Esther	  de	  Vries                 	  Anna	  Sediva	  e.d.vries@jbz.nl 	                   	  anna.sediva@lfmotol.cuni.cz...
Workshop	  program	  •  IntroducBon	  &	  example	  	  	  	  by	  Esther	  de	  Vries	  •  European	  Immunoglobulin	  Map...
Faculty Disclosure                               relevant issues dr. Esther de Vries	              Company                ...
Electronic	  voBng	  –	  QuesBon	  1	  (grouping	  quesBon)	  I	  am	  a?ending	  the	  meeAng	  of	  :	  	  1.	  ESID	  	...
Electronic	  voBng	  –	  QuesBon	  2	  I	  am	  working	  in	  :	                       100                               ...
Electronic	  voBng	  –	  QuesBon	  3	                                         100                         100             ...
IntroducBon	  &	  example	  	  Esther	  de	  Vries	  ESID	  -­‐	  SAS	  
Awareness	  of	  PID	  is	  low	  –	  but	  recogniBon	  is	  important	  •  Individual	  PIDs	  are	  rare	  •  But	  alt...
Example	  of	  an	  awareness	  campaign:	  www.alAjdziek.nl	  in	  the	  Netherlands	  
Electronic	  voBng	  –	  QuesBon	  4	                                     100                         100We	  have	  a	  w...
Electronic	  voBng	  –	  QuesBon	  5	  I	  think	  it	  is	  important	        100                            100to	  have...
European	  Immunoglobulin	  Map	  	  Anna	  Sediva	  ESID	  
European Immunoglobulin Map        Issues on access to treatment for PID        patients in Europe        Outcome of quest...
European Immunoglobulin MapGoals§  to create an overview on availability of      EUROPE                                  ...
EUROPE IMMUNOGLOBULIN MAP   IVIG 2011                           SCIG 2011                                                 ...
EUROPE IMMUNOGLOBULIN MAP 2012     IVIG 2012      SCIG 2012full availibilitylimitationno availibilityno response
EUROPE 2012                                           IVIG/SCIG ratio   100%IVIG                     adults               ...
Electronic voting – question 6I think                100                                  100immunoglobulins will   75    ...
Electronic voting – question 7                     100                                 100I think              75         ...
World	  PI	  Week	  2012	  	  Jose	  Drabwell	  IPOPI	  
WORLD PRIMARYIMMUNODEFICIENCY WEEK
World Primary Immunodeficiency Week     22 – 29 April 2011 and 2012                   	       q    Global awareness campa...
      Participating Countries  Argentina       	  Australia   Belgium    Brazil         Canada         ColombiaCzech Repub...
WPIW Mission 	  Drive recognition of primary immunodeficiencies (PI) as an                           	  increasingly impor...
WPIW 2012 Poster
Electronic voting – question 8WHAT IF?          100   100                  100   100                  75                  ...
Ways	  to	  address	  other	  specialists	  /	  specialBes	  	  	  Mikko	  Seppänen	  ESID	  
ConsulBng	  other	  specialBes	  –	  do	  our	  colleagues	  have	  a	  chance	  to	  be	  aware	  of	  PIDDs?	  •  16	  s...
INFECTIONS                                                      AUTOIMMUNE DISEASESSinusitis                              ...
Electronic	  voBng	  –	  QuesBon	  9	  The	  syndromic	  nature	  and	  variability	  of	  CVIDs	  and	  their	  manifesta...
“Care	  Path	  for	  Immunodeficiency”	  in	  general	  hospitals	  	  Esther	  de	  Vries	  ESID	  
“Care	  Path	  for	  Immunodeficiency”	  in	  general	  hospitals	  	                                                      ...
EducaBon	  through	  distance	  learning	  strategies	  	  Peter	  Vickers	  INGID	  
Education through the internet andother distance learning strategiesDR. PETER VICKERS
WHY?Ò  The cheapest and easiest way to communicate    and interact with the highest number of people.Ò  Can easily allow...
WHAT?Ò  Sound/visual   lectures, e.g. Immune Deficiency    FoundationÒ  Interactive teaching programmes, e.g. http//    ...
WHAT TO CONSIDER?Ò  Access  to equipment and electricity to run the    equipment.Ò  Technophobia.Ò  Different languages...
Electronic voting – Question 10OPINION - DISTANCE LEARNING:                              100                              ...
