins (21.39%). The most reported ICD was T74.2 (sexual abuse), in 71.21% of cases. The most accomplished procedure was the “multiprofessional service for attention to people in situation of sexual violence” (84.46%), followed by hepatitis C serology (6.63%). As gray literature, the Brazilian Public Safety Yearbook showed 45,460 cases of rape per year in the country, 89% of which are women (40,459) and reported only in 35% of cases (14,161), in 2015.  Conclusions: More than 77% of clinical care in Brazil registered as sexual abuse against women occur under the age of 24 years. The number of hospital visits is below the expected, showing that in addition to potential registration errors, many women choose not to seek health care in this situation. Acute treatment is very important and able to avoid diseases development. More campaigns are needed to encourage the search for healthcare directed to victims, as a public health measure. PIH22 Intestinal Parasitic Disease And Hygienic Conditions In Children: Diagnostic Evaluation For Prevention Balladares-Saltos M, Robalino X, Guerendiain M National University of Chimborazo, Riobamba, Ecuador

Objectives: To determine the intestinal parasitism prevalence and the relationship between parasite species and hygienic conditions of schoolchildren.  Methods: This study comprised 61 children (7.77 ± 2.18 years) of a rural school of San Juan, Chimborazo, Ecuador. The participants integrate the EVANES research project and were randomly selected. To determine intestinal parasitism, faeces were analysed. A survey was applied to know the hygienic conditions (water treatment, type of treatment and hand washing) of families and schoolchildren. Data analysis was performed using Chi-square test. Informed consent was obtained and the Helsinki rules were followed.  Results: The prevalence of intestinal parasitism was 93.4%. The parasites identified were cysts of Entamoeba coli (78.7%), Entamoeba histolytica (65.6%), Giardia lamblia (24.6%), Embadomonas intestinalis (19.7%), Chilomastix mesnili (9.8%) and Endolimax nana (13.1%), Giardia lamblia trophozoites (1.6%) and Hymenolepis nana eggs (8.2%). When comparing species according to hygienic parameters, it was observed that the frequency of Embadomonas intestinalis, Chilomastix mesnili and Endolimax nana infections was lower in children of families who treated the water for shower and washed their hands before eating. Hymenolepis nana development was lower in children who drank water treated (boiled, chlorinated, filtered) and use it to shower.  Conclusions: Schoolchildren of rural highlands have a high prevalence of intestinal parasitism, presenting protozoa and helminths. According to our results, the water treatment may contribute to prevent this pathology. PIH23 Socioeconomic And Environmental Determinants In Breast Cancer Incidence And Mortality: Scientiometric Review, 2006 - 2016 Margarido OT, Michellon E, Costa CK Universidade Estadual De Maringá, Maringá, Brazil

Objectives: To verify the socioeconomic and environmental factors those are associated to breast cancer incidence and mortality in different countries.  Methods: Scientiometric review developed from the publications of the databases MEDLINE and LILACS, included in the Virtual Health Library. The keywords used in the research were BREAST CANCER and SOCIOECONOMIC FACTORS, BREAST CANCER and ENVIRONMENTAL FACTORS and BREAST CANCER and PESTICIDES. The search was undertaken in the middle of 2016 and as limits the publications were adopted from 2006 to 2016.  Results: 34 publications were selected to be better studied, 14 dealing with the association between breast cancer and socioeconomic factors, 12 of the association with environmental factors and 8 of the association with pesticides. Positive association between higher socioeconomic status and breast cancer incidence was observed in three articles, mediated by differences in exposure to reproductive factors, hormone replacement therapy and alcohol ingestion. Positive association between lower socioeconomic status and mortality rate was observed in eight articles, attributed mainly to disparities in access to health services and less information regarding the prevention of breast cancer. Positive association between environmental factors, with regard to smoking, exposure to cadmium and

INFECTION – Clinical Outcomes Studies PIN1 Efficacy and Safety of Interferon-Free Therapies For Chronic Hepatitis C Patients Coinfected With Hiv: Systematic Review of Clinical Trials Ferreira VL1, Souza VR2, Pedrozo RC1, Pontarolo R1 Federal do Paraná, Curitiba, Brazil, 2Prati-Donaduzzi, Toledo, Brazil

