WORLD HEALTH SUMMIT IN HIROSHIMA 2018

2018

Hiroshima

未来型グローバル医療⼈育成センター

Center of the Education of Futuristic Global Medical Professionals

Saturday Oct. 6, 2018 Hiroshima University Hospital

Photo by Hiroshima Prefect.

Welcome message

Dear Friends and Colleagues,

The year 2018 has been another amazing year packed with scientific progress. A continued digital revolution is providing a massive accumulation of new data related to health and diseases. However, despite these great achievements, the global burden of diseases, especially non-communicable diseases, has remained largely unchanged and leading causes of death worldwide. Epidemics are turning into pandemics through the increasing interconnectivity of our world and the globalization of lifestyle. Therefore, we need forums such as World Health Summit in Hiroshima to rethink our approaches and obstacles on all levels with the purpose is to strengthen the worldʼs healthcare systems.

The World Health Summit in Hiroshima is a unique space where scholars from a variety of disciplines and professional cohorts meet to discuss work in progress in their fields of interest. We believe you will enjoy a lively exchange of ideas with a diverse audience of faculties, graduate students in the conference. We will mostly certainly enjoy the opportunity to meet and exchange ideas with you.

On behalf of the Organizing Committee, we would like to welcome you to the World Health Summit in Hiroshima 2018 to make the best of this unique event. Join us to make this world become a healthier world.

Susumu Tazuma Yoshiaki Kiuchi Director Director

Center for the education of Hiroshima University Hospital futuristic global medical professionals

Access

臨床管理棟 ３階

3rd floor Clinical Administration Building

Main Conference Room ⼤会議室

Main Program Opening remarks (13:00~13:05) Prof. Yoshiaki Kiuchi

Director of Hiroshima University Hospital Keynote lecture 1, 2 (13:05~14:35) Chair

Prof. Susumu Tazuma Deputy Director of Hiroshima University Hospital

Speaker 1. Disaster resilience in an aging society: Lessons from the Great East Japan

Earthquake and Tsunami Ichiro Kawachi (United States of America) ............................................. 1

2. Artificial Intelligence in Medicine: Concepts, Challenges and Lessons

Tien Yin Wong (Republic of Singapore) ................................................. 2

Short Break（14:35~14:40）

Keynote lecture 3, 4 (14:40~15:50) Chair

Prof. Masatoshi Matsumoto Community-based Medical System Department Graduate School of Biomedical & Health Sciences, Hiroshima University

Speaker 3．Large-scale cohort studies in Japan: Current status and future perspectives

Mariko Naito (Japan) ......................................................................... 3 4．The Challenges of Public Health in the Developing World

Md Moshiur Rahman (People's Republic of Bangladesh) ........................... 4

Break（15:50~16:00）

Workshop (16:00~17:00) Chair

Prof. Kotaro Tanimoto Professor of Orthodontics Department Deputy Dean of Dentistry, Hiroshima University Hospital Prof. Takanori Taogoshi Assistant Professor of Pharmaceutical Services Department Hiroshima University Hospital

Speaker 1. Current status of Japanese primary care and development of measuring tool for medical complexity in Japan

Shuhei Yoshida (Japan) ...................................................................... 5

2. Health care issues in Papua New Guinea Yuki Koga (Japan) ............................................................................. 6

3. The challenge for Indonesian in near future related to lifestyle disease, End Stage Renal Disease patient management

Theresia Maria Toji Pio (Republic of Indonesia) ....................................... 7 4. Estimating the impact of nationwide supplementary immunization campaigns on the epidemiology of measles in Cambodia, Philippines and Vietnam, 2007-2017

Momoko Yamaoka (Japan) .................................................................. 8 5. Panel discussion (16:40~17:00) Closing remarks (17:00~17:05)

Prof. Susumu Tazuma Director of Center for the Education and Futuristic Medical Professionals, Deputy Director of Hiroshima University Hospital

Abstracts

1

Disaster resilience in an aging society: Lessons from the Great East Japan Earthquake and Tsunami Ichiro Kawachi, MD, PhD Professor, Department of Social Epidemiology Chair, Department of Social & Behavioral Sciences Harvard School of Public Health

