Global Health

Asia-Pacific Academic Consortium for Public Health

The 45th Annual Conference

October 24 - 27, 2013

Wuhan, China

Conference Proceedings
Edited by Zongfu Mao, Qiqiang He, Haiyan Xiao
 The 45th Asia-Pacific Academic Consortium
for Public Health
held at School of Public Health, Wuhan University,
Wuhan China, October 24 - 27, 2013

Conference Proceedings

Theme: Global Health

Editors: Zongfu Mao Qiqiang He Haiyan Xiao

To learn more about the APACPH please visit the webpage http://proceedings.apacph
Advisory Committee

Achyuta Samanta KIIT University

Bambang Wspriyono University of Indonesia
Bei Wu Duke University
Carl Anderson Johnson University of Southern California
Carolyn Hodges The University of Tennessee
Chan Li Chong
Chris Woods Duke University
Colin Binns Curtin University
Edwin Trevathan Saint Louis University
Elizabeth Merwin Duke University
Fatma Lestari University of Indonesia
Guoxun Chen The University of Tennessee
Harshalal Seneviratne University of Colombo
Hung-Yi Chiou Taipei Medical University
Indika Karunathilake University of Colombo
Jarueyporn Suparp Mahidol University
Jay Maddock University of Hawaii
Kamarudin D. Mudin
Khairul Anuar MAHSA University
Liming Li Peking union medical college

Low Wah Yun University of Malaya

Masamine Jimba University of Tokyo
Masayuki Shima Hyogo College of Medicine
Maznah Dahlui University of Malaya
Mohd Amin Jalaludin University of Malaya
Myongsei Sohn Yonsei University
Osman Ali Royal Perak University
Paul Erwin The University of Tennessee
Paula Palmer Claremont Graduate University

Phitaya Charupoonphol Mahidol University

Prayoon Fongsatitkul Mahidol University
Rohini Seneviratne University of Colombo
Shin-Han.Tsai Taipei Medical University
Steven Allender University of Deakin,
Tomiko Hokama The University of Tokyo
Victor Hoe University of Malaya
Walter K. Patrick University of Hawaii
Xinguang Chen Wayne State University
Young Moon Chae Yonsei University
Yuanan Lu University of Hawaii
Kun Chen Zhejiang University
Jie Gong The Centers for Disease Control and Prevention of Hubei Province
Yan Guo Peking University
Yuantao Hao Sun Yat-Sen University
Guoqing Hu Zhongnan University
Yonghua Hu Peking University
Weimin Huang Open University of Kaohsiung
Qingwu Jiang Fudan University
Haidong Kan Shanghai Jiaotong University
Juan Li Jilin University
Xiaoxiong Li Sichuan University
Yan Li Kunming Medical University
Jiafa Liu The Centers for Disease Control and Prevention of Hubei Province
Xiao Ma Sichuan University
Qingyue Meng Peking University
Yiming Mu 301 Hospital
Xu Qian Fudan University
Guifan Sun China Medical University
Qiang Sun Shandong University
Hongzhuan Tan Zhongnan University
Jingling Tang The Chinese University of Hong Kong
Fudi Wang Zhejiang University
Tangchun Wu Huazhong University of Science and Technology
Hong Yan Xi 'an Jiaotong University School of Medicine
Shibing You Wuhan University
Zhaokang Yuan Nanchang University
Zhaoyang Zhang National Health and Family Planning Commission
Junhu Zhang National Health and Family Planning Commission
Zhijie Zheng Shanghai Jiaotong University
Xiaoni Zhong Chongqing Medical University School of Public Health
Qun Zuo Hebei University
 Preface
The 45th Asia-Pacific Academic Consortium (APACPH) Conference is hosted by the School of
Public Health, Wuhan University in Wuhan City, capital of Hubei Province, from the October 24 to
27, 2013.
APACPH is an international non-profit organization registered in Honolulu, USA as a 501(c)(3)
corporation, comprising many of the largest and most influential schools of Public Health in the
Asia-Pacific region and dedicated to improving professional education for public health.
Launched in 1984 with just five members, APACPH now has over 81 member institutions in 23
countries throughout the Asia-Pacific region with Regional Offices in Bangkok, Beijing, Brisbane,
Hawaii, Malaysia and Tokyo. Through its activities, the members aim to tackle the unique public
health challenges of the Asia-Pacific region, for example specific health issues of workers within
the growing economies of the region.
APACPH encourages and supports the achievement of the following objectives through its member
institutions. Its objectives are following:
1. To enhance the quality and relevance of educational and training programmes in public health;
2. To expand knowledge, improve skills and demonstrate effective interventions;
3. To raise awareness, of current, emerging, and re-emerging public health issues and develop
programmes of action for their resolution;
4. To enhance the capacity and sustainability of public health systems; and
5. To assist in policy and leadership development for health.
The theme of this year’s conference is "Global Health" which reflects the need for innovative
exploring mechanisms to face and solve the global health related problems for the purpose of
ensuring a sustainable response to today's health challenges. The 25 subthemes including
Millennium Development Goals and Post- millennium Development Goals of Global Health,
International Major Outbreaks and Disasters and International Health Cooperation, Health
Education and Promotion, Aging and Aging Health Industry, Tobacco Control, AIDS Prevention
and Control, Environment and Health, Occupational Safety and Occupational Health, Nutrition,
Food and Health, Women Health, Maternal, Child and Adolescent Health, Chronic
Non-Communicable Diseases, Infectious Diseases, Health Management and Health Policy, Mental
Health and so forth.
The Organizing Committee of 45th APACPH Conference has received more than 1000 abstarcts
from 30 countries or so. All the abstracts have been carefully reviewed by renoewd experts in public
i
health field, including Prof. Liming Li, Prof. Mohd Amin Jalaludin, Prof. Walter K. Patrick, Prof.
Jay Maddock, Prof. Jin-ling Tang and so forth. 179 abstracts and 408 abstracts have been selected as
oral presentation and poster presentation repsetctively through peer-review.
All the participants with their tremendous support and kind understanding have been greatly
appreciated by the Organzing Committee and the Secretariat of the 45 th APACPH Conference!

The organizing Committee of 45th APACPH Conference

October 2, 2013

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 Contents
Keynote Speech ............................................................................................................................. 1
Australia（澳大利亚） ............................................................................................................... 10
Bangladesh（孟加拉国） ........................................................................................................... 18
Brazil（巴西） ............................................................................................................................ 27
Cananda(加拿大) .............................................................................. Error! Bookmark not defined.
China（中国） ............................................................................................................................ 29
China, Hong Kong（香港） ..................................................................................................... 137
China, Taiwan（台湾） ............................................................................................................ 147
Fiji （斐济） ............................................................................................................................ 167
Georgia（格鲁吉亚） ............................................................................................................... 170
India （印度） ......................................................................................................................... 172
Indonesia(印度尼西亚) ............................................................................................................. 182
Japan（日本） .......................................................................................................................... 249
Kazakhstan（哈萨克斯坦）..................................................................................................... 260
Korea（韩国） .......................................................................................................................... 262
Malaysia（马来西亚） ............................................................................................................. 274
Nepal（尼泊尔） ...................................................................................................................... 309
Netherlands(荷兰) ............................................................................. Error! Bookmark not defined.
Nigeria(尼日利亚) ............................................................................. Error! Bookmark not defined.
Philippines(菲律宾) ................................................................................................................... 313
Singapore (新加坡).................................................................................................................... 319
South Africa(南非) ............................................................................ Error! Bookmark not defined.
Sri Lanka(斯里兰卡) ................................................................................................................. 321
Sudan (苏丹).............................................................................................................................. 343
Thailand(泰国) .......................................................................................................................... 345
United States(美国) ................................................................................................................... 370
United States Minor Outlying Islands ...................................................................................... 391

iii
Keynote Speech ............................................................................................................................. 1

Emerging Cancers in Asia: Are we too much Westernized? ....................................................... 3

Public Health Professional Education in China .......................................................................... 5
China on the Frontiers of Global Health .................................................................................... 7
Australia（澳大利亚） ............................................................................................................... 10

A Call to Arms for Collaboration in Obesity Prevention ........................................................... 11

Advances and Future Prospects in Public Health Nutrition in the Asia Pacific Region .............. 11
Role of Early Life Nutrition in Obesity Prevention ................................................................... 12
An Australian Perspective in Public Health Education and MPH .............................................. 12
Mushroom Intake Reduces Epithelial Ovarian Cancer Risk in Southern Chinese Women ......... 12
Impact of Heatwaves on Mental Illnesses in A Temperate City in China................................... 13
Prevalence of Dietary Supplement Use in Healthy Pre-school Chinese Children in Australia and
China ...................................................................................................................................... 13
Factors Associated with Breastfeeding Duration: A Prospective Cohort Study in Sichuan
Province, China....................................................................................................................... 14
Early Introduction of Complementary Feeding: A Prospective Cohort Study in Sichuan Province,
China ...................................................................................................................................... 15
Condom and Oral Contraceptive Use and Risk of Cervical Intraepithelial Neoplasia in Australian
Women .................................................................................................................................. 15
Learning and Teaching Epidemiology with Audience Response Technology ............................ 16
Alcohol Consumption and Health Status of Family Members: Health Impacts Without Ingestion
............................................................................................................................................... 16
A Physical Activity Chart to Reduce Misclassification of Activities by the Global Physical Activity
Questionnaire......................................................................................................................... 17
Bangladesh（孟加拉国） ........................................................................................................... 18

Masculoskeletal Disorders (MSDs) Among Bangladeshi Type 2 Diabetics Subjects .................. 19

Characterization of Areas of Deficient Knowledge About DM Among Type 2 Bangladeshi
Diabetic Subjects Attending A Tertiary Care Hospital .............................................................. 19
Determinants of Dyslipidemia Among Bangladeshi Type 2 Diabetic Subjects .......................... 20
Prevalence of Metabolic Syndrome in Bangladeshi Population: A Comparative Study of
Different Recommendations ................................................................................................... 21
Co-existing Hypertension as Independent Risk Factor in Diabetic Retinopathy in Type-2
Diabetes ................................................................................................................................. 21
Association of Complications with Disproportionately High Intake of Dietary Carbohydrate in
Bangladeshi Type 2 Diabetic Subjects ..................................................................................... 22

iv
 A comparative study on Traditional and Skill Based Health Education on hand washing among
Secondary school children in Bangladesh ............................................................................... 23
Undiagnosed Diabetes and Dyslipidemia in Bangladeshi Population ....................................... 23
Determinants of Antenatal Care Utilization in Rural Areas of Bangladesh ............................... 24
Prevalence and Risk Factors of Childhood Overweight and Obesity in Primary School Children
of Dhaka City .......................................................................................................................... 25
Prevalence of Frozen Shoulder Among Type 2 Diabetic Subjects in Bangladesh Attending Health
Care Centre ............................................................................................................................ 25
Brazil（巴西） ............................................................................................................................ 27

Reflections of Transport and Mobility in the Quality of Urban Health ..................................... 28

China（中国） ............................................................................................................................ 29