How	  to	  organize	  awareness	  with	  limited	  resources	  	  Lokman	  Mohd	  Noh	  ESID	  
How	  to	  organize	  awareness	  when	               limited	  resources	  are	  available	  	                           ...
Strategy-­‐	  collaboraBve	  effort	  Local	  (	  NPII-­‐	  My	  PIN)	                                                     ...
Total	  number	  of	  PID	  cases	  from	  1986-­‐2011	                      (1	  clin	  	  immunologist)	                ...
PID	  occurs	  in	  South	  East	  Asia	     but	  resources	  are	  limited	                 1.      Create	  awareness	 ...
PROVOKING	  STATEMENT	  •  PID	  occurs	  in	  S	  E	  Asia	  /ASEAN	  region	  with	  a	     populaBon	  of	  almost	  50...
Electronic	  voAng	  –	  QuesAon	  11	                                100                        100   100ESID	  /	  INGID...
Everyone	  
Let’s	  work	  together	  to	  define	  suitable	  signals	  for	  awareness	  	  • Discussion!	  
Esther	  de	  Vries        	  Anna	  Sediva	  e.d.vries@jbz.nl 	           	  anna.sediva@lfmotol.cuni.cz	  esid@estherdev...
Awareness workshopesid+voting
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Awareness workshopesid+voting

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Workshop on increasing awareness concerning primary immunodeficiencies held in Florence, Italy in October 2012.

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Awareness workshopesid+voting

  1. 1. Esther  de  Vries  Anna  Sediva  e.d.vries@jbz.nl    anna.sediva@lfmotol.cuni.cz  esid@estherdevries.nl  www.estherdevries.nl   Increasing  awareness  of  PID  worldwide     Workshop  by  ESID-­‐INGID-­‐IPOPI   Jointly  organised  by  ESID  Working  Par7es  for  Educa7on  and  PID-­‐care  in  development  
  2. 2. Workshop  program  •  IntroducBon  &  example        by  Esther  de  Vries  •  European  Immunoglobulin  Map        by  Anna  Sediva  •  World  PI  Week  2012  by  Jose  Drabwell  •  Ways  to  address  other  specialists  /  specialBes        by  Mikko  Seppänen  •  “Care  Path  for  Immunodeficiency”  in  general  hospitals        by  Esther  de  Vries  •  EducaBon  through  distance  learning  strategies        by  Peter  Vickers  •  How  to  organize  awareness  with  limited  resources        by  Lokman  Mohd  Noh  •  Let’s  work  together  to  define  suitable  signals  for  awareness  by  everyone  
  3. 3. Faculty Disclosure relevant issues dr. Esther de Vries   Company Nature of Affiliation•  Companies: CSL Behring, •  Honoraria, expenses Sanquin•  Company: Baxter •  Funded researchOff-Label Product Usage•  None
  4. 4. Electronic  voBng  –  QuesBon  1  (grouping  quesBon)  I  am  a?ending  the  meeAng  of  :    1.  ESID    2.  INGID   100  3.  IPOPI   75   48,64.  I  am  (related  to)  a  sponsor   50 25,7 25 17,1 8,6 0 1 2 3 4
  5. 5. Electronic  voBng  –  QuesBon  2  I  am  working  in  :   100 100   75 751.  paediatric  –  clinical   50 44,4 50 50ONLY   27,8 25 30 25 16,7   11,1 10 10 0 0 0 02.  adult  –  clinical  ONLY   1 2 3 4 5 1 2 3 4 5   ESID INGID3.  paediatric  –  clinical  AND  lab  /  research   100 100   75 75 50 504.  adult  –  clinical  AND  lab  /   50 33,3 33,3 33,3 50research   25 25 0   0 0 0 0 0 0 1 2 3 4 5 1 2 3 4 55.  lab  /  research  ONLY   IPOPI SPONSOR