Natural disasters are increasing in frequency and severity worldwide. Due to population aging, older people are increasingly affected. For example, up to two-thirds of the affected populations in the 2011 Great East Japan Earthquake and Tsunami were older residents who were 60 years old or over. My presentation will focus on the lessons learned about resilience in the aftermath of the March 11 disaster. Recovery after major disaster poses a unique set of challenges for the older population, including disruption of medical care for pre-existing conditions, pre-existing functional limitations that impede recovery, and social isolation in the aftermath of housing loss and resettlement. I will present findings from a unique ongoing field study in which we gathered baseline information about the health status and living conditions of older residents residing in the town of Iwanuma, Miyagi Prefecture, seven months before the earthquake and tsunami. Approximately 2.5 years after the disaster, we conducted a follow-up survey allowing us to investigate the risk and protective factors for a variety of disaster-related health conditions, including PTSD, dementia, and metabolic syndrome. A consistent finding to emerge from our study is the role of community-level social cohesion (“social capital”) in preventing adverse health outcomes in the aftermath of disaster.

Keynote lecture

2

Artificial Intelligence in Medicine: Concepts, Challenges and Lessons

Tien Yin Wong, MD, PhD Professor & Medical Director, Singapore National Eye Center Chair of Ophthalmology & Vice Dean Duke-Nus Medical School National University of Singapore

Artificial intelligence (AI) is a hot area of technology that has vast potential to

impact on medicine and healthcare. In the past few years, a sub-set of AI technology, known as deep learning (DL), has generated significant interest has shown substantial potential to be used to address a range of healthcare and clinical problems such as analysis of electronic medical records (EMR) to predict disease risks, hospital admissions or enhance treatment procedures for diseases. Another area of substantial progress has been the use of AI and DL techniques on medical imaging. These include screening for retinal diseases from retinal photographs or optical coherence tomography (OCT) scans, lung conditions from chest X-rays, skin cancers from skin photographs, and detection of breast cancer spread in the lymph nodes. DL technology has also been utilised to identify risk factors associated with cardiovascular diseases (e.g., blood pressure, smoking and body mass index) from retinal photographs. Even as AI technology evolves and becomes increasingly popular, with performance approaching and surpassing human-level performance, there remain significant technical, clinical and medico-legal challenges in the field, including overcoming “black box” phenomenon, which may prevent AI and DL systems from easy translation from the laboratory to real-world clinical practice. Using screening of diabetic retinopathy (DR), a major cause of blindness, as an example, this talk will first review the historical development of AI in DR screening, examining new data and modelling, and discussing the progress of the field and lessons learnt. Understanding these issues and challenges are critical for physicians, researchers, health administrators and policy makers to embrace AI in medicine and healthcare.

Keynote lecture

3

Large-scale cohort studies in Japan: Current status and future perspectives Mariko Naito, DDS, PhD Professor Department of Oral Epidemiology Graduate School of Biomedical & Health Sciences Hiroshima University

Cohort studies play a critical role in discovering factors that contribute to variability in disease risk in human populations. Large cohort studies have been conducted with the goal of assessing the relationships among biomedical factors, environmental exposure, and health outcomes. Technological advances have enabled the incorporation of genetic data into such studies.

In Japan, population-based cohort studies with more than 100,000 participants, such as the Japan Public Health Center-based Prospective (JPHC; https://epi.ncc.go.jp/jphc/) study and Japan Collaborative Cohort (JACC; https://publichealth.med.hokudai.ac.jp/jacc/) study, started in the 1980s and 90s. Large genome cohort studies began in the 2000s, such as the Japan Multi-Institutional Collaborative Cohort (J-MICC; http://www.jmicc.com/) study, Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT; https://epi.ncc.go.jp/jphcnext/), and Tohoku Medical Megabank Organization (ToMMo; http://www.megabank.tohoku.ac.jp/).