Global Health – Challenges and Opportunities for Public Health Education & Research in the
Asia and Pacific ....................................................................................................................... 30
Air pollution, Health Outcomes and Possible Mechanism ....................................................... 30
The Relationship Between Lifestyle and Gestational Diabetes Mellitus ................................... 31
A Time-stratified Case-crossover Study of Flooding and Waterlogging and Number of Cases of
Malaria in Mengcheng County, China ..................................................................................... 32
Contraceptive Use and Impact Factors Among Reproductive-age Women Seeking Abortions in
Southeast of China: A Hospital-based Study ........................................................................... 32
Soy Isoflavone Protect Learning and Memory Ability of Rats Through Alleviating the
Cerebrovascular Damage Induced by β-amyloid ..................................................................... 33
Risk Factors for HIV Infection in MSM: A Cross-sectional Study in Central China ..................... 34
A Survey of Brain Fitness Products Consumption Practices Among High School Students ....... 34
Study on the Protective Effect of Lycium Babarum Polysaccharides on Human Glomerular
Mesangial Cells in High Glucose.............................................................................................. 35
Are There Associations Between Lifestyle Behaviors and Quality of Life in Cancer Survivors? . 35
Tooth Brushing Practices and Related Factors Among 4th and 5th Grade Students of Migrant
Schools in Shanghai ................................................................................................................ 36
Breastfeeding Methods Before 6 Month and Child Development Zhejiang Province, China .... 37
Effect of A School-based Nutritional and Oral Health Promotion Program on Students of
Migrant Schools in Shanghai: A 2-year Quasi-experimental Study ........................................... 38
The Short-term Effects of Particulate Matter on Lung Function of College Students in Autumn
and Winter in Wuhan ............................................................................................................. 38
Implementation of National Essential Medicines Policy and Its Influencing Factors in China: A
Cross-sectional Study of Township Health Centres .................................................................. 39
Research on the Economic Evaluation Method of Standard-Unit-Epidemic-Disease ................ 40
Sodium Ferulate Inhibits High-fat Diet-induced Inflammatory Factors Expression in Human
v
Umbilical Vein Endothelial Cells .............................................................................................. 40
Factors Influencing the Health of Employees in the Furniture Market ..................................... 41
Comparison on Syphilis Epidemiology Among Local Residents and Floating Pregnant Women in
Zhejiang Province ................................................................................................................... 42
Different Patterns and Trends of Thyroid Cancer Incidence in Chinese Population of Shanghai,
Hong Kong, Singapore and Los Angeles .................................................................................. 42
The Relationship Between Prior School Bullying/Victimization Experiences and Current
Depression of College Students in Shanghai ........................................................................... 43
Noise Monitoring in Different Functional Areas of Luzhou and the Effects of Noise on the
Health of Residents ................................................................................................................ 44
Passive Smoking During Pregnancy and Age of Menarche in Daughters .................................. 44
An Information Platform for Global Health ............................................................................. 45
A Three-week Multi-focus Psychosocial Residential Rehabilitation Intervention for Cancer
Survivors in Shanghai, China ................................................................................................... 46
The Impact of Chronic Medical Conditions on Quality of Life in Cancer Survivors.................... 46
Using Medications Sales Surveillance for Early Detection of Infectious Diseases Outbreaks in
Rural China ............................................................................................................................. 47
Application of Seasonal ARIMA Model in Forecasting Incidence Cases of HFMD in Shenzhen,
China ...................................................................................................................................... 48
Psychopathological Profile of Breast Cancer Patients Based on the Symptom Checklist-90-R: A
Hospital-Based Survey ............................................................................................................ 49
A Research of Social Support on the Effects of HIV/AIDS Patients Living Quality ...................... 49
The Relationship Between Parental Child-rearing Behavior and Mental Health in Chinese
College Students..................................................................................................................... 50
A Systematic Review: Prevalence Rate of Hypertension in China in 2000-2010 ....................... 50
Correlations Between Dietary Habits and Sleep Quality in Chinese College Students .............. 51
The Relationship Between Parental Rearing Styles and Internet Addiction Disorder in Chinese
College Students..................................................................................................................... 52
An Investigation into Perception of Meaning of the Term “Unintentional Injury” Among Some
Health Professionals and University Students ......................................................................... 52
Changes of Health Status and Institutionalization Among Older Adults in China ..................... 53
Analysis of Birth Defects Status in Hubei Province form 2003 to 2011 .................................... 53
Analysis on Burden of Cardiovascular Diseases in Residents of Shiyan During 2007-2009 ....... 54
Mandarin Version of A Face Version of the Modified CFSS-DS: Transcultural Adaptation and
Psychometric Properties Analysis ........................................................................................... 54
Multiple Correspondence Analysis on Cohort Maintenance of Pre-exposure Prophylaxis in
MSM ...................................................................................................................................... 55
Association Between miR-33a Levels and Chronic HBV-induced Liver fibrosis ......................... 56
vi
Correlation of ERG Over-expression with Adverse Clinicopathologic Features of Prostate Cancer
in a Chinese Patient Cohort .................................................................................................... 56
Effect of Chalcones Extracted from Angelica Keiskei on the mRNA Expression of Insulin Signal
Molecules in Hepatocytes of Rats with Diabetes ..................................................................... 57
The Study of the Influence Factors of the the in Hubei Province Based on Quantile Regression
Model..................................................................................................................................... 58
Study on the Health-related Quality of Life and Influential Factors Among Left-behind Children
in Rural China ......................................................................................................................... 58
Analysis of the Willingness to Participate in the Pre-Exposure Prophylaxis Clinical Trial among
Chinese Men Who Have Sex with Men ................................................................................... 59
Association between Sleep and Risk of Work-related Injuries among Farmers in Heilongjiang
Province, People’s Republic of China ...................................................................................... 59
A study on Recovery Effect of the Maternal of Episiotomy by Systematic Nursing Intervention
............................................................................................................................................... 60
Determinants and Status on Mental Health Among the Persons Living in Yunnan Unexplained
Sudden Death Areas ............................................................................................................... 61
The Effectiveness of the Self-management of Regular Physical Activity Program: Using a
Randomized Controlled Trial ................................................................................................... 61
Preliminary Study on Risk Evaluation Model of Breast Cancer Among Women in Western China
............................................................................................................................................... 62
Estimate of A Predictive Cut-Off Value for Neck Circumference Reflecting Abdominal Obesity in
Elderly Chinese Men ............................................................................................................... 63
Analysis of Psychology Factors of Insulin Resistance and Treatment on Patients with Type 2
Diabetes in China.................................................................................................................... 63
The Value of Echo-contrast RT3DE for Assessment of Left VentricularFunction in Patients with
Left Ventricular Non-compaction ............................................................................................ 64
Evaluation of Arterial Alterations and Associated Factors of Chronic Kidney Disease .............. 65
Development and Validation of a Tuberculosis Medication Adherence Scale .......................... 65
Professional Spirit of Medical Staff ......................................................................................... 67
trans, trans-Muconic Acid as A Biomarker of Occupational Exposure to High-level Benzene in
China ...................................................................................................................................... 68
Study on Etiology and Epidemiology of Severe Fever with Thrombocytopenia Syndrome in
Hubei Province, China ............................................................................................................ 68
Defining the Role of Hpv in Cervical Adenocarcinoma: A Multi-Centre Study in China............. 69
Transmission Risk and Genetic Diversity of Hepatitis C Virus Among Methadone Maintenance
Treatment Patients: A Case-Control Study .............................................................................. 70
Prevalence, Awareness and Control of Hypertension Among Elderly People in Wuhan, China 71
Secret Inquiries About Tobacco-Free Implementation In Hubei Province ................................ 72
vii
Serum Selenium Status, Polymorphisms in Mitochondrial Superoxide Dismutase, and Risk of
Type 2 diabetes ...................................................................................................................... 72
Blood Pressure and Obesity Among Children and Adolescents ............................................... 73
Introduction to Global Health Major Program for Undergraduates in China ............................ 73
The Association of 23 Urinary Metals with Altered Heart Rate Variability and Coronary Heart
Disease ................................................................................................................................... 74
Strategy to Administrate the Patient Ward of Respiratory System Far from Pollution Circle and
Polluted Streets ...................................................................................................................... 75
Prevalence of Hepatitis B Infection and Reexamination of Its Epidemiology............................ 75
Using Case Vignettes to Assess HIV/AIDS-related Stigma Attitudes among Medical Students in
Beijing, China ......................................................................................................................... 76
Poster 4(ID195) ...................................................................................................................... 76
Study on Indoor Air Quality of an University Classroom in China ............................................ 76
Post-abortion Care (PAC) Service Demand among Unmarried Women in Kunming: A
Hospital-based Study .............................................................................................................. 77
Research on the Determinants of the Rural Disabled Person’s Behavior of Receiving
Rehabilitation ......................................................................................................................... 78
Obesity, Adipose Tissue and Insulin Resistance, an Alarming Triad .......................................... 78
Approaching to Calculate the Contribution Rate of CDC’s Work on Life Expectancy with Delphi
and AHP Methods .................................................................................................................. 79
KAP of the Workers OnSchistosomiasis Control in Jingjiang Section of Changjiang Waterway
Bureau ................................................................................................................................... 79
The Research of the Damage of Methyl Mercuric Chloride on rats’ Hippocampus .................. 80
Assessing the Scientific Research Capability on Schistosomiasis in Five Schistososomiasis
Control Institutions Along the Middle and Lower Reaches of the Yangtze River in China: Results
from a bibliometricanalysis of Chinese literatures .................................................................. 80
Association of Iternet Use with Mental Health Among Chinese College Students.................... 81
Water and the Apothecary of Life. Chinese Online Participation in Environmental Health
Communication ...................................................................................................................... 81
Effect of Lycium Barbarum Polysaccharides on Rats’ Cavemous Nerve Clamping Injury Repair 82
The Associations Between Dietary Intake and Mental Health in Chinese College Students...... 83
Study on the Relationship Between the Quality of Community Health Services and the
Residents’ Satisfaction in Shiyan, Hubei Province of China ...................................................... 83
Nutrition Knowledge Awareness, Eating Behavior and Nutritional Attitude of Taxi Drivers in
Beijing, China ......................................................................................................................... 84
Correlation Analysis of Short-Term Air pollution and Hospital Admissions of respiratory
diseases in Wuhan, China ....................................................................................................... 84
Effect of Laminaria Japonica Polysaccharides on Genital System Recuperation of Local
viii
Radiation Damaged Male Rats ................................................................................................ 85
Gender Differences in Healthy Homes Environments Related to Childhood Obesity in Nanchang,
China ...................................................................................................................................... 85
Correlation of ERG Over-expression with Adverse Clinicopathologic Features of Prostate Cancer
in a Chinese Patient Cohort .................................................................................................... 86
Explore the Influences on Rate of Breastfeeding at Six Months in Zhejiang Province, China .... 87
Survey and Research on Health Literacy for Higher Vocational College Students in Nanyang City
............................................................................................................................................... 87
Evaluation of the Cognitive and Behavioral Effects of a Peer Education Model-Based
Intervention to Sun safe in Children........................................................................................ 88
Dietary Vegetable Oil Consumption in A Rural Chinese Population and Its Relation to
Hypertension: A Cross-sectional Population-based Survey...................................................... 88
AStudy on Equity of Health Status and Health Care Utilization of Migrant Children in Pinghu
City of Zhejiang Province ........................................................................................................ 89
Persistent Organic Pollutants – Dioxins ................................................................................... 90
The Status and Trend of Injury Among School Children and Adolescents in China: A
Meta-analysis ......................................................................................................................... 90
Exploring the Training Goals and Competencies of Global Health Undergraduate Program in
China ...................................................................................................................................... 91
A Study on the Mode of Medical Insurance Payment in the Context of New Medical
Reform----Based on the Empirical Research of the New Rural Cooperative Medical System in
Gansu Province ...................................................................................................................... 92
Study on the effect of social capital with the survival quality of HIV/AIDS ............................... 92
Impact of Micronutrient Supplementation in Pregnancy on Prevalence of Anemia, Birthweight,
Duration of Gestation and Perinatal Mortality in Rural Tibet .................................................. 93
Challenges in Providing Basic Public Health Services: A Case Study in Western Rural China .... 93
How Much Do GPs Know About Family Doctor System and Are They Satisfied? – Data from
Shanghai ................................................................................................................................ 94
Effectiveness Evaluation of Capitation Reform in the New Rural Cooperative Medical Scheme
(NRCMS) Payment System Reform Based on Demanders’ Perspective .................................... 95
Analysis of the Path to Promote Medical Students’ Humanistic Literacy ................................. 95
What Factors Affect Residents’ Decision to Sign the Contract with family doctors? –A Behavior
Survey in Pudong New Area, Shanghai ................................................................................... 96
Evaluation Study on the Effect of Participating Farmers’ Medical Expense After the
Implementation of Capitation Reform .................................................................................... 96
Analysis for Patients, Satisfaction with Community Health Institutions in Pudong New Area... 97
Prevalence of Health Related Risk Behaviors Among Chinese College Students ...................... 98
The Association of Parental BMI and Cardiovascular Disease Risk Factors in Offspring ............ 98
ix
Concerns About Air Quality and Environmental Protection Among Residents of Nanchang,
China ...................................................................................................................................... 99
The Longitudinal Study of the Influence of NRCMS on the Utilization of in-hospital Service in
Rural Areas of Mainland China................................................................................................ 99
Survey and Research on Language Environment and Higher Vocational College Students’
Health Behavior .................................................................................................................... 100
QCC Application in the Surgical Instrument Traceability for Security Management ............... 101
Comprehensive Hospital Health Education on the Impact of Chronic Disease Control .......... 101
Treatment with Wogonin to Mouse with Streptozotocin-Induced Type 1diabetes: Effects on
Adiponectin, Osteopontin and Insulin Signal Pathway in The Adipose Tissue ........................ 102
Investigation and Analysis of the Related Knowledge, Attitude and Behavior on AIDS of The
Fsws in Jiangsu Province, China ............................................................................................ 102
Challenges for Elimination of Schistosomiasis Japonica in China: Praziquantel Resistance in
Schistosoma Japonicum........................................................................................................ 103
An Outbreak of 2009A (H1N1) Influenza in A School — Chongqing, China, 2013 ................... 104
Trend analysis of Total Health Expenditure in Western Less Developed Region, China -- Gansu
Province as An Example ........................................................................................................ 105
Functional Evaluation of Community Healthcare Service Centers in Nanchang Using TOPSIS
Analysis ................................................................................................................................ 105
Relationship between Concentration Changes of Particulate Matter and Aerosol Scattering
Coefficient ............................................................................................................................ 106
Knowledge, Perceptions and Acceptability of Human Papillomavirus Vaccine Among Medical
Students in Chongqing of China: A University-wide Survey ................................................... 107
Quality of Life for Patients with Esophageal or Cardiac Lesion: A One-year Follow-up ........... 107
The Temporal Characteristics and Trend of Hepatitis B Incidence Cases in China Based on
National Data from 2006 to 2012 ......................................................................................... 108
How Can Educational Interventions Improve Primary Pharmacists' Competencies for Taking
Responsibility on Primary Medication Requirements: Cross-sectional Study and Interviews . 108
Web-Based Respondent-Driven Sampling: A Methodology Study ......................................... 109
Association Between Eating Frequency and Blood Pressure and Lipids in Chinese Adults ..... 110
The BLM-3AB Challenge Assay: A Micronuclei-based Method for Measuring DNA Repair
Capacity ............................................................................................................................... 110
Myeloperoxidase Polymorphism and the Risk of Lung Cancer: Systematic Review and
Meta-Analysis....................................................................................................................... 111
A Quantitative Survey on Perceptions of Hot Temperature Health Risks Among Residents in
Hainan Province ................................................................................................................... 111
A Study of the Microbiological Quality of Kitchen Dishcloths in Domestic Homes in China ... 112
The Analysis of the Bargaining Power between Hospitals and Health Insurers in China ......... 112
x
Profile of Anthropometric, Biochemical, and Body Composition Assessment of Obese
Adolescent Among Student of Hasanuddin University, Makassar, Indonesia ......................... 113
The Accumulation and Efflux of Lead Depend on ATP-dependent Efflux Pump - Multidrug
Resistance Protein 1 and Glutathione in Testis Sertoli Cells ................................................... 113
Research and Evaluation on the Psychologyof HIV/AIDS Patients .......................................... 114
Dietary Flavonols and The Risk of Pancreatic Cancer: A Meta-analysis of Prospective Cohort
Studies ................................................................................................................................. 115
Can We Improve Actively Life Quality for Maternal? An Attempt to Reasonable Indexing for
Intrahepatic Cholestasis of Pregnancy .................................................................................. 115
Research and Evaluation on the Psychologyof HIV/AIDS Patients .......................................... 116
The Networks of Sheep Movements in Three Counties of China and the Implications of
Network Properties for Brucellosis Spread............................................................................ 117
Analysis of Needlestick and Sharps Injuries Among Nurses in A Chinese Teaching Hospital ... 117
Study on Happiness Level and Its Influencing Factors of College -graduated Migrant Workers
............................................................................................................................................. 118
Direct Costs and Related Factors in Patient with Hepatitis B of Jiangsu Province, China ........ 118
A Systematic Review on Food Lead Concentration and Dietary Exposure in China ................ 119
Research on Actualities of Patient Safety Culture in Five Hospitals in Sichuan Province ........ 120
Reliability and Validity of the Physical Activity Enjoyment Scale (PACES) Among Older Adults
with Hypertension in Wuhan, China ..................................................................................... 120
Health-Related Quality of Life Measured with EQ-5D in Residents of Jiangsu Province, China121
Study on the Impact of System of Guiding Rural Residents to Form Reasonable Health Seeking
Behavior ............................................................................................................................... 121
Analysis on the Development of A Coastal Maternal and Child Health Care Hospital Between
2004 and 2012 in China ........................................................................................................ 122
Analysis of related factors in the medical conflicts of stomatology in Guangzhou City of China
............................................................................................................................................. 122
Effect of Winter Swimming on Blood Biochemical Parameter and Cardio Function ............... 123
The disease burden analysis of inpatient with Coronary Disease during 2002-2012 .............. 123
Evaluation of Training Effects on Diabetes for CDC Staffs ...................................................... 123
Analysis of Disease Constitution in Hospital in Central China from 2010 to 2011 .................. 124
Analysis of Premixed Insulin Analogues Use in Type 2 Diabetic Patients in China .................. 124
The Relationship of County General Hospitals’ Financial Performance and the Number of Beds
in Hubei Province, China....................................................................................................... 125
The Disease Burden Analysis of Inpatients with Type 2 Diabetes Mellitus During 2002 – 2012
............................................................................................................................................. 125
Factors Associated with the Length of Stay of Patients with Respiratory Diseases in China ... 126
Symptomatic Vein Thrombosis Associated with Peripherally Inserted Central Catheters in
xi
 Breast Cancer Patients .......................................................................................................... 126
Comprehensive Assessment of Nutritional Status of the Elderly Patients in Five Cities in China
............................................................................................................................................. 127
Factors Influencing the Hospital Charges of Inpatients with Type 2 Diabetes Mellitus ........... 127
Evaluation of Carotid Arterial Circumferential Strain in Health Subjects by Two-dimensional
Speckle Tracking Imaging ...................................................................................................... 128
Evaluation of Myocardial Function of Left Ventricular in Patients with Severe Aortic Stenosis by
Two Dimensional Speckle Tracking Imaging .......................................................................... 128
Chronic Mitral Regurgitation: A Pilot Study to Predict Postoperative Left Ventricular Contractile
Function Using Speckle-Tracking Echocardiography .............................................................. 129
Compared with findings of surgery and/or coronary angiography , Evaluate the ultrasonic
diagnosis value for congenital coronary artery fistula ........................................................... 130
The Application of Transthoracic Echocardiography for the Diagnosis of Coarctation of Aorta
............................................................................................................................................. 131
Non-Compacted Ventricular Myocardium with Congenital Cardiac Malformations ............... 131
The Enhanced Value of Left Ventricular Opacification in the Diagnosis of Noncompacted
Ventricular Myocardium ....................................................................................................... 132
Literature Review on Chinese Medical Aid Policy (1963-2013) .............................................. 133
Utilization of Oral Hypoglycemic Agents in Wuhan, China: A 5-year Retrospective Study ...... 133
Correlates of Depression Among HIV/AIDS Patients in Rural Central China............................ 134
A Study About Effectiveness of the New Rural Cooperative Medical Care Payment Reform
Which Was Based on Development Model ........................................................................... 134
The Pingshan Route Maps of Buliding up the Health Management System for Everyone ...... 135
Characterization of MBL producing Pseudomonas aeruginosa isolated from patients with Cystic
Fibrosis by phenotypic and genotypic methods.* ................................................................. 135
China(Hong Kong) .................................................................................................................... 137