  6. 6. Electronic  voBng  –  QuesBon  3   100 100 83,3 75 75 58,3I  have  a  :   50 41,7 50 25 25 16,71.  junior  /  trainee   0 1 2 0 1 2posiBon   ESID INGID2.  established  /  senior   100 100posiBon   75 66,7 75 75   50 50 33,3 25 25 25 0 0 1 2 1 2 IPOPI SPONSOR
  7. 7. IntroducBon  &  example    Esther  de  Vries  ESID  -­‐  SAS  
  8. 8. Awareness  of  PID  is  low  –  but  recogniBon  is  important  •  Individual  PIDs  are  rare  •  But  altogether  PIDs  make  up  a  substanBal  number  of  affected  paBents  in   Europe  and  worldwide  (esBmate:  1  in  8-­‐10,000  people)  •  PID  paBents  have  more  infecBons,  but  ‘normal’  people  also  suffer  from   infecBons  •  PIDs  have  a  geneBc  basis  •  When  you  come  from  a  PID  family,  the  chances  you  have  PID  too  are  not  small  •  PIDs  can  be  treated  (anBbioBcs,  anBfungals,  anBvirals;  immunoglobulins;                G-­‐CSF;  C1-­‐inh;  SCT;  gene  therapy)  •  The  prognosis  of  paBents  with  PID  depends  on  Bmely  recogniBon  &  treatment  
  9. 9. Example  of  an  awareness  campaign:  www.alAjdziek.nl  in  the  Netherlands  
  10. 10. Electronic  voBng  –  QuesBon  4   100 100We  have  a  web-­‐ 75 55,6 75 55,6based  awareness   50 50campaign  for  PID  in   25 22,2 22,2 25 27,8 16,7our  country  :   0 0   1 2 3 1 2 31.  yes   ESID INGID   100 1002.  no   75 65,5 75 66,7   50 50 33,33.  I  don’t  know   25 27,6 25 6,9 0 0 0 1 2 3 1 2 3 IPOPI SPONSOR
  11. 11. Electronic  voBng  –  QuesBon  5  I  think  it  is  important   100 100to  have  a  web-­‐based   72,2 75 75awareness  campaign   50 50for  PID  in  my  country  :   50 50 27,8   25 25 0 0 0 01.  yes,  very  important   0 0 1 2 3 4 1 2 3 4   ESID INGID2.  it  would  be  nice     100 100 83,3 78,1 75 753.  not  really   50 50   25 18,8 254.  no,  it  is  useless,  a   16,7 3,1 0 0 0waste  of  Bme  and   0 1 2 3 4 0 1 2 3 4money   IPOPI SPONSOR
  12. 12. European  Immunoglobulin  Map    Anna  Sediva  ESID  
  13. 13. European Immunoglobulin Map Issues on access to treatment for PID patients in Europe Outcome of questionnaire / survey in European countriesESID - Anna Sediva, Klaus Warnatz, Helen Chapel
  14. 14. European Immunoglobulin MapGoals§  to create an overview on availability of EUROPE Ig MAP 2006 Iceland immunoglobulin and other PID treatments fully covered Sweden Finland in European countries no information Norway Estonia not covered Latvia Denmark Lithuania Ireland Netherlands United Belarus Kingdom§  to monitor progress and improvement Poland Germany Belgium Ukraine Czech Rep Luxembourg Slovakia France Moldova Austria Hungary Switzerland Slovenia Romania Liechtenstein Croatia Bosnia Serbia Portugal Italy and§  to use the „European Immunoglobulin Herzegovina Bulgaria Spain Macedonia Greece Montenegro Map“ as a tool for negotiations with EU/ Albania national authorities in order to reach full availibility of treatment for each PID patient
  15. 15. EUROPE IMMUNOGLOBULIN MAP IVIG 2011 SCIG 2011 80 40 20 40 50 30 5 40 70 1 20 No reply 35 10 75 availableAvailable but notused much Comments: only one product N percentage of SCIG substitutionUnavailable
  16. 16. EUROPE IMMUNOGLOBULIN MAP 2012 IVIG 2012 SCIG 2012full availibilitylimitationno availibilityno response
  17. 17. EUROPE 2012 IVIG/SCIG ratio 100%IVIG adults children 50%IVIG 10%IVIG 10/90 50/50 100/0 90/10 100/0 10/90 10/90 10/90 60/40 50/50 33/67 100/0 100/0 100/0 60/40 95/5 70/30 10/90 85/15 70/30 50/50 50/50 70/30 70/30 80/20 90/10 75/25 90/10 75/25 40/60 90/10 60/40 100/0 100/0 100/0 100/0 100/0 100/0 100/0 90/0 85/15 80/20 100/0 100/0 45/55 75/25 80/20 90/0 100/055/45