These studies are particularly valuable for examining the occurrence of non-communicable diseases, mortality, and survival as they relate to gene–environment interactions. They will eventually serve as important nationwide research platforms for the creation of scientific evidence for the Japanese population. Adoption of the consortium method by incorporating ongoing studies is essential for expanding the potential of such studies and achieving their goals. Keynote lecture

4

The Challenges of Public Health in the Developing World Md Moshiur Rahman, MBBS, MPH, PhD Associate Professor Department of International Health & Medical Care Graduate School of Biomedical & Health Sciences Hiroshima University

Public health is the art and science of preventing disease, prolonging life and promoting health through various organized efforts. It works for the protection and improvement of health for all people and to limit disparities. Many of the public health issues disproportionately affect the developing countries. Unfortunately, not much success has been experienced as expected ʻHealth for All (HFA) by 2000ʼ as the Declaration of Alma-Ata (1978). Now, we have the Sustainable Development Goals (SDGs), where health is located at the heart of development, although it is still challenging for the universal health coverage. In this Summit, I will illustrate the challenges and achievements of the immunization activities of two different countries in Asia and Africa as a fundamental component of primary health care.

The Expanded Program on Immunization (EPI) is the most successful public health intervention in Bangladesh. EPI is being conducted as the role model throughout the country and has contributed significantly to reduce mortality and morbidity from vaccine-preventable diseases (VPDs). Sudan is the third largest country in Africa started EPI as a pilot project in 1976 and polio eradication efforts in 1994. The tragic consequence of polio in Africa is causing permanent paralysis of millions of children.

Prevention is the only long-term logical approach of lowering the global disease burden since the countries lack in resources to manage the epidemic diseases. It is important to remember the numerous evidence-based preventive efforts achieving greater public health successes over the last five decades.

Keynote lecture

5

Current status of Japanese primary care and development of measuring tool for medical complexity in Japan Shuhei Yoshida, MD, PhD Assistant Professor Department of Community-based Medical System Graduate school of Biomedical and Health Sciences, Hiroshima University

Primary care has a pivotal role in the health care system by treating and preventing common diseases, which leads to improvement of quality of life. Primary care is increasingly valued in Japanese medical education system. Introduction of board-certified training system for family physicians this year was a large step.

To guarantee the quality of primary care, many countries define the competence of family physicians. Japan Association of Primary Care also has defined the competency which includes the management of medical complexity. Various biomedical, psychological and social factors affect the complexity of illness. There is a scarcity of scientific evidence on how to assess and treat the complexity of medical conditions. Also experts of this regard is few in Japan.

We cooperated with Minnesota University and a research team in Scotland to develop a measuring tool for medical complexity. This tool was called as Patient Centred Assessment Method (PCAM). PCAM evaluates “Health and Well-Being”, “Social Environment”, “Health Literacy and Communication” and “Service Coordination”, which includes not only biomedical problems but also psycho-social problems.

Currently, we are developing the Japanese version of PCAM. Using the Japanese version in Japanese communities, we will contribute to the whole person care in Japanese primary care settings.

Workshop

6

Health care issues in Papua New Guinea Yuki Koga, B.Sc.Phm. Doctorʼs Course Student Graduate School of Biomedical & Health Sciences Hiroshima University Department of Pharmaceutical Services Hiroshima University Hospital

Papua New Guinea (PNG) is an Oceanian country which is in the southwestern Pacific Ocean. About eight million people spread over the mainland and 600 islands, but many communities are extremely isolated and not accessible by road. In PNG, the health care services are improving step by step since the founding a country, 1975. However, there are still difficult problems to be solved below.

First, the provision of infrastructure, especially road construction, is not satisfactory. Sixty percent of the population lack access to clean water and 55% lack access to sanitation. In addition, it occurs serious logistics problems that the leading time for new medical supplies is required several months. Second, the insufficiency of health facilities and staffs is also an outstanding problem. The number of doctors and pharmacists per 1,000-population are quite low, 0.058 and 0.025 respectively. Although Government expenditure on the health care system accounts for 4.3% of GDP, the facility density per 1000 population is still 0.325. Third, the lack of infection awareness is a major problem, especially in rural areas. Malaria is the leading cause of illness and death in PNG. 478,497 cases are reported, along with 306 deaths. In addition, PNG has the highest incidence of TB and AIDS in the Pacific region, estimated 30,000 and 3,000 new cases are also reported. For solving these problems, PNG still needs help as contributions and volunteers from around the world. I will introduce JICAʼs volunteer activity based on my experience in a hospital pharmacy in PNG.