Training Doctors for Promoting Peace and Harmony ............................................................. 138

Fighting Against Chronic Diseases: What Can We Learn from Hypertension? ........................ 138
Finding Alternative Financing Mechanism for Long-term Sustainability of Healthcare: What
Role Can Employers Play? ..................................................................................................... 139
Perceived Benefits and Needs of Pregnant Women Undertaking DNA-Sequencing Based
Non-Invasive Prenatal Test for Down Syndrome in Hong Kong: A Qualitative Study .............. 140
Factors Associated with Young Adult Binge Drinking Practices in Hong Kong: A Cross-sectional
Study .................................................................................................................................... 140
Can Self-collected HPV DNA Sampling Be A Screening Tool for Cervical Cancer? ................... 141
Using Travel Data to Estimate the Epidemic Size during a New Influenza Pandemic: A Joint
Estimation Approach ............................................................................................................ 141

xii
 Tobacco and Alcohol Control: Challenges to Academic Public Health .................................... 142
Public Health Implications of DNA-Based Non-Invasive Prenatal Testing Service for Down
Syndrome in Hong Kong ....................................................................................................... 143
What We Dream for in Health Education – Community Self-Promoting of Physical Activities 143
Developing Drinking Advice to Empower the Hong Kong Adults to Make Educated Choices on
Alcohol Consumption ........................................................................................................... 144
Patients’ Perceptions of Patient Engagement in Hong Kong .................................................. 145
The Core Components of Inpatient Experiences: Development and Validation Short-Form
Patient Experience Questionnaire in Hong Kong (SF-HKIEQ) ................................................. 146
China (Taiwan) .......................................................................................................................... 147

A pilot Study of BQ Chewing Habit Among Aborigines in Taiwan........................................... 148

The Residual Effects of Motorcycle Head and Spinal Injuries ................................................. 148
The Taiwan Experience in Control of Motorcycle Injuries ...................................................... 149
Effects of Osteoporosis and Time Length on Recurrent Falls in Older Men and Women ........ 149
Applying Resistance Training Exercise Program to Enhance Gait Function in Elderly for
Chronically Ill Patients .......................................................................................................... 150
Feasibility Assessment for Community Pharmacies to Provide Quit-Smoking Services .......... 151
Outcome of Hearing Screening for New Taipei City Newborns .............................................. 151
Analysis of Effectiveness of New Taipei City Active Case Finding Strategies for Detecting
Tuberculosis ......................................................................................................................... 152
New Taipei City Blueprint for Medical Resource Planning ..................................................... 152
Taiwan’s Aging Population and Community Hospice and Palliative Care................................ 153
Factors Affecting Suicidal Behavior — Case Examples from 2010 to 2012 Suicide Reports .... 154
Occupational Injuries and the Guest Worker Program: Comparison of the Occupational Injury
Rates among Migrant and Native Workers in Taiwan ............................................................ 154
Tuberculosis Care in Taiwanese Indigenous Patients: Tribe-engaged and Culturally Inclusive
Education ............................................................................................................................. 155
Alcohol Tax Policy in Relation to Inpatient Expenditure from Alcohol Attributed Diseases in
Taiwan .................................................................................................................................. 155
A Longitudinal Study of Factors Associated with Objective-measured Physical Activity Among
Older Adults ......................................................................................................................... 156
The Management Dipute About Taiwan’s Prescription Drug ................................................. 157
The Impact of Health Promotion Activities on Physical Fitness Maintenances of the Elderly in A
Community in Taiwan ........................................................................................................... 157
The Study of Relationship among Experiential Marketing, Customer Satisfaction and Customer
Royalty in Physical Examination Center ................................................................................. 158
Correlates of Smoking Behavior Among School Aged Adolescents in Four Countries in South

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 East Asia ............................................................................................................................... 159
Analysis of Invasive Pneumococcal Disease Pandemic and Vaccination in Children Under Age
Five in New Taipei City Between 2008～2012....................................................................... 159
New Taipei City Marginal Adolescent Drug Prevention Guidance Program ............................ 160
New Taipei City Health Education and Promotion Model ...................................................... 160
Public Health Department, New Taipei City Government Local Nutrition and Well-Being for
Seniors ................................................................................................................................. 161
Evaluating the Effect of Physician Personal Brand on Medical Resource Allocation in Taiwan 162
The Impacts of Organizational Characteristics of Dialysis Centers on Quality of Peritoneal
Dialysis care.......................................................................................................................... 162
A Study on the Willingness of Nursing Staff to Provide Discharge Planning Services ............. 163
Changing Perspectives of the Interrelation between Unemployment and Health .................. 163
Evaluation of Acute Toxicity and Teratogenic Effects of Ractopamine by Daphnia magna Embryo
Assay .................................................................................................................................... 164
Evaluation of Acute Toxicity and Teratogenic Effects of Female Hormones by Daphnia magna
Embryo Assay ....................................................................................................................... 164
Patterns and Predictors of Immediate Suicide Risk After A Cancer Diagnosis ........................ 165
Analysis for Patients, Satisfaction with Community Health Institutions in Pudong New Area. 165
Evaluation of Acute Toxicity and Teratogenic Effects of Five Commonly Used Antibiotics by
Daphnia Magna Embryo Assay ............................................................................................. 166
Fiji （斐济） ............................................................................................................................ 167

Recent Trend in the Increase of Oral Cancer in Fiji: Betel Nut Chewing - Is It A Risk Factor? .. 168
Betel Quid Chewing and Oral Cancer in Fiji ........................................................................... 168
Unbooked Mothers (Pregnant women with no antenatal care) ............................................. 168
Betel Nut Chewing- Is It An Emerging Risk Factor for Oral Cancer in Fiji? .............................. 169
Georgia（格鲁吉亚） ............................................................................................................... 170

Setting of Public Health in Georgia ....................................................................................... 171

India （印度） ......................................................................................................................... 172

Education holds the key to Empowerment and Sustainable Livelihood for the Indigenous
People in India...................................................................................................................... 173
Epidemiology of Dyspepsia in Delhi: An underestimated Public Health Challenge ................. 173
Cardiovascular Disease Risk Factor Profiling of Group C Employees in JIPMER, Puducherry, India
............................................................................................................................................. 174
HIV Surveillance in India –Success and Challenges Ahead Madhulekha Bhattacharya ........... 175
Association of Maternal Water, Sanitation and Hygiene (WASH) Practices and Premature
Delivery: A Cross Sectional Study Among Indigenous Tribal Communities in Odisha, India .... 175

xiv
 A Cross Sectional Study of HRV Among Medical Students with Different Levels of Obesity ... 176
Curse of the Occult in Fish meal Industry- Lesson to learn .................................................... 176
Hyperamylasemia as an Indicator of Acute Pancreatitis in Severe Leptospirosis .................... 177
Tribal Health: Issues and Challenges – A Camp Based Study in North Kerala ......................... 177
Better Programme Outcome During YoIRI (2012-13) in 8 Districts of Odisha, India, Through
Improved Programme Management ..................................................................................... 178
Exploration of Anthropological Traits of Community Mindset Traditionally Influenced by Son
Preference Culminating in Female Foeticide- Indian Scenario ............................................... 179
Analysis of Flexible Financing of Public Health Facilities Under National Rural Health Mission
(NRHM) in India .................................................................................................................... 179
Improving Access to Institutional Delivery Through Public Private Partnership Model: Lessons
from A Tribal District in India ................................................................................................ 180
Indonesia(印度尼西亚) ............................................................................................................. 182