  18. 18. Electronic voting – question 6I think 100 100immunoglobulins will 75 75 53,3be available for all 50 37,5 50 50PID patients in 25 12,5 25 26,7 20Europe by 2020: 0 0 0 0 1 2 3 4 1 2 3 41. yes, in Western ESID INGIDEurope 100 1002. yes, all over 75 75Europe 50 50 50 32,3 33,3 29 22,6 25 16,1 25 16,73. no 0 0 0 1 2 3 4 1 2 3 44. I don‘t know IPOPI SPONSOR
  19. 19. Electronic voting – question 7 100 100I think 75 75immunoglobulins 50 44,4 50 52,9will -by 2020- 33,3 22,2 35,3 25 25preferentially 0 0 11,8be used as: 0 1 2 3 4 0 1 2 3 41.  SCIG ESID INGID 100 1002.  IVIG 75 75 59,4 50 50 503.  Equally 33,3 25 18,8 25 16,7 9,4 12,5 04.  I don‘t know 0 1 2 3 4 0 1 2 3 4 IPOPI SPONSOR
  20. 20. World  PI  Week  2012    Jose  Drabwell  IPOPI  
  21. 21. WORLD PRIMARYIMMUNODEFICIENCY WEEK
  22. 22. World Primary Immunodeficiency Week 22 – 29 April 2011 and 2012   q  Global awareness campaign q  All PID stakeholders q  Doctors, patients, nurses, industry q  28 – 2011 and 32 – 2012 (13 and 17 IPOPI) q  Media outreach campaigns q  Medical & public awareness campaigns q  Advocacy campaigns q  Targeted events q  Publications / Scientific editorials q  Arabic, German, Italian, Polish, Portuguese, Spanish, Serbian
  23. 23.   Participating Countries Argentina  Australia Belgium Brazil Canada ColombiaCzech Republic Egypt France Germany Greece Hungary India Iran Italy Japan Mexico Morocco Netherlands Peru Poland Portugal Puerto Rico Serbia Slovakia South Africa Spain Sweden Turkey UK USA Venezuela
  24. 24. WPIW Mission  Drive recognition of primary immunodeficiencies (PI) as an  increasingly important disease group;Increase understanding amongst medical professionals,researchers, nurses, patients, school teachers, day careemployees and the public;Stimulate efforts to improve recognition, diagnosis, treatmentand quality of life of people living with PI world-wide;Encourage health authorities to use awareness materialsproduced by IPOPI and other stakeholders to promote timelydiagnosis and treatment;Promote the model of combining physician education andglobal awareness with the infrastructure to diagnose and treat PI.
  25. 25. WPIW 2012 Poster
  26. 26. Electronic voting – question 8WHAT IF? 100 100 100 100 75 75All the 50 50stakeholders in 25 25each country 0 0 0 0collaborated in 1 2 1 2this campaign? ESID INGIDWould this thenmake a real 100 93,5 100 100difference 75 75to raising 50 50awareness? 25 25 6,5 0 0 01.  YES 1 2 1 22.  NO IPOPI SPONSOR
  27. 27. Ways  to  address  other  specialists  /  specialBes      Mikko  Seppänen  ESID  
  28. 28. ConsulBng  other  specialBes  –  do  our  colleagues  have  a  chance  to  be  aware  of  PIDDs?  •  16  standard  textbooks,  various  specialBes  •  Some  textbooks  sBll  lack  chapters  on  PIDDs   –  When  existed,  were  well  wrinen,  concise  and  accurate.     –  With  a  few  posiBve  excepBons,  PIDDs  were  poorly   integrated  into  the  remaining  body  of  text  and  tables.   –  No  textbook  covered  full  spectrum  of  CVIDs  syndromic   findings,  possibly  due  to  space  constraints?     –  Inaccuracies  on  PIDD-­‐related  findings  were  frequent  in   texts  (outside  a  specific  chapter).    