Workshop

7

The Challenge for Indonesian in near future related to lifestyle disease, End Stage Renal Disease patient management Theresia Maria Toji Pio, RN1,2, Michiko Moriyama, RN, MSN, PhD1 Masterʼs Course Student 1Division of Nursing Science Graduate School of Biomedical & Health Sciences, Hiroshima University 2Nakajima Tsuchiya Clinic- Hemodialysis Center, Hiroshima, Japan

Indonesia is the fourth most populated nation in the world after China, India and the United States. According to the World Bank`s Indonesian real GDP growth picked up to 5.2 percent year on year in the quarter of 2017 from 5.1 percent in the previous quarter. For 2017, the country`s GDP growth rose to 5.1 percent from 5.0 percent in 2016, its highest growth rate in four years. Related to that, the lifestyle has change to Indonesian people. For example people become more consumptive and sedentary. And it will not change the top three of main causes of death in Indonesia in the near future. Stroke (21%), Ischemic Heart Diseases (9%) and Diabetes (7%) (WHO,2012). Furthermore, the prevalence of unhealthy lifestyle increasing burden of non-communicable diseases (NCDs), end-stage renal diseases (ESRD) that results from NCDs is growing concern in Indonesia. With the target of achieving Universal Health Coverage (UHC) by 2019, public provision of treatment to address the burden of ESRD will become financially unsustainable due to the high cost of dialysis, unless an appropriate policy is developed. Treatment for ESRD currently included in the benefit package under the National Health Insurance Scheme called the Jaminan Kesehatan Nasional (JKN) are for both Hemodialysis (HD) and Peritoneal Dialysis (PD). Both modalities offer substantial health benefits over supportive care albeit at a very high cost. Despite this, peritoneal dialysis as the first line treatment (PD-first policy) for ESRD patients is recommended to be implemented under JKN as it less costly but provides a similar level of health benefit compare to that of hemodialysis. One of the key point is it is not possible to establish a HD unit throughout the country given that Indonesia is made up of over 6,000 inhabited islands. On the contrary, it is possible to offer equitable access to home based PD. (Policy Brief: Health Technology Assessment for Renal Dialysis for ESRD in Indonesia, 2016)

Workshop

8

Estimating the impact of nationwide supplementary immunization campaigns on the epidemiology of measles in Cambodia, Philippines and Vietnam, 2007-2017 Momoko Yamaoka1, Jose Hagan2 5th Grade Medical Student 1Hiroshima University School of medicine 2WHO Regional Office for the Western Pacific

WHOʼs Western Pacific Region is committed to eliminating measles. As a result of the strengthening of national immunization programs, measles cases and incidence continued to decline significantly or be maintained at very low levels in many countries in the Region towards 2012. Despite this achievement, the Region experienced a Region-wide measles resurgence from 2013. The failure of supplementary immunization activities (SIAs) may be one of the causes for this resurgence. Administrative coverage is often used to measure the performance of SIAs, but whether it truly reflects the impact of the campaign remains unclear. In this study, we aimed to make conclusions about how to correctly time and target SIAs. Referring to raw data reported to WHO, we estimated the impact of each SIA on the targeted population, using a Bayesian structural time-series model. Combining the results of the analysis with information about the SIAs, we explored what the important factor might be in order to reduce measles virus transmission. We found that administrative coverage may not completely measure the performance of a SIA on the targeted population. In addition, even when a campaign has an impact on the targeted population, it does not necessarily have an impact in reducing measles virus transmission in the overall population. Considering these conclusions, we should not rely too heavily on the immunization strategy of “achieving and maintaining 95% vaccination coverage”. By utilizing strong and sensitive surveillance systems, countries and areas should identify groups with low immunity, and conduct effective SIAs for these identified groups.

Workshop

1-2-3, Kasumi, Minami-ku, Hiroshima, Japan 734-8551

E-mail: miraigata@hiroshima-u.ac.jp

URL: https://www.hiroshima-u.ac.jp/hosp/sinryoka/chuoshinryo/globalmedicalprofessionals

Hiroshima University Hospital

未来型グローバル医療⼈育成センター

未来型グローバル医療⼈育成センター

WORLD HEALTH

SUMMIT

in Hiroshima

2018