Emergency/Disaster Response Preparedness for Earthquake in the hospitals in Indonesia ... 183
Based on Hospital Safety Index ............................................................................................. 183
"Indonesian Public Health Training: Practice and Research ................................................... 183
Ergonomic Design for Junior High School Furnitures at Jakarta, Based On Anthropometric Data,
Indonesia, 2012 .................................................................................................................... 183
Smoking Behaviors of Street Childrens in Makassar Indonesia .............................................. 184
Socioeconomic Characteristic of Service Quality Inpatient at Labuang Baji Hospital, Makassar,
South Sulawesi, Indonesia .................................................................................................... 185
Unemployment, Lack of Bridging Social Capital and HIV-risk Behaviours Among Male Injecting
Drug Users in Makassar, Indonesia........................................................................................ 185
Risk Factors of low APGAR Score Infants in Luwuk, Banggai Regency, Indonesia.................... 186
Measurement Model of the Theoretical Model That Affect Patient Safety Climate in Private
Hospitals in Indonesia........................................................................................................... 186
Integrated Marketing Communications (IMC) Healthy Behavior Without Tobacco for Youth in
Low Income Family of Surabaya City ..................................................................................... 187
Contribution of Smoke-Free Workplace and Other Factors in Improving Smoker's Chances of
Cessation .............................................................................................................................. 188
Linkages Between Climate Variability And Dengue Hemorrhagic Fever in Palembang, Indonesia
............................................................................................................................................. 188
Household Food Insecurity and Expenditure on Cigarette Were Associated to Underweight
Among Under-five Children in East Java, Indonesia ............................................................... 189
Under Five Mortality in Low Socio Economic Groups: Cross Sectional Survey Results in Four
Poorest Quintile Districts in Indonesia 2010-2011................................................................. 190
Homebirth Care in the Eyes of Indonesian Women in Amsterdam, the Netherlands ............. 190

xv
The Effect of Counseling and Discipline on the Increase Behavior Personal Hygiene of
Elementary School at Donggala District Central Sulawesi ...................................................... 191
Environmental Health risk Analysis of Benzene Exposure at Painting Unit Workers PT.X Jakarta
2010 ..................................................................................................................................... 192
Child Survival Program and Infant Mortality in Depok, Indonesia, 2013 ................................ 192
The Role of Support in Improving Quality of Life of PLHIV in Indonesia Year 2011(Qualitative
Study in 10 Provinces) .......................................................................................................... 193
Assessment of Mercury Accumulation in Dry Deposit, Surface Soil and Foodtuffs in Luwuk Gold
Mine, Central Sulawesi, Indonesia ........................................................................................ 193
Efficacy of Red Palm Oil and Carrot Noodle on Blood Retinol, IgG, and Nutritional Status of
Children Aged 7-9 Years ........................................................................................................ 194
Estimation of Iron Bioavailability from Food Consumption at Pregnant Women in Bogor,
Indonesia ............................................................................................................................. 195
Body Composition And Body Image Among Adolescents In Rural And Urban Indonesia ........ 195
Factors That Influence Chronic Complications of Elderly with Diabetes Mellitus ................... 196
Zinc Levels and the Incidence of Respiratory Infection and Diarrhea in the Stunting-Wasting
Children and Normal Children .............................................................................................. 196
Analysis of Disparities in Health Center Quality Between Rural, Coastal and Urban Areas at
Kutai Kartanegara District, Indonesia .................................................................................... 197
The Quality of Clinical Care Caesarean Section in Hospitals That Have Been Implementing
Quality Management Systems .............................................................................................. 198
Hyphoglicemic Activity of Black Tea as Good as Green Tea But Better Than Mullberry Leaf Tea
on Diabetic Rats ................................................................................................................... 198
Psychological Violence Against Wives and Its Determinants in Bekasi 2013 .......................... 199
Safe and Short Cut Behaviour Intention Analysis Among Workers at Pertamina Hulu Enerji
Offshore North and West Java (PHE ONWJ) .......................................................................... 199
Role of Exclusive Breastfeeding and Pneumonia Among Children Under Five years in Bogor
District West Java Province Indonesia ................................................................................... 200
Occupational Risk Perception and Wearing Determinant of Personal Protective Equipment
Among Small Scale Printing Operators In Makassar .............................................................. 201
Knowledge and Attitude of Preconception Women in Relationship with the Compliance on
Consuming Multi Micronutrient Capsules, in Makassar, Indonesia ........................................ 201
Relationship Between Smoking and Chronic Complications of Elderly with Diabetes Mellitus
Type 2, In Indonesia.............................................................................................................. 202
Analysis of Peer Education Towards Knowledge and Attitude of Peer Education About Early
Marriage in Makassar, South Sulawesi Indonesia .................................................................. 202
Predictor of Safe Behavior on Plywood Workers in Samarinda East Kalimantan .................... 203
A Model Development of Community Based Public Health Surveillance System for Integrated
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Disease Surveillance and Response (IDSR) in Bogor Municipal, Indonesia ............................. 204
Effect of Nutritional Counseling Nutrient Intake Blood Pressure and Outpatient Hypertension
Patients General Hospital Southeast Sulawesi Province ........................................................ 204
Risk Factors of Low APGAR Score Infants in Luwuk, Banggai Regency, Indonesia ................... 205
Eco-epidemiology Status Analysis of Dengue Hemorrhagic Fever (DHF) Endemicity in South
Sulawesi Province ................................................................................................................. 205
Knowledge, Attitude And Practice of Pregnant Mothers Toward Antenatal Care And Its Relation
To Lowbirth Weight .............................................................................................................. 206
Assessing The Target Hazard Quotients (THQs) Of Lead Via Drinking Water And Seafood
Consumption From Paniai Lake, Paniai Regency Papua, Indonesia 2013 ............................... 206
Early Detection of Benzene Poisoning in Informal Shoe Workers of Ciomas Shoe Industry, Bogor
District, West Java, Indonesia ............................................................................................... 207
The Effects of Propolis to Fasting Blood Glucose and Glucose Tolerance of Prediabetes Patients
............................................................................................................................................. 207
Initiation of Breastfeeding Enhanches Survival Exclusive Breastfeeding on Baby Who Had Born
in Bengkulu City, Indonesia ................................................................................................... 208
The Risk of Chronic Diseases to Mental Emotional Disorder Among Adult Population in
Indonesian ........................................................................................................................... 209
Corelation between Ozone Concentration in Ambient Air and Asthmain Jagakarsa, South
Jakarta, 2011-2012 ............................................................................................................... 209
Ciliwung’s Health Evaluation ................................................................................................. 210
The Contribution of Premarital Permissiveness and Reproductive Related Knowledge to Female
Adolescent Sexual Behavior in Indonesia .............................................................................. 210
Visual Characteristic Among Elderly Drivers in Fukuoka City, Japan ...................................... 211
Fitness Prediction Model (VO2max) From Selected Elementary Student in East Jakarta,
Indonesia in 2013 ................................................................................................................. 212
The Influence Education, Knowledge & Autonomy of Women to Unmet Need Contraception
Among Provinces with High and Low Fertility in Indonesia ................................................... 212
Risk Factors Causing Malaria Among Children Under Five Years Old in Lewoleba City, Lembata
Regency of the East Nusa Tenggara Province, NTT, 2013 ....................................................... 213
The Influence Process of Polishing to Lung Function on Workers Part of Polishing in PT. Surya
Toto Indonesia 2011 ............................................................................................................. 214
Psychoeducation Intervention for Deaf Adolescent Community and Its Relevant Policy
Advocacy: Case of Bengkala Village, Buleleng District, Bali, Indonesia .................................. 214
Health Status of Old Age Population in Indonesia ................................................................. 215
Serum Organochlorine Level in Horticulture Farmers and Pesticide Exposure Estimation in Pati
Regency, Indonesia ............................................................................................................... 215
Evaluation of IMCI Computer Adaptation And Training Tool (ICATT) to increase the skills of
xvii
health providers in the case management of childhood illnesses .......................................... 216
A Training Model for TBAs as "Agent of Change" In the Implementation of Exclusive
Breastfeeding in Bogor District, West Java, Indonesia ........................................................... 217
Elderly in Prioritized Districts for Food Insecurity in Indonesia More Vulnerable to Nutritional
Disturbance .......................................................................................................................... 217
Correlation and Prediction Model for Malaria Prevention Behavior in Indonesia .................. 218
Economic Burden of Breast Cancer in Makassar, South Sulawesi Province, Indonesia ........... 219
Caesarian Births: Actual Billing versus Insurance Reimbursement at Private Hospital, An Effort
to Anticipate Universal Health Coverage In Indonesia ........................................................... 219
Cost and Intervention of HIV/AIDS Program Using Top Down and Bottom up Approach:
Evidence from Indonesia ...................................................................................................... 220
The Body Composition of Obese Adolescents in Hasanuddin University ............................... 220
Establishing TB Control Through Workplace ......................................................................... 221
Need Assessment Results on Expanding TB Control Through the Workplace ........................ 222
Practice of Exclusice Breast Feeding (EBF) Among Mothers of Uunder-Two Year Children in
Sub-District Kajhu, Aceh Indonesia 2013 ............................................................................... 222
Overweight-Years Metric and Risk of Type-2 Diabetes ........................................................... 223
Development of Sound Absorbing Material Waste Based toward Green Technology: A
Literature Review ................................................................................................................. 223
Revealing the Denial Facts: The Increasing Numbers of Sexually Active Indonesian Adolescent
............................................................................................................................................. 224
The Relationship Between Organizational Factors With Performance of Universal Precautions
Programs in Rsup DR.Wahidin Sudirohusodo Hospital Makassar, 2013 ................................. 225
Factors Associated With Community Preventive Action Towards Avian Influenza After An
Outbreak .............................................................................................................................. 225
Factors Associated with the Utilization (Claim) of Elderly Secondary Care Inpatient at Social
Health Insurance Main Branch Office, South Jakarta, 2012 ................................................... 226
Physical Activity as the Predominant Factor of Waist Circumference of Jakarta Health Provincial
Office Employees in 2013 ..................................................................................................... 227
A Picture of Children and Their Right in 3 Regions of Palu City, Indonesia ............................. 227
Potential Safety Risk Analysis of Liquefied Petroleum Gas (Lpg) Year 2011 ............................ 228
Preliminary Survey from Triple Helix to Quinto Helix: A CSR Program for Berau Sanitation
Program in Improving Quality of Life .................................................................................... 228
Gender Differences in Transition to Employment of FPHUI Graduates .................................. 229
Assessment of Maternal Nutritional Status and Perceived Insufficient Milk .......................... 230
Physicians Motivation in Prescribing in Risa Sentra Medika Hospital ..................................... 230
Health Insurance and 5-Year Survival Rate of Cervical Cancer Patients at National Hospital,
Jakarta, 2007-2010 ............................................................................................................... 231
xviii
Utilization of Maternal Health Care Service and Skilled Birth Attendants in Jayawijaya,
Indonesia 2013 ..................................................................................................................... 231
Understanding Local Concept and Health Seeking Behaviors to Describe the Pattern of the
Cause of Death in Children under Five .................................................................................. 232
Nutrition Education and Home Gardening Program to Improve Mother Nutritional Knowledge
and Children Nutritional Status in Rural Setting in Indonesia ................................................ 233
Birth Attendance and Midwife Ratio in Cianjur District-Jawa Barat, Indonesia, 2013............. 233
Related Factors of Dry Eyes Syndrome on the Workers That Use VDT in Pestiside Factory ..... 234
Indoor Pm2,5 Concentration And The Declining of Adult’S Lung Function Around Pulo Gadung
Industrial Area East Jakarta 2012 .......................................................................................... 234
Stabilized Rice Bran Oil and Its Fractions Have Antiproliferative Activity on Cancer Cell Lines
But Not on Normal Cells ....................................................................................................... 235
Physical Activity and Energy Intake from Calorie Beverages Among Overweight and
Non-overweight Males and Females ..................................................................................... 236
Risk Factors of Adolescents Dehydration in Indonesia ........................................................... 236
Determinants of Acute Respiratory Tract Infection Among Under-five Children Living in
Barracks after Tsunami inAceh Besar, Indonesia, 2006. ......................................................... 237
Determinant Factors of Coronary Heart Disease Occurrence of the Productive Ages in Central
Bogor Village, West Java Province, Indonesia, 2012 .............................................................. 238
Modeling of Dengue Hemorrhagic Fever Intervention in Indonesia (A Contextual Approach) 238
Neonatal Death and Its maternal Factors at Four Poorest Districts in Indonesia .................... 239
Description of District Income and Health Financing also the Correlation with Severely Wasted
in Indonesia 2007 ................................................................................................................. 239
Occupational Health and Safety Culture Assessment: Case Study in Coal Mining Company in
Indonesia ............................................................................................................................. 240
Knowledge of Iron and Folic Acid (Ifa) Supplementation Amongst Pregnant Women in Lebak
and Purwakarta District, Indonesia: A Qualitative Study ....................................................... 240
Ferritin and Oxidative DNA Damage (8 hydroxydeoxyguanosine) Levels in Pregnant Women in
Gowa, Indonesia ................................................................................................................... 241
Factors Associated With Anemia Incidence in Endemic Area of Malaria at Mamuju Regency,
West Sulawesi Province, Indonesia ....................................................................................... 242
The Impact of NSDEP-PWs Intervention to the Performance of Posyandu in the Villages of NICE
Project, Maros Distirct, Indonesia ......................................................................................... 242
PM2.5 Exposure and Lipid Profile Among Male Highway Toll-workers in Jakarta .................... 243
The Correlation of Malaria Prevention Behaviour in Indonesia ............................................. 244
Practice of Female Circumcision among Under-five Female Children in Bukittinggi, West
Sumatra, Indonesia, 2011. .................................................................................................... 244
Breastfeeding and Reduced Risk of Ovarian Cancer .............................................................. 245
xix
 Profile of Anthropometric, Biochemical, and Body Composition Assessment of Obese
Adolescent Among Student of Hasanuddin University, Makassar, Indonesia ......................... 245
Behavior of Female Sex Workers in Drug Abuse to the Increasing Cases of HIV in Indonesia . 246
Physical Working Environment Risk Factor on Acute Respiratory Infection (ARI) for Workers of
PT. X Garment Industry Indonesia in 2013 ............................................................................ 247
Smart Anti-Smoking Youth : A Creative Education Method to Prevent the Increasing Number of
Youth Smoking Prevalence in Indonesia ................................................................................ 247
Comorbidity effect on Early Re-hospitalizaion among Heart Failure Patients in Jakarta,
Indonesia ............................................................................................................................. 248
Japan（日本） .......................................................................................................................... 249