  29. 29. INFECTIONS AUTOIMMUNE DISEASESSinusitis Meningitis Lungs Eye Otitis & conjuctivitis ThyroidPneumonias Liver and biliary Lymphatic tissue BloodInfectious diarrhea Other Gastrointestinal Skin Other Mikko Seppänen / HumanArt Helena Schmidt Tmi. Sponsored by Sanquin Finland, open domain
  30. 30. Electronic  voBng  –  QuesBon  9  The  syndromic  nature  and  variability  of  CVIDs  and  their  manifestaBons   100 100 92,9may  not  be  well  covered  in   88,9textbooks.  As  shown,  Early  diagnosis   75 75of  even  the  most  common  life-­‐threatening  PIDDs  (CVIDs)  may  be   50 50delayed  and    PIDD  physicians  may  have  difficulBes  in  communicaBng   25 25with  colleagues  in  other  fields  of   11,1 7,1 0 0 0 0medicine  due  to  omissions  in   0 0standard  textbooks.     1 2 3 4 1 2 3 4  To  promote  learning,  anAbody   ESID INGIDdeficiencies  should  be  described  in  textbooks  with   100 100 100the  aid  of  concise  figures:   74,2 75 75  1.  yes,  I  agree   50 50   25 25 12,9 12,92.  maybe   0 0 0 0   0 0 1 2 3 4 1 2 3 43.  probably  won’t  help    4.  no,  that  won’t  work   IPOPI SPONSOR
  31. 31. “Care  Path  for  Immunodeficiency”  in  general  hospitals    Esther  de  Vries  ESID  
  32. 32. “Care  Path  for  Immunodeficiency”  in  general  hospitals     Results  of   QuesBonnaires   Data  Care  Path   history  &  tests   Online   StaBsBcal   PublicaBons   system   analysis  
  33. 33. EducaBon  through  distance  learning  strategies    Peter  Vickers  INGID  
  34. 34. Education through the internet andother distance learning strategiesDR. PETER VICKERS
  35. 35. WHY?Ò  The cheapest and easiest way to communicate and interact with the highest number of people.Ò  Can easily allow for two-way dialogue.Ò  Can utilise many types of media – oral, written word, pictures/diagrams, animation.Ò  Proven method of teaching and involving people in diverse and distant countries/ communities.Ò  Can be tailored to individual needs.
  36. 36. WHAT?Ò  Sound/visual lectures, e.g. Immune Deficiency FoundationÒ  Interactive teaching programmes, e.g. http// ig.clinicalcommunities.netÒ  Interactive information giving/receivingÒ  Self-help groupsÒ  Professional/patient organisations/groups, e.g. INGIDÒ  Educational establishments, e.g. University of HertfordshireÒ  In-hospital/medical centre teachingÒ  On-line groups/on-line case studies, e.g. LinkedInÒ  Skype
  37. 37. WHAT TO CONSIDER?Ò  Access to equipment and electricity to run the equipment.Ò  Technophobia.Ò  Different languages.Ò  Cost.Ò  Time.Ò  Standardisation/credibility of information.Ò  Regular updating.Ò  Enthusiasm.
  38. 38. Electronic voting – Question 10OPINION - DISTANCE LEARNING: 100 100 88,91.  is the only way forward for the 75 75 60 dissemination of 50 50 information about 40 immunology and 25 25 PID. 0 0 11,1 0 0 0 0 1 2 3 4 1 2 3 42.  is a waste of time ESID INGID3.  could be very useful as long as it 100 94,4 100 is combined with 75 75 75 face-to-face teaching 50 50 25 25 254.  has not totally 5,6 0 0 0 0 convinced me, but 0 1 2 3 4 0 1 2 3 4 I am prepared to try it. IPOPI SPONSOR
  39. 39. How  to  organize  awareness  with  limited  resources    Lokman  Mohd  Noh  ESID  
  40. 40. How  to  organize  awareness  when   limited  resources  are  available     LOKMAN  MOHD  NOH   Pediatric  Immunologist  ,  previously  University  Science  Malaysia  Many  countries  in  South  East  Asia    would  encounter  limitaBon  of  resources.  Malaysia,    populaBon      28,728,607  (July  2011  est.);  0-­‐14  years:  29.6%    PID  esBmates  that  significantly  affects  health    (based  on  prevalence  of  1:  8,000-­‐  10  ,000)1      Malaysia      expected  à    2900  -­‐  3500  PID  paAents  (Singapore  2.7  per  100,000  )Lim  etal  2003        My  PIN    diagnosed    150  PID    up  to  Apr  2012      2  clinical  Immunologist    (  1  per  14mill);  InfecBous  disease  consultant  (19)  in  2009.                              Ped  immunologist:  Ped  InfecBous  Diseases  specialist  [1:  10]  TerBary    clinical      immunology  lab      3  (Penang,  KL,  Kota  Bharu)    Hospital  with  terBary    faciliBes    for  PID  clinic    -­‐  3.                                1.European  PID  Expert  group.  Chair  Jorgo  Chatzimarkakis  2009  