1Universidade

Objectives: To evaluate the efficacy and safety of interferon-free (IFN-free) therapies for chronic hepatitis C (HCV) patients coinfected with HIV since the possibility to present more adverse effects (AE) in this group of patients, thus increasing the clinical evidence of these therapies.  Methods: A systematic review was carried out including randomized clinical trials that brought information about efficacy (sustained virologic response, rapid virologic response and virological failure) and safety (adverse events- AE) outcomes.  Results: A total of 10 clinical trials with 1,626 patients were included, mostly with HCV genotype 1 and treated during 12 or 24 weeks. The virological response outcomes evaluated presented rates of approximately 91%, while the rate of virological failure was less than 7%. Discontinuations due to AE were less than 3%. Direct-acting antivirals (DAAs) of second-generation had several advantages: virological response values higher than the mean reached by older therapies based on the use of IFN, reduced treatment time, increased safety and the possibility of several combinations to suit the patient’s need.  Conclusions: In this way, IFN-free therapies appear as a good option for the treatment of chronic hepatitis C in the group of patients coinfected with HIV. PIN2 Risk Factors Associated With Tuberculosis In Punjab, Pakistan Mahmood HM1, Rafiq A2 1King Saud University, Riyadh, Saudi Arabia, 2Islamia University, Bahawalpur, Pakistan

Objectives: Tuberculosis is a one of the most contagious disease in the world. The number of patient of tuberculosis is increasing enormously day by day. The so rapid increase is associated with some particular risk factors that are responsible for it. The objective of our study was to identify the particular risk factors that are responsible for its spread and fully eradicate from the world.  Methods: Retrospective study was conducted from in punjab Pakistan to identify the risk factors of the tuberculosis. A structured questioner was prepared to conduct the interview with the patients. The questioner consist of anticipated risk factors that are responsible for discontinuation of tuberculosis treatment i.e. duration of treatment, misconceptions and false belief, poverty and malnutrition, herbal medicines, literacy, patient compliance and smoking. Among the hospitals of punjab, almost 2500 patients were considered to identify the risk factors of tuberculosis.  Results: In this study there were 2500 subjects under consideration, among these 2500 patients, 1680 were males that accounts for 67.2% of total suspects and 820 females that is 32.8% of total subjects. The percentage of different risk factors are in the following ratio. HIV 1.6%, not aware of duration of treatment 68.8%, not aware of ADRS 26.8%, misconceptions 9.2%, poverty and malnutrition 90.8%, herbal medicine 15.2%, illiteracy 66.4%, smoking 23.2%, lack of DOTS therapy 76.4%.  Conclusions: Tuberculosis is a highly contagious disease. We have concluded that HIV, not knowing about the duration of treatment, person that are not aware of ADRS, poverty, malnutrition, person taking herbal medicine treatment, those who are illiterate, smokers and those having severe condition and not having DOTS therapy are at high risk of getting this infection. There are still many other important factors according to studies conducted in recent years. But in Pakistan we have to minimize these factors to overcome this disease. PIN3 Predictors of Early Discontinuation of Interferon-Free Direct Antiviral Agents in Patients With HCV and Advanced Fibrosis: Results of A Real-Life Cohort Miotto N, Mendes LC, Zanaga LP, Goncales ES, Lazarini MS, Pedro MN, Goncales Jr FL, Stucchi RS, Vigani AG, Vigani AG UNICAMP, Campinas- SP, Brazil

Objectives: To determinate risk factors for premature treatment discontinuation among patients infected with HCV with advanced fibrosis treated with IFN-free direct antiviral agents (DAA)-based therapy.  Methods: We included all patients with chronic HCV infection and advanced fibrosis who initiated treatment with IFNfree DAA therapy at an university hospital from December 2015 through June 2016. We prospectively collected data from medical records using standardized questionnaires and evaluated them using EpiInfo 7.1.2.0. Primary outcome was treatment interruption and factors associated.  Results: Of total, 214 patients were included in this study, 180 patients treated with sofosbuvir(SOF) + daclatasvir ± ribavirin(RBV), 31 received SOF + simeprevir ± RBV, and 3 treated with SOF+RBV. Treatment discontinuation rate was 8.9% (19), and cirrhotic decompensation was the main reason (8; 42.1%). Among patients with Child B or C cirrhosis (31), 10 (32.2%) prematurely interrupted treatment. Risk factors for treatment discontinuation in univariate analysis were higher age (p 0.0252), higher comorbidity index (p 0.0078), higher Model for end stage liver disease (MELD) (p< 0.0001), higher FIB-4 (p 0.0122), and lower hemoglobin (p 0.0185) at baseline. Multivariate analysis demonstrated that higher age