Progress in Infant Health in Okinawa, Japan ......................................................................... 250

Effects of Particulate Air Pollution on Respiratory Symptoms and Pulmonary Function in Japan
............................................................................................................................................. 250
What Are the Further Competencies Required for Regional Health Workers in Japan? ......... 251
Effect of Awareness of Household Expenses on Social Rehabilitation .................................... 251
Parents and School Connectedness as Protective Factors for Multiple Risk Behaviors Among
Thai Female Adolescents ...................................................................................................... 252
Prior HIV Testing Experience and Risk Personalization Are Associated with Positive Intention to
Future Testing Among A Probability Sample of General Population in Nonthaburi, Thailand . 253
Prevalence and Reported Reasons of Unplanned Treatment Interruption Among Patients on
Antiretroviral Therapy in the Democratic Republic of Congo ................................................. 254
BOP (Base of the Pyramid) Business's Impact on Global Health: Future Prospects on Utilizing
BOP Business ........................................................................................................................ 254
A Study Analysis of the Sense of Burden and Amounts of Trips of Nursing Staff in Providing
Nursing Care ......................................................................................................................... 255
Progress of the Research on Current Situation of Clinical Trials in Asian Area ........................ 256
A Study on Assessment of Medical District in a Provincial City in Japan ................................ 256
A study on Restructuring of the Childcare Facility for Reduction of Stress from Child Rearing in
Local CIties, Japan ................................................................................................................ 257
A Study of Nursing Meals to Improve Quality of Life for Older People ................................... 257
Disease Characteristics of Visitors Attending A Clinic in Timor-Leste ..................................... 258
Does Antiretroviral Therapy Increase Risky Sexual Behavior of the Recipients? A Result from A
Cohort Study In Khon Kaen, Thailand.................................................................................... 259
Kazakhstan（哈萨克斯坦）..................................................................................................... 260

Ntersectoral Collaboration Role in Health Protection Initiatives in Kazakhstan ...................... 261

Republic of Korea（韩国） ...................................................................................................... 262

xx
 Information Systems Approach to Workplace Health Promotion .......................................... 263
Cost-effectiveness Analysis of Alcohol Control Strategies in South Korea .............................. 263
The Economic Burden of Epilepsy in Korea, 2010 .................................................................. 264
Factor Analysis for Healthcare Expenditures and Its Future Trends in Korea.......................... 265
Analysis on Cost Accounting of Cataract Surgery in South Korea: Focusing on Ophthalmic
Clinics and Hospitals ............................................................................................................. 265
Analysis and Utilization of Public Data in the Age of Big Data -Health Related Data Linkage
Among Agencies in Republic of Korea ................................................................................... 266
Suggestions for the Improvement of Obstetric No-fault Medical Malpractice Compensation
System in Republic of Korea .................................................................................................. 267
Policy Implications for Expansion of National Health Insurance Coverage to Ultrasound; A
Comparative System study ................................................................................................... 267
Building the Patient Safety System: Based on the Patient Safety Databank ........................... 268
A Study on the Causes of the Medical Accidents from Analyses of Rulings on Malpractice
Lawsuits in Orthopedics in ROK ............................................................................................ 269
Regulatory Issues on Personalized Medicine and Genomics in South Korea .......................... 270
Impacts on the Legal Guidelines for Protecting Genomic Information of Human in South Korea
............................................................................................................................................. 270
An Exploratory Study on Pharmaceutical Company's Performance and Growth in South Korea
............................................................................................................................................. 270
An analysis of factors that are related to the persistence of metabolic syndrome over two
consecutive years ................................................................................................................. 271
Utilization Behavior and Satisfaction of Premier Rooms by Types of Medical Institutions in
South Korea .......................................................................................................................... 272
Perception and Knowledge on Personalized and Genomic Medicine in South Korea: Based on
‘Experts Survey for Personalized and Genomic Medicine’ ..................................................... 273
Malaysia（马来西亚） ............................................................................................................. 274

The Role of NGO in Community Screening for Breast Cancer Among Females of Malaysia .... 275
Mental Health in Asia ........................................................................................................... 275
Prevalence and Trend of Communicable Diseases Among the Orang Asli (Aboriginal) Population
in Peninsular Malaysia Over the Years ................................................................................... 276
Rural Health Training Model at Universiti Malaya Sabah: PUPUK: Rural Health Perspectives . 277
Socio-demographics & Behavioural factors affecting Betel Quid Chewing Cessation in Malaysia
............................................................................................................................................. 277
The Prevention of Non communicable Diseases Among Malaysian Aborigines ..................... 278
Motorcycle Accidents: Impact of Prevention Policies - Malaysia............................................ 279
Maternal Marital Status and Other Risk Factors of Adverse Birth Outcomes Among Young

xxi
Malaysia Women .................................................................................................................. 280
Online Victimization of Adolescents and Relationship to Use of Social Networking Sites (SNS)
............................................................................................................................................. 280
Awareness of Warning Signs and Symptoms of Cancer and Anticipated Delay in Help Seeking
............................................................................................................................................. 281
Trends in the Prevalence of Intestinal Parasitic Infections Among Orang Asli (Aborigines) over
the Past Forty Five Years (1967—2013)................................................................................. 282
Teaching Community Diagnosis and Intervention in the Undergraduate Curriculum Through A
Field Residential Program (FRP) in the Rural Villages, Malaysia............................................. 282
Chronic pain, impact of pain and pain severity with poor physical function in older people .. 283
Assessing Knowledge and Practice on Clinical Pathways Among Healthcare Professionals in
Universiti Kebangsaan Malaysia Medical Centre ................................................................... 283
A Qualitative Study of Knowledge about Abortion Among Malaysian Women Who Experienced
Voluntary Induced Abortion ................................................................................................. 284
What Improves Quality of Life- Views from Post-stroke Survivors in Kano, Nigeria ................ 285
Cost Effective Analysis (CEA) of Recall Methods for Cervical Cancer Screening Program in
Selangor - Which is the Best? ............................................................................................... 285
Knowledge and Practice of the use of Prescription Medicines, Complementary and Alternative
Medicines and Food Supplements among Elderly Malay Population in the Community ........ 286
Association of Sitting and Obesity Among Adults in Rural Communities in Malaysia ............. 287
Pre-sarcopenia and Its Relationship with Physical Disability Among Rural Elderly in Pahang,
Malaysia: A Cross Sectional Study ......................................................................................... 288
Health Seeking Behavior among T2DM in Primary Care Setting: A Grounded Theory Approach
............................................................................................................................................. 288
Correlates of Lifestyle and Sociodemographic Factors with Prostate Symptoms Among Elderly
Men ..................................................................................................................................... 289
Prevalence and Factors Associated with Falls Among Community-Dwelling Elderly in Malaysia
............................................................................................................................................. 289
The Prevalence of Obesity and Its Associated Factors among Adolescents and Young Adults: 290
A Cross Sectional Study ........................................................................................................ 290
Environment and Health Landfill .......................................................................................... 291
Effects of Progressive Muscle Relaxation to Alleviate Job Stress in the Automotive Assembly
Line- A Worksite Health Promotion Programme (WHPP) ...................................................... 291
Evaluation the Effectiveness of A Five Year Workplace Wellness Program in Kuala Lumpur,
Malaysia ............................................................................................................................... 292
Dengue Vector Surveillance in Kuching, Kota Samarahan, Bau and Serian Districts of Sarawak,
Malaysia ............................................................................................................................... 293
Two New Species of Simulium (Gomphostilbia) (Diptera: Simuliidae) From Peninsular Malaysia,
xxii
 With Keys to 10 Peninsular Malaysian Species of The Simulium batoense Species-group ..... 293
Knowledge Attitude and Practice on Diabetes and Diabetes Care in A Rural Community in
Malaysia ............................................................................................................................... 294
Employee Assistance Programme: A Workplace Intervention for Psychological Health and
Sickness Absence .................................................................................................................. 294
Incidence of Adverse Transition Among Adolescents of Kinta, Perak ..................................... 295
Decentralization of Tuberculosis Integrated Programme in A Semi Urban Community: A Review
of the Challenges in Initiating the Programme and Its Limitations on Implementation .......... 296
Substance Abuse and Psychiatric Morbidity among Urban Low Income Residents in Kuala
Lumpur, Malaysia ................................................................................................................. 297
The Rural Medical Mobile Mission (RM3) in Cambodia: The University Kuala Lumpur Royal
College of Medicine Perak Experience .................................................................................. 297
Socioeconomic Inequalities in the Choice of Healthcare Provider in Malaysia: Underlying
Determinants ....................................................................................................................... 298
Rota Viral Infection: A Significant Disease Burden to Libya.................................................... 299
Effectiveness of A 6-month Community-based Healthy Lifestyle Intervention Program Among
Adults at High Risk of Type 2 Diabetes in Malaysia ................................................................ 299
Men's Involvement in Unintended Pregnancy, Contraception, and Legal Safe Abortion:
Challenges to MDG 5B Universal Access to Reproductive Health........................................... 300
What Sexuality Means to Malaysian Young Women: Results from A Qualitative Research .... 301
Ethnic Difference in Vitamin D Status and Its Associated Factors Among Teachers in A Tropical
Country, Malaysia ................................................................................................................. 302
Awareness and Acceptance of Dengue Self-test Kit Among Households of Community with
Various Levels of Previous Exposure to Dengue .................................................................... 302
Domestic Waste Management in Kuala Lumpur: Current Strategies and Knowledge, Attitude
and Practice of Recycling or Waste Separation by Residents ................................................. 303
Sources of Information on Sexual and Reproductive Health Among Adolescents .................. 304
Health of Female Foreign Domestic Workers in Malaysia: Stressors, Buffers, & Resilience .... 305
Modelling Dengue Incidence and Climatic Factors using Poisson and Negative Binomial Model
............................................................................................................................................. 305
Relevance of Established Risk Factors Associated with the Development of Hypertension
among Selected Communities above the Age of 30 in Pahang: A Cross Sectional Study ........ 306
Validation of the Teacher Reporting Attitudes Scale (TRAS) for Child Abuse and Neglect Among
Malaysian Primary School Teachers ...................................................................................... 306
The Impact of Men’s Health Project on the health behavior of community in rural Kudat, Sabah,
Malaysia ............................................................................................................................... 307
Nepal（尼泊尔） ...................................................................................................................... 309

xxiii
 Knowledge and Risk Perceptions about HIV/AIDS among Nepalese Migrants in Gulf Countries:
A Cross-sectional Study ........................................................................................................ 310
Assessing Health Status of Rural Village Development Committee of Nuwakot District of Nepal
............................................................................................................................................. 310
Reasons behind Women Having Abortion and Consequences of Abortion: A Study among
Aborted Women in Charikot, Nepal ...................................................................................... 311
Philippines(菲律宾) ................................................................................................................... 313