  41. 41. Strategy-­‐  collaboraBve  effort  Local  (  NPII-­‐  My  PIN)   InternaAonal  (NACLIS)   NaAonal  clinical  Immunology  symposium  •  1987-­‐1993  1  ped  immunologist  &  1   immunopathologist  [HKL(paBent  care)  &  IMR(Lab)]   •  Sponsored    Univ  Sains  Malaysia,  co  host  •  1994-­‐1999    (  1  ped  Imm(LMN)&  1  lab  Immu)  HUSM    Malayan  Society  Allergy  &  Immunology   &  Lab   •  Invited  guest  faculty  from  HK  ,  UK  &  Australia  •  2007-­‐2011  (2  ped  Immunologists(LMN+AHAL)  ).   to  above  sympopsium    yearly  since  2009   AMDI  Penang/UPM  Serdang  •  2007  Nat  PID    iniBaBve  (NPII)  `  interacBve   •  Difficult  cases  are  discussed    with  invited   cooperaBon  clinician  &  Immunopath  &  lab  scienBst   Guest  during  a  dedicated  sessions  •  2009  Malaysian  primary  immunodeficiency  network   •   assistance  from  referred  labs  for  special  test   (MyPIN)  replacing  NPII  •  AcAvity:  Pediatricians  &  Ped  InfecAous  Dis  Specialist   refers  to  3  centres:  a)  H  Sg  Petani     DIRECTION  :   1.  b)  H  USM  Kota  Bharu  (a&  b)  LMN  as  visiAng     •  To  get  clinical  immunology  subspecialty     c)  H  K  Lumpur  (AHAL  &  LMN)   credenBalled  &  to  allow  training  g  program   part  local  /Overses   Awareness  creaAon  ;  meeAngs  Ped  Soc   •  Gezng  criBcal  mass  of    clinical/physician   –  Immunological  society   immunologists    &  immunopathologists   –  Media  /  books  /proceedings   •  Building  terBary  infra  structures   •  CollaboraBve  research    
  42. 42. Total  number  of  PID  cases  from  1986-­‐2011   (1  clin    immunologist)   (2    Clin    Immunologists)   (1.2x (10 x increase) increase) Average 2.5/yr 24 case / yr 3 cases/ yr N=108   N=30                  up  to                                July   HKL-­‐UPM   HUSM   (2  centres)   HUSM, UKM-­‐HKL     HSAH, HKL, (3 centres)
  43. 43. PID  occurs  in  South  East  Asia   but  resources  are  limited   1.  Create  awareness  (  Local  bodies  with  ESID)   2.  Generous  support  (  clinical  &  invesAgaAons)                With  InsAtuAons  ,  with  potenAal  for  collaboraAon      3.    Teaching  sBnts    in    countries  with  limited  resources    supporBng     specialty  program   As  areas  of  interest  or  on  its  own.     .        
  44. 44. PROVOKING  STATEMENT  •  PID  occurs  in  S  E  Asia  /ASEAN  region  with  a   populaBon  of  almost  500,000  million.  •  The  morbidity  and  mortality  of  PID  is  high   especially  with  delayed  recogniBon.  •  Coupled  with  limited  resources  the  situaBon   could  be  catastrophic  for  the  PID  paBent.    •  The  ESID    group  has  led  the  way  by  having     iniBated  this  workshop,  more  could  be  done  to   assist  in  providing  improved  care  for  their  PID   paBents  
  45. 45. Electronic  voAng  –  QuesAon  11   100 100 100ESID  /  INGID  /   90 75 75IPOPI  can  help  to   50 50change  PID   25 25 10 0awareness   0 1 2 0 1 2and  care  in   ESID INGIDcountries  like  Malaysia:   100 93,8 100 100   75 751.  yes   50 50   25 25 6,3 0 0 02.  no   1 2 1 2 IPOPI SPONSOR
  46. 46. Everyone  
  47. 47. Let’s  work  together  to  define  suitable  signals  for  awareness    • Discussion!  
  48. 48. Esther  de  Vries  Anna  Sediva  e.d.vries@jbz.nl    anna.sediva@lfmotol.cuni.cz  esid@estherdevries.nl  www.estherdevries.nl   Thank  you  for  your  a?enAon!  

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