Background Awareness regarding fever is reportedly low among Indian urban parents, leading to its over- management among under five children. We attempted to study the awareness and fever management practices of South Indian urban parents. The objectives were to find the awareness of parents regarding childhood fever management, and correlates of practices. Methods One hundred parents of under-five children with history of fever in past three months were randomly selected and interviewed using a predesigned tool. Children’s weight and height was measured. Awareness scores for causes of fever and fever management were constructed. Logistic regression was done to identify correlates of incorrect practices. Results 95% parents were aware about correct temperature above which fever became harmful. Awareness score for causes of fever was poor (<1) among 41% parents. Mothers’ complications awareness scores were better than fathers (p<0.05). 81% parents used antibiotics; only 18% consulted a doctor before doing so. 17% parents using antibiotics did not complete the prescribed course. The independent correlates of poor fever management practices were working parents (OR: 6.28; 95%CI: 1.7-23.16), lesser number of children (OR: 3.08; 95%CI: 1.01-9.37), poor compliance for antipyretics (OR: 9.20; 95%CI: 1.64-51.52) and giving antipyretics without consulting doctors (OR: 5.43; 95%CI: 1.69-17.47). Poor knowledge of available pediatric antipyretic preparations was negatively correlated (OR: 0.13; 95%CI: 0.02-0.64). Conclusion Fever awareness was fair among urban parents. Mothers had better awareness than fathers. Increased awareness for correct fever management of under-five children is desirable among urban parents to reduce misuse of antibiotics and antipyretics.

Funding Acknowledgements Type of funding sources: None. Introduction Mitral dysfunction is a commonly found valvular abnormality in the US. The association between mitral dysfunction with sudden death is both complex and controversial. Purpose To assess mitral dysfunction as a potential risk factor for sudden death using medical and autopsy records in a population-based registry of sudden deaths. Methods From 2013-2015, out-of-hospital deaths aged 18-64 reported by Emergency Medical Services in Wake County, North Carolina were screened to adjudicate 399 sudden death victims. Medical records were available in 270 victims, echocardiograms in 53, and autopsies in 64. Echocardiogram reports of none/trace/trivial mitral insufficiency were compared to patients with mild, moderate, or severe insufficiency. Autopsy reports for thickened mitral leaflets, calcification, and redundancy were reviewed. Additionally, available echocardiograms from a control group of 1101 patients were reviewed for mitral insufficiency. Demographics and clinical comorbidities were assessed from medical and death records. Mean, t-tests, and a bivariate logistic regression were estimated, as appropriate. Results Of the 53 victims with echocardiograms, mean age was 53 years, 36 (65.5%) were male, and 21 (39.6%) were African-American. Victims with available echocardiograms were more likely to have congestive heart failure (41.8%), coronary artery disease (50.9%), and diabetes (47.3%) compared to victims without echocardiograms. None/trivial/trace insufficiency was present in 27 victims (50.9%), mild insufficiency in 18 (34.0%), and moderate-severe insufficiency in 8 (15.1%). There was no association between severity of mitral insufficiency with demographic covariates or comorbid conditions. The presence of structural mitral valve abnormalities, including thickened leaflets, calcification, and redundancy of the mitral valve, were present in only 8 (12.5%) of 64 victims with autopsies. In a control group of 1101 date-matched patients from the same county, 57 (4.8%) patients had an echocardiogram available. 14 (24.6%) of these patients had mild-moderate mitral insufficiency. Conclusion Mitral insufficiency and structural abnormalities of the mitral valve are often identified in echocardiograms or autopsies of sudden death victims. Living controls had approximately half the prevalence of mitral insufficiency, suggesting that mitral dysfunction and its associated comorbidities are associated with sudden death.

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Sudden death accounts for approximately 10% of deaths among working age adults and is associated with poor air quality. We hypothesize that clinical risk factors for sudden death would modify the relationship of fine particulate matter (PM 2.5 ) to sudden death. Sudden death victims in Wake County, NC from 3/1/2013 - 2/28/2015 were identified by screening Emergency Medical Services (EMS) reports and adjudicated based on EMS, medical, and death records (n=399). Daily PM 2.5 concentrations for Wake County from the Air Quality Data Mart were linked to event and control periods for each individual. Using a case-crossover design, conditional logistic regression estimated OR (95%CI) for sudden death for a 5μg/m 3 increase in PM 2.5 with a 1-day lag, adjusted for temperature and humidity, across risk factor strata. Sensitivity analysis assessed consistency of main effects. Left ventricular hypertrophy (LVH) and neutrophil to lymphocyte ratio (NLR) were included as estimates of arrhythmic potential and inflammation, respectively. Low concentrations of PM 2.5 are potential risk factors for sudden death (Table 1). However, no clinical risk factors for sudden death modify that association. LVH and NLR, in contrast to clinical risk factors, are associated PM 2.5 and sudden death. Sensitivity analysis had no effect on the direction and minimal effect on the magnitude of the associations. Left ventricular hypertrophy and inflammation may be the final step in the mechanism whereby poor air quality and clinical risk factors trigger arrhythmia or myocardial ischemia and sudden death. This abstract does not necessarily reflect EPA policy.

Background: Efforts to prevent sudden death may be hampered by restrictive case definitions impairing accurate estimates of incidence and risk factors of sudden death. Sudden cardiac death (SCD) definitions include requirements for presence of comorbid coronary artery disease (CAD) and various time criteria since onset of symptoms or when victims were last seen well. We compared prevalence of three SCD definitions within a registry of all-cause natural, sudden deaths. Hypothesis: We assessed the hypothesis that the restrictive criteria of three SCD definitions underestimate sudden death and exclude populations with increased medical comorbidities. Methods: Using a registry of 399 adjudicated sudden death cases among adults aged 18-64 in Wake County, North Carolina in 2013-2015, we included 271 cases after excluding for missing values, chronic kidney disease, or heart failure. Time since last seen alive was classified as less than one hour or 24 hours from scene reports. Presence of CAD and co-morbidities were defined from clinical or autopsy records. Prevalence of SCD using criteria defined by Atherosclerosis Risk in Communities (ARIC), the World Health Organization (WHO), and the Oregon Sudden Unexpected Death (SUD) registry were calculated. Prevalence of SCD risk factors were calculated for the 3 SCD subgroups and compared to the original 271 victims using two-sample t-test and Fisher’s exact test for continuous and categorical variables. Results: Among the 271 cases, criteria were met for the three SCD definitions for n (%): ARIC 28 (10%), WHO 54 (20%), and SUD 90 (33%) (Table 1). ARIC and WHO-defined SCD cases were younger than the original 271 cases. There were no significant differences in sociodemographic and clinical factors by any SCD group compared to the original 271 cases. Conclusion: Restrictive SCD definitions that require the presence of CAD or a specific time frame of identification of death underestimate the incidence of sudden death and hinder effective prevention efforts for sudden death.