Emergence of Global Health Education in the Asia-Pacific Region ......................................... 314

Analysis of the maintenance and depreciation costs and requirements of Selected government
hospitals in the Philippines ................................................................................................... 314
Knowledge on HIV and Sexually Transmitted Diseases, Self-Efficacy and Communication Skills
on Condom Use of Selected College Students: Basis for Development of Health Education and
Promotion Materials ............................................................................................................ 315
Changes and Challenges of the Hospital Sector in the Philippines ......................................... 316
An Assessment of Medicine Entitlement Programs and their role in Universal Health Coverage
in the Philippines .................................................................................................................. 316
Public Health Law Review on Six Countries in Western Pacific Region: Republic of Korea, The
Philippines, Samoa, Vanuatu, Kingdom of Cambodia, Lao People’s Democratic Republic ...... 317
Singapore (新加坡).................................................................................................................... 319

Occupational Risk Factors for Low Back Pain among Drivers of Three-Wheelers in Sri Lanka . 320
Sri Lanka(斯里兰卡) ................................................................................................................. 321

The APACPH Global Public Health Education Model in the Asia-Pacific Region ...................... 322
Experience of Provision of Basic Occupational Health Care in Non-formal Workplace Though
Primary Health Care (PHC) .................................................................................................... 322
Initiation, Maintenance and Quitting of Betel Quid Chewing in Estate Populations in Sri Lanka
............................................................................................................................................. 323
Addressing Human Resources in Health (HRH) Issues in An Island Nation - the Maldivian
Experience ........................................................................................................................... 324
Three Wheeler and Tuk-Tuk Accidents: An Emerging Burden in Motor Vehicle Deaths and
Injuries in Sri Lanka............................................................................................................... 324
Reframing Rural Health: Health Beyond the Health Sector .................................................... 325
Medical Students in Health Assistance in Areas of Conflict ................................................... 325
Climate Factors and Dengue Fever in Selected Areas of Sri Lanka ......................................... 325
Sri Lanka: Advocating for SRH/HIV Integration Through Partnerships and Networking Using
Provincial Structures as A Platform ....................................................................................... 326
Psychosocial Well Being & Its Influence on School Performance of Children from Institutions

xxiv
and Children Live with Parents ............................................................................................. 326
Adaptation and Validation of Effort-Rewards-Imbalance Model Among Administrators:
Evidence from Sri Lanka........................................................................................................ 327
Health Promotion in Workplaces as A strategy for Modification of Risk Factors for NCDs: .... 328
A Practical Example from Sri Lanka ....................................................................................... 328
Salt Consumption Estimated by 24 Hour Urinary Sodium Excretion Among Employees of
Government Administration Officers in Sri Lanka .................................................................. 328
Delirium: A Cause for Concern .............................................................................................. 329
Impact of Media on Child Mental Health .............................................................................. 330
The Impact of the Absence of the Biological Father on the Well Being of 11-16 Year Children in
the Western Province of Sri Lanka ........................................................................................ 330
Health Promotion Tool to Reduce The Tobacco Consumption in Men Through Their Children in
Low Socio-Economic Groups In Kandy District, Sri Lanka ....................................................... 331
Health Promotion Approach to Improve the PA Level Among Women Who Live Low
Socio-economic Group in Sri Lanka ....................................................................................... 332
Knowledge of Cervical Cancer and Its Preventive Strategies Among Nursing Students in A
Developing Country .............................................................................................................. 333
Obstetric Risks and Adverse Birth Outcomes in Teenage Pregnancies: Experience of A Tertiary
Care Centre in Sri Lanka ........................................................................................................ 333
Climatic Factors and Occurrence of Dysentery in Sri Lanka ................................................... 334
Prevalence and Correlates of Noise Induced Hearing Loss Among Traffic Policemen in the City
of Colombo .......................................................................................................................... 334
Development of a tool (NULMSDQ) to assess neck and upper limb musculoskeletal disorders
among female garment workers in a free trade zone in Sri-Lanka ......................................... 335
Prevalence Of Neck And Upper Limb Msds Among Female Apparel Workers In An Export
Processing Zone In Sri Lanka ................................................................................................. 336
Correlates of the Three Domains of Burnout Among Nursing Officers Working in Government
Teaching Hospitals in Colombo ............................................................................................. 336
Prevalence of perceived stress & its influencing factors among staff of the urban area Banks in
Northern Srilanka ................................................................................................................. 337
Prevalence of Obstructive Sleep apnea Risk and Related Factors in Public Transport Bus Drivers
in Jaffna, Sri Lanka ................................................................................................................ 338
Influence of Pre-pregnant BMI and Gestational Weight Gain on Pregnancy Outcomes in A
Teaching Hospital of Northern Sri Lanka ............................................................................... 339
Ensuring school water safety by minimizing wastage: a successful story at a school in a
developing country in South Asia ......................................................................................... 339
Knowledge on Menopausal Related Health Problem and Factors Influencing on It Among
Female Nursing Staff in Teaching Hospital Jaffna .................................................................. 340
xxv
 Trend and Influencing Factors on Reproductive Health Knowledge and Family Planning Usage
Among Teenage Pregnant Mothers at A Tertiary Care Center in Northern Sri Lanka.............. 340
Ante-natal Iron Supplementation in Sri Lanka: Compliance and Factors Affecting ................. 341
A Study of Association between Sedentary Life Style and Childhood Obesity in Urban Sri Lanka
............................................................................................................................................. 342
Sudan (苏丹).............................................................................................................................. 343

Job Stress and Work Ability among White Collar Employees of Khartoum Ministry of Health,
Sudan ................................................................................................................................... 344
Thailand(泰国) .......................................................................................................................... 345

The Thai Vision: Practice to Policy Public Health Education Program Accreditation ............... 346
Dental Caries Status and Oral Hygiene Habits among Secondary School Children Aged 12-13
Years Old in Yangon Region, Myanmar .................................................................................. 346
Pesticide Use Practices and Its Related Factors Among Farmers in Pyin OO Lwin Township,
Myanmar.............................................................................................................................. 347
The Relationship Between Mother’s Work and Infant Mortality in Thailand ......................... 347
Achievement as Evidence: Strategic Action for Sustainable Financing of Health Promotion .. 348
Clogging the airways: Smoking in airports in Asia ................................................................. 349
Factors Affecting the Neuropsychological Effects of Rice Farmers Exposed to Chlorpyrifos in
Thailand ............................................................................................................................... 349
Factors Toward Gingivitis and Oral Hygiene Among 7-to 9-year-old Children in Thailand ...... 350
Behavior change among the patients after the detection of coronary heart disease of
Kathmandu valley ................................................................................................................. 351
Adolescent Depression Screening Among International School Students in Bangkok, Thailand
............................................................................................................................................. 351
Health Impacts of Klong-Luang Dam Construction to Local Community in Khoa-Chan District,
Cholburi Province, Thailand .................................................................................................. 352
Removal Efficiency of Arsenic (III) by Coconut Shell Char and Rice Husk Ash Adsorbent ........ 353
Evaluation of the Integrated Disease Surveillance System in a district of Rajasthan, India ..... 353
Diclosure of HIV Status to the Intimate Partners Among Plhiv in Monywa Consortium Art Clinic,
Myanmar.............................................................................................................................. 354
Factors Affecting the Public Health Performance Evaluation of Sub-district Health Promoting
Hospital Directors in KhonKaen Province, Thailand ............................................................... 354
The Organizational Commitment Factors Affecting Core Competency of Public Health Officers
at Sub-District Health Promoting Hospitals in Sakon Nakhon Province .................................. 355
Development of High Impact Styrene Tube for the Detection of Cryptosporidium and Giardia
Enteric Protozoa in Water and Food ..................................................................................... 356
Fear of Falling and Related Factors in Older Persons Living in the Community ...................... 357
xxvi
 The Bright and Healthy Thai Kid Project, A Three-year Study to Combat Childhood Obesity . 357
Mapping of Groundwater Quality for Drinking Purposes in Khon Kaen City, Thailand ........... 358
Computer Assisted Instruction “learning of Nutrition Flag for 5th Grade and 6th Grad Deaf
Students” ............................................................................................................................. 359
Cytogenetic Biomonitoring of Workers Exposed to Diethylamine Analysis in Peripheral Blood
Lymphocytes ........................................................................................................................ 359
Diclosure of HIV Status to the Intimate Partners among Plhiv in Monywa Consortium Art Clinic,
Myanmar.............................................................................................................................. 360
Using Biomarker and Symptoms for Evaluation of Exposure Toluene Levels Among Road
Sweepers in Bangkok ............................................................................................................ 360
Health Literacy Level of Patients in Srinagarind Hospital, Khon Kaen Province, Thailand ....... 361
Muscle Pain among Thai Massage Practitioners.................................................................... 362
Teen’s perception on Cigarette plain packaging mock up ...................................................... 362
Thai Neuro-healing Touch (SKT 8): A Mental Health Care Technique for Children with Autism
............................................................................................................................................. 363
Pre-marital sex among Thai Adolescents, the study from the Reproductive Health Survey 2009
............................................................................................................................................. 363
Comparison on the Limits of Detection Between Quantitative Realtime RT-PCR and
Conventional RT-PCR for Influenza A and B Viruses............................................................... 364
The Quality of Work Life and Barriers to Work Among People Living with HIV/AIDs;
Effectiveness of SKTs Meditation Exercise ............................................................................. 365
Fatigue and Factors Related Among Thai Nurses ................................................................... 365
Smoking, Alcohol Drinking and Betel Quid Chewing Among Myanmar Youth Workers in Mae
Sot District of Tak Province, Thailand .................................................................................... 366
Headaches and Factor related among Thai Monks ................................................................ 367
The Evaluation of Payment Mechanism Regarding Health Promotion and Disease Prevention
Programs in Northeastern Thailand ...................................................................................... 367
Effectiveness of SKT Meditation Innovation Exercise on Spatial Disorientation and Vestibular
effects: A Pilot study in an Hostage ....................................................................................... 368
Prevention and Control of Iodine Deficiency of Pregnant Women Associated with Neonatal
Neurobehavioral Development............................................................................................. 369
United States(美国) ................................................................................................................... 370

Can Lessons Learned from the Growth of Advanced Practice Nursing Roles in the U.S. Inform
New Strategies for Meeting Health Needs of Geographically Isolated Populations in China? 371
Health and Education in the United States: Moving Towards a Virtuous Cycle ...................... 371
Multiple Approaches to Reduce the Consumption of Sugar-Sweetened Beverages ............... 372
The Roles of Vitamin A in the Regulation of Hepatic Glucose and Fatty Acid Metabolism ..... 372

xxvii
 Addressing Oral Health Disparities among Middle-aged and Older Americans: Comparison of
Asians with other Racial/Ethnic Populations ......................................................................... 373
Multi-country study of betel quid chewing: Introduction and the example of Guam............. 374
The U.S. Tradition and Experience in Public Health Training .................................................. 375
Environmental and Policy Approaches to Reducing Obesity in the USA ................................. 375
Impact of Motorcycle Injury Prevention Policies in the Asia-Pacific Region ........................... 376
Future Research Directives in Oral Cancer Prevention and BQC - Cessation .......................... 376
Global Collaboration for the Health of Indigenous Peoples ................................................... 376
GLOBAL HEALTH: THE NEW ERA IN EDUCATION FOR HEALTH ................................................ 377
Health Professionals as Peacemakers .................................................................................... 378
Doctors as Peacemakers ....................................................................................................... 378
Socioeconomic Determinants of Obesity: A GEE Analysis ...................................................... 378
Reactions to Framing of Cessation Messages Among Dual-Smoker Couples .......................... 379
The U.S. Tradition and Experience in Public Health Training .................................................. 379
Promoting Health Among Asian Adults and Children Worldwide Using Culturally Tailored
Technology-centered Tools ................................................................................................... 380
Effective Concentration and Recovery of Infectious Enteric Virus from Environmental Waters
............................................................................................................................................. 381
Exploring Patient Perspectives about “Potentially Preventable Hospitalizations" for Heart
Failure and Diabetes in a Hawai’i Hospital ............................................................................ 381
Health and Suffering in the Occupied Palestinian Territory ................................................... 382
Impact of early life antimicrobial exposure on reproductive outcomes ................................. 383
iCook: Development and Pilot Testing of a Cooking Intervention for Youth and Adults ......... 383
Income, inequality, and infant mortality rates in the U.S. ...................................................... 384
Effects of parabens on adipocyte differentiation and adipogenesis in vivo: is there an
environmental link to obesity? ............................................................................................. 385
Monitoring of Hawaiian Environmental Waters Using Enteric Viruses as A Potential Indicator- A
Seasonal Study ..................................................................................................................... 385
Air Quality and Pollution on Children’s Health: Results from a Cross-Sectional Survey in
Nanchang, China .................................................................................................................. 386
Concordance in Perceptions of Risk and Harm Among Dual Smoking Couples ...................... 387
Internet Delivered Diabetes Management ............................................................................ 387
Mixed Methods for Global Health Research: Systematic Literature Review and Application to
the Study of Care of Older Adults ......................................................................................... 388
Effects of Preterm Delivery and Early Intervention on Infants’ Mental Development_A Two-Year
Follow-Up Study ................................................................................................................... 389
Medicinal herbs inhibit castrate-resistant prostate cancer via multiple mechanisms ............ 389
United States Minor Outlying Islands ...................................................................................... 391
xxviii
Pushing Technology Closer to the Patient: Community-Based Health Workers Can Perform
Screening Echocardiograms to Assess for Heart Failure ........................................................ 392

xxix
Keynote Speech

1
Joseph Jao-Yiu SUNG
Mok Hing Yiu Professor of Medicine
Vice Chancellor and President, The Chinese University of Hong
Kong
Academician, The Chinese Academy of Engineering

Professor Joseph Jao-Yiu Sung is currently Mok Hing Yiu

Professor of Medicine, Vice Chancellor and President of the Chinese University of Hong Kong
(CUHK). Previously, he was Chairman of the Department of Medicine and Therapeutics from 1999
to 2010, Associate Dean (Clinical) of the Faculty of Medicine from 2002 to 2004 and Associate
Dean (General Affairs) from 2004 to 2009, and Head of the Shaw College from 2008 to 2010.

Educated at the University of Hong Kong and the University of Calgary, Canada, he completed his
Doctor of Medicine at CUHK in 1997.

He was President of the Hong Kong Society of Digestive Endoscopy from 2000 to 2004, and of the
Hong Kong Society of Gastroenterology between 2002 and 2004. He was also Vice-President of the
Hong Kong Academy of Medicine from 2001 to 2005, and of the Hong Kong College of Physicians
between 2003 and 2005.

He has been an invited keynote speaker for many named lectures from around the world, including
India, the Philippines, Australia, Canada, South Africa, Thailand and Taiwan, and has received
many prestigious awards including Eminent Scientist of the Year from the International Research
Promotion Council (IRPC) and the Asian Hero Award from Time Magazine in 2003, the Most
Outstanding Contribution Award (Clinical Therapeutics) from the Hong Kong Government in 2007,
the State Award for Science and Technology Promotion from the People’s Republic of China,
2007–2008and 2013-2014, and Honorary Member of the American Society of Gastrointestinal
Endoscopy in 2009, Ho Leung Ho Lee Award 2012, World Outstanding Chinese Award 2013,
Master of World Organization of Gastroenterology 2013.

Professor Sung has an illustrious publication career of 6 books, 18 book chapters, 680 full
peer-reviewed papers, and 380 abstracts.

2
Emerging Cancers in Asia: Are we too much Westernized?

3
Liming Li
Epidemiology professor of School of Public Health, Peking
University
Former President of Chinese Academy of Preventive Medicine
Board Chairman, Chinese Academy of Medical Sciences
Executive Vice President, Peking Union Medical College
Founding director of Chinese Centre for Disease Control and
Prevention

Professor Liming Li received his MD and MPH diploma in Beijing Medical University in 1982 and
1986, and got the post-doctoral fellow in the Johns Hopkins University (U.S.A) during 1990-1992.
Professor Liming Li was elected an Honorary Fellow of the Faculty of Public Health of the Royal
Colleges of Physicians of the United Kingdom (HonFFPH) in 2010. He has been involved in the
following academic research areas, such as study on epidemiological study of the cardiovascular
diseases, study on the quality of life among the elderly in China, study on the professional education
for public health, prevention and control of non-communicable diseases, and public health policy
and evidence-based decision making study.

Professor Liming Li is an accomplished researcher and teacher. He has published numerous

manuscripts on the epidemiology and prevention of hypertension and is the chief editor of the
epidemiology textbook currently used by public health students in China. He is current President of
Chinese Epidemiology Association, Chief Editor, Chinese Journal of Epidemiology and Chinese
Journal of Public Health Management, current President of National Expert Committee on Chronic
Disease of the Ministry of Health of P. R. China and also Chair of the Public Health Committee of
the Ministry of Education Steering Committee for Medical Education, P. R. China. He is also a
chronic disease expert of WHO West Pacific Region, Adjunct Professor/Guest Professor/Honorary
Professor at the University of California, Los Angeles, Tulane, Claremont Graduate University,
University of Southern California, Chinese University of Hong Kong and Oxford University.

4
Public Health Professional Education in China

5
Lincoln C. Chen, MD
President of China Medical Board

Lincoln C. Chen is President of the China Medical Board. Started

in 1914, the Board was endowed by John D. Rockefeller as an
independent American foundation to advance health in China and
Asia by strengthening medical education, research, and policy.

Earlier at Harvard, Dr. Chen was the founding director of the Harvard Global Equity Initiative
(2001-2006), the Taro Takemi Professor of International Health and Director of the University-wide
Harvard Center for Population and Development Studies (1987-1996). In 1997-2001, Dr. Chen
served as Executive Vice-President of the Rockefeller Foundation, and in 1973-1987, he
represented the Ford Foundation in India and Bangladesh.

Five years ago, Dr. Chen assumed the Chair of the Board of BRAC USA, having completed two
three-year terms as Chair of the Board of CARE/USA. BRAC Bangladesh and BRAC International
constitute members of an organizational alliance that is the largest NGO addressing poverty in the
world. Dr. Chen was the co-founder of the NGO Forum, a regular informal exchange to promote
cooperation among presidents of the world’s leading NGOs. Dr. Chen also serves at Harvard as
Co-Chair of the Advisory Committee to the FXB Center on Health and Human Rights, the Advisory
Board of the Harvard Ministerial Leadership Forum, and a Fellow at the Harvard Asia Center. He
is also a member of the Board of the Institute of Metrics and Evaluation (University of Washington),
the Public Health Foundation of India, and the UBS Optimus Foundation. He was the Special
Envoy of the WHO Director-General in Human Resources for Health (2004-2007), and the
Founding Chair of the Global Health Workforce Alliance (2006-2008).

Dr. Chen is a member of the National Academy of Sciences’ Institute of Medicine, the American
Academy of Arts and Sciences, the World Academy of Arts and Sciences, and the Council on
Foreign Relations. He is a member of the Harvard School of Public Health Visiting Committee. He
graduated from Princeton University (BA), Harvard Medical School (MD), and the Johns Hopkins
School of Hygiene and Public Health (MPH).

6
China on the Frontiers of Global Health

7
MARY BROWN BULLOCK, Ph.D

Mary Brown Bullock was named Executive Vice Chancellor of Duke Kunshan University in
September 2012. She is also a Senior Scholar at the Woodrow Wilson International Center in
Washington, D.C. and President Emerita of Agnes Scott College in Atlanta, Georgia.
Immediately prior to her appointment at Duke Kunshan University Bullock served as Distinguished
Visiting Professor of China Studies at Emory University from 2006 to 2012. From 1995 to 2006 she
was President of Agnes Scott College. During her tenure as president the college greatly expanded
its student enrollment, its faculty and its physical facilities. She was active in national educational
associations including serving for two terms as chair of the National Association of Independent
Colleges and Universities and the Women’s College Coalition. Also a member of the board of
directors of the American Council on Education Bullock was a leader in American higher education.
Prior to her time as a college president Mary Bullock was the Director of the Asia Program of the
Woodrow Wilson International Center for Scholars and Director of the Committee on Scholarly
Communication with the People’s Republic of China at the National Academy of Sciences.
Mary Bullock is a long-time student of U.S. – China relations having received her M.A. and Ph.D.
degrees from Stanford University in Chinese history. Her research and publications have focused on
U.S. – China educational and scientific relations. Two of her books are being translated into
Chinese and will be published by Beijing Commercial Press in early 2014: An American Transplant:
The Rockefeller Foundation and Peking Union Medical College and her most recent book, The Oil
Prince’s Legacy: Rockefeller Philanthropy in China.
Professionally active in many China-related American organizations Mary Bullock currently serves
as chair of the China Medical Board, and as a director of the Henry Luce Foundation, the National
Committee on U.S. – China Relations, the Harvard-Yenching Institute, the Asia Foundation, and the
8
National Humanities Center. She has also been active in corporate relations, currently serving as a
director of Genuine Parts Company.
Mary Bullock and her husband George live in Atlanta, Georgia but will be spending most of their
time in Kunshan, China.

Ming-hui Ren, M.D., Ph.D.

Director-- General of the Department of International Cooperation at the National Health and
Family Planning Commission of the People’s Republic of China

Dr. REN is the Director-General of the Department of International Cooperation at the Ministry of
Health (MOH) of the People’s Republic of China. Throughout his career, Dr. REN has been
involved in numerous health policy research projects including the “Health care systems research in
ruralChina” (MOH), “Financing and organization of health care services in poverty areas of
China”(World Bank), “The pilot study of health insurance reform in urban China” (Chinese State
Council)and the “Experiment in community health protection-policy exploration, training and
demonstration program” (UNDP). In recent years, as a senior representative of the
Chinesegovernment, he served as a leading board member in a number of international
organizations including WHO, UNAIDS, and the Global Fund to Fight AIDS, TB and Malaria. He
is also the point ofcontact for many Chinese bilateral cooperation mechanisms in health. Dr. REN
received his MD,MPH and PHD from Xi’an Medical University in 1987, Harvard School of Public
Health in 1993 and Peking University in 2008, respectively.

9
Australia（澳大利亚）

10
Guest Lecture 1 (from APACPH)
A Call to Arms for Collaboration in Obesity Prevention
Steven Allendera, Kremlin Wickramasingheb, Melanie Nicholsa
aUniversity of Deakin, Australia

bUniversity of Oxford, UK

Obesity persists as a leading public health problem in the Asia Pacific. High and growing obesity rates across
the region bring attendant increases in morbidity, mortality and financial burden of disease. Lessons from
two decades of trials have identified promising approaches to obesity prevention but no single successful
strategy. Most promising interventions appear to be those that are multi-level, multi strategy. Critical to the
success of these approaches is the involvement of the community in the design, implementation and
evaluation of these initiatives. Better collaboration is required between community practitioners, researchers
and policy makers to ensure obesity prevention efforts represent best available evidence and stand the best
chance of being effective. This presentation describes current efforts for large scale population prevention in
Australia including a national collaboration for knowledge translation and exchange. We have created a
collaboration across the Asi- Pacific region for obesity prevention and this presentation will describe, and
provide an invitation to join, for researchers from across the Asia Pacific.

Guest Lecture 2
Advances and Future Prospects in Public Health Nutrition in the Asia Pacific Region
Prof Colin Binns
John Curtin Distinguished Professor of Public Health, School of Public Health, Curtin University, Perth, Australia

In the past 50 years substantial progress has been in made in improving the health and wellbeing of all ages
in our region, particularly of infants and children. Fifty years ago infant mortality was around 130 per 1000
live births in the East Asia and Pacific Regions, although in some of the remote areas of Papua New Guinea
was above 500. While infant mortality in the region now averages below 20 and is as low as 3 in Japan, it
remains above 100 in some remote areas. During the same period average life expectancy in the region has
increased from 50 years to 72 years, and is as high as 83 in Japan. Improvements in nutrition and the food
supply have made a major contribution to this improvement.
Early life nutrition is not only important for health and development during infancy, but is related to chronic
disease prevalence later in life. Breastfeeding, particularly exclusive breastfeeding, has a major role in
reducing infections and mortality and is important in maximising the child’s IQ. Goal Four of the
Millennium Development Goals is to reduce child mortality and within this goal are targets related to infant
mortality and child mortality. The most common causes of death in young children remain diarrhoeal disease
and lower respiratory tract infection, but in 50-60% of these cases, under-nutrition is the predisposing cause.
In early childhood breastfeeding provides most protection against infection and death, even in in cases when
the mother herself may have sub optimal nutrition. Benefits for mothers who breastfeed include a reduction
in ovarian and pre-menopausal breast cancer rates. Nutrition in early life is related to adult obesity, heart
disease, diabetes and renal disease. Control of chronic diseases in our region depends on modifying the four
major risk factors of tobacco, diet, physical inactivity and alcohol. The dietary steps needed in our region to
control chronic disease will include improvement in breastfeeding rates, elimination of prelacteal feeds and
reduction in the use of infant formula. Together with the implementation of dietary guidelines for adults
these public health measures will contribute to improving public health in our region.
11
Oral 1 (from APACPH)
Role of Early Life Nutrition in Obesity Prevention
Colin Binns
School of Public Health, Curtin University, Perth Australia

In the Asian region childhood nutrition problems have traditionally been under nutrition. But around three
decades ago the situation began to change and there are now substantial numbers of obese children. In Asia
(excluding Japan), nearly 5% of preschool aged children were estimated to be overweight or obese in 2010, a
50% increase in prevalence since 1990. In 2010, preschooler obesity rates were higher in Western Asia
(which includes the Middle East) than in Eastern, South-eastern, or South Central Asia (15, 5, 5, and 4%
respectively). But because of the large populations in India and China, the actual number of overweight and
obese infants is very large. In Australia in school age children, the rate has reached 21%, but has plateaued
for the past decade. However the collection of statistics is hampered in Asia by the varying definitions in use.
For most of Asia obesity rates are still rising in all socio-economic strata. It is far easier to prevent obesity
than it is to treat it and so the public health emphasis should be on prevention. The first step in an obesity
prevention program is to ensure that all mothers have the opportunity to breastfeed their infants, exclusively
for six months and then continuing while complementary feeds are introduced. Infants who are not breastfed
are 33% more likely to become obese children. Preventing obesity in children requires regular monitoring of
growth, but a study of Chinese mothers shows that they do not perceive that their child is overweight or
obese. As a part of health promotion programs health workers and parents need to be educated on the
importance of appropriate growth of a healthy diet as the basis of a healthy life.

Oral (from APACPH)

An Australian Perspective in Public Health Education and MPH
Prof. Catherine Bennett PhD
Deakin University, Australia

Oral 2 (ID71)
Mushroom Intake Reduces Epithelial Ovarian Cancer Risk in Southern Chinese Women
Andy H. Lee, Dada Su, Li Tang, Maria Pasalich, Colin W. Binns
School of Public Health, Curtin University, Perth, Australia

Objective: To investigate the association between mushroom consumption and risk of epithelial ovarian
cancer in southern Chinese women.
Method: A hospital-based case-control study was undertaken in Guangzhou, Guangdong Province, from
2006 to 2008. Participants were 500 incident epithelial ovarian cancer patients and 500 controls, with a mean
age 59 (SD 6) years. Information on habitual mushroom consumption was obtained by face-to-face interview
using a validated and reliable food frequency questionnaire. Logistic regression analyses were performed to
assess the association between mushroom intake and the ovarian cancer risk.
Results: The ovarian cancer patients consumed less mushrooms (mean 28.48, SD 37.45g/day) than controls
(mean 30.75, SD 41.85g/day). Apparent reductions in cancer risk were found at high levels of intake,
especially for the common white button mushroom with adjusted odds ratios 0.68 (95% confidence interval
0.52 to 0.89) for women consuming more than 2g per day relative to those below, p = 0.005. Decreases in
risk at high levels of intake were also observed for serous and mucinous subtypes of epithelial ovarian
12
tumours.
Conclusions: Intake of mushrooms particularly white button mushroom appeared to be inversely associated
with the incidence of epithelial ovarian cancer in southern Chinese women.

Oral 3 (ID161)
Impact of Heatwaves on Mental Illnesses in A Temperate City in China
Ying Zhanga, Xuena Liub, Jingxuan Zhangc, Baofa Jiangb
a China Studies Centre, School of Public Health, University of Sydney, Sydney, Australia
b School of Public Health, Shandong University, Jinan, China

c Shandong Mental Health Centre, Jinan, China

Background: Little is known about the impact of heatwaves on mental illness in China. Jinan, located in
northern China, is one of the Chinese cities hit frequently by heatwaves in summer. This study aimed to
examine the risks of heatwave on mental illness hospital visits and admissions in Jinan.
Methods: Data including daily number of hospital visits and case note data for those who were hospitalised
were collected from Shandong Mental Health Center in Jinan during the summer of 2010 (1st Jun- 31st Aug).
A heatwave was defined by having maximum temperature above the 95th percentile of local normal
temperate for three and more days. The hazard period included heatwave days plus three days afterwards to
allow lagged effects. Univariate analysis and the generalised estimating equation (GEE) regression were
performed.
Results: In total, there were 16451 hospital visits and 842 hospital admissions over the study period with
four heatwaves identified. Results did not show a significant difference in daily hospital visits (outpatients)
between the hazard period and the non-hazard period (225 vs. 262, p>0.05). However, the GEE models
showed that the heatwave hazard may increase 5% (1%-9%) hospitalisations due to depression, 10%
(4%-15%) hospitalisations due to manic state/hysteria, and 5% (3%-11%) hospitalisations due to sleeping
disorder, but not for other types of hospitalisations.
Conclusion: This is the first study quantifying the risk of heatwave on mental illness in China. It shows that
heatwave has significantly increased certain types of mental illness hospitalisations in China. Findings will
be of significance to assist in developing strategies and interventions to prevent and reduce burden of mental
illness in the changing climate. (Project was partially funded by China973Program:2012CB955500955502)

Oral 4 (ID189)
Prevalence of Dietary Supplement Use in Healthy Pre-school Chinese Children in Australia
and China
Shu Chen1, Colin W Binnsa, Bruce Maycocka, Yi Liub, Yuexiao Zhangc
aCurtin University, Perth, Australia;

b Sichuan University, Sichuan, PR China;

c Wuhan University of Science and Technology, Wuhan, China

Background: There is a growing use of dietary supplements in many countries including China and
Australia. This study aimed to document the prevalence and types of dietary supplements used and
characteristics of Chinese pre-school children using dietary supplement in Australia and China.
Methods: A survey was carried of Chinese mothers with preschool aged children in Perth, Western Australia
(n=237) with a response rate of 95.6% and in Chengdu and Wuhan, China (n=2079) with a response rate of
13
86.6%.
Results: A total of 22.6% of the Chinese children in Australia and 32.4% in China were taking dietary
supplements. In China, the most commonly used dietary supplements were calcium (58.5%, average intake
105 mg/day) and zinc (40.4%, average intake 4.4 mg/day). In Australia, the most frequently used types were
multi-vitamins/minerals preparations (46.2%) and fish oil (42.3%, average intake 860 mg/day). After
controlling for potential confounding variables, the results of the binary logistic regression analysis showed
that ‘being unwell during the past month’ (OR=1.44, 95% CI 1.05-1.97) and ‘having a higher household
income’ (OR=1.53, 95% CI 1.13-2.08) were significantly related to dietary supplementation among children
in China. In Australia, ‘not employed mothers’ (OR=3.83, 95% CI 1.09-13.4), ‘higher education level of the
mother’ (OR=2.51, 95% CI 1.19-5.27), ‘never breastfed’ (OR=6.75, 95% CI 1.29-35.31) and ‘older age of
the child’ (OR=3.11, 95% CI 1.42-6.83) were possitively associated with dietary supplement use.
Conclusions: There is a high prevalence of supplement usage in Chinese children in Australia and China.
Because of the unknown effects of many supplements on growth and development and the potential for
adverse drug interactions, parents should exercise caution when giving their infants or young children dietary
supplements. Wherever possible it is preferable to achieve nutrient intakes from a varied diet rather than
from supplements.

Oral 5 (ID319)
Factors Associated with Breastfeeding Duration: A Prospective Cohort Study in Sichuan
Province, China
Li Tang, Colin W. Binns, Andy H. Lee
School of Public Health, Curtin University, Perth, Australia

Background: Breastfeeding is the optimal feeding method for healthy infants and the WHO recommends
breastfeeding for at least two years or longer. The objective of the study was to determine the duration of
breastfeeding and associated factors during the first 12 months postpartum in Sichuan.
Method: A longitudinal study of infant feeding practices was conducted among 695 mothers who delivered
at seven health facilities during 2010-2011 in Jiangyou. Participants were recruited and interviewed before
discharge and were followed up by telephone at 1, 3, 6 and 12 months postpartum. Information on feeding
methods and potential associated factors of breastfeeding duration was obtained using structured
questionnaires. The duration of breastfeeding was estimated by the Kaplan-Meier method. Cox regression
analyses were then performed to identify factors associated with cessation of ‘any breastfeeding’.
Results: The median duration of ‘any breastfeeding’ was 8.0 (95% CI 7.8, 8.2) months. Multivariate analysis
revealed that maternal age (≥ 25 years) (adjusted hazard ratio (aHR) 0.62, 95% CI 0.51, 0.76) and intended
duration of breastfeeding (> 6 months) (aHR 0.71, 95% CI 0.58, 0.86) were associated with breastfeeding
duration for at least 12 months. In addition, women who delivered at township health centres (aHR 0.75,
95% CI 0.60, 0.95), introduced solid foods when the infant was at least 6 months of age (aHR 0.77, 95% CI
0.61, 0.98) and those who returned to work after 6 months postpartum (aHR 0.59, 95% CI 0.46, 0.76) were
less likely to stop breastfeeding before the infant’s first birthday.
Conclusions: The ‘any breastfeeding’ duration in Jiangyou was far below what is recommended. The
advantages of prolonged breastfeeding for at least two years need to be emphasized in the future promotion
strategies in Sichuan. Additional education programs should be provided to working mothers to help them
maintain breastfeeding as long as possible.

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Oral 6 (ID324)
Early Introduction of Complementary Feeding: A Prospective Cohort Study in Sichuan
Province, China
Li Tang, Colin W. Binns, Andy H. Lee
School of Public Health, Curtin University, Perth, Australia

Background: Early introduction of complementary foods prior to 6 months of age may shorten
breastfeeding duration and expose the infant to increased rates of morbidity and mortality. WHO
recommends exclusive breastfeeding to 6 months before complementary foods are commenced. The aims of
the study were to document the ages of complementary foods introduction and to identify the determinants
associated with early introduction of complementary feeding in Sichuan Province.
Method: A prospective study of infant feeding practices was conducted among 695 mothers who delivered
at seven health facilities in Jiangyou during 2010-2011. Participants were recruited and interviewed before
discharge and were followed up by telephone at 1, 3 and 6 months postpartum. Information on
complementary feeding and its potential associated factors was obtained using structured questionnaires. Cox
regression analyses were performed to determine factors related to early introduction of complementary
feeding.
Results: Approximately nine in ten infants in Jiangyou had received complementary foods before 6 months.
The median age to start complementary feeding was 4.5 (95% CI 4.4, 4.6) months. Fruit juice and vegetable
juice were the earliest food introduced, followed by yolk. Mothers who perceived that most of their friends
breastfed (adjusted hazard ratio (aHR) 0.70, 95% CI 0.58, 0.84) and those who returned to work when the
infants were at least 6 months old were less likely to initiate complementary feeding early (aHR 0.73, 95%
CI 0.58, 0.91). On the other hand, infants who had been introduced to infant formula regularly before 6
months of age were at a higher risk of receiving complementary foods prematurely (aHR 1.81, 95% CI 1.42,
2.31).
Conclusions: Introducing complementary foods before 6 months postpartum was widely practised in
Jiangyou. The appropriate age at which to introduce complementary foods and its benefits need to be
emphasized in the future breastfeeding education strategies in Sichuan.

Oral 7(ID868)
Condom and Oral Contraceptive Use and Risk of Cervical Intraepithelial Neoplasia in
Australian Women
HuiJun Chiha, Andy H. Leea, Linda Colvillea, Daniel Xub, Colin W. Binnsa
aSchool of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia
b Department of Medical Education, Faculty of Health Sciences, Curtin University, Perth, Australia

Background: Cervical intraepithelial neoplasia (CIN) is initiated by human papillomavirus (HPV) infection.
Besides vaccination, use of condoms is an effective barrier against HPV infection and may reduce the risk of
CIN among women highly susceptible to HPV infection. Its protective effect needs to be ascertained on other
women. In addition, there is no consensus on the use the consumption of oral contraceptives and the health
of the cervix. Therefore, the present study aims to assess the association between condom use and oral
contraceptive consumption and the risk of CIN.
Methods: A cross-sectional study was conducted in Perth clinics in Western Australia. A total of 348 women
15
responded to the structured questionnaire. Information sought included demographic and lifestyle
characteristics such as the use of condom for contraception, consumption of oral contraceptive, and duration
of oral contraceptive usage. Crude and adjusted odds ratios (OR) and associated 95% confidence intervals
(CI) were calculated using unconditional logistic regression models and reported as estimates of the relative
risk.
Results: The prevalence of CIN was 15.8%. The mean duration of oral contraceptive consumption among
women with CIN was approximately 2.5 years shorter (p = 0.002). Comparing to usage of less than 3 years,
prolonged consumption of oral contraceptive for more than 10 years is associated with a lower risk with the
adjusted OR being 0.17 (95% CI 0.04-0.69). Use of condoms might also reduce CIN risk (p = 0.577).
Conclusions: Despite the relatively small sample size, it is confirmed that use of oral contraceptive is not
associated with an increased risk of CIN. Prolonged use of oral contraceptive demonstrated its benefits and
should not be discontinued without consultation with general practitioners.

Oral 8(ID931)
Learning and Teaching Epidemiology with Audience Response Technology
Philip R. Baker
School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia

Background: The learning and teaching of epidemiology is core to many public health programs. Many
students find the content of epidemiology, and specifically risk of bias assessment, challenging to learn.
Howbeit, learning is enhanced when knowledge is able to be acquired from an active-learning, hands-on
experience.
Methods: The innovative use of wireless audience response technology “clickers” was incorporated into the
lectures of the university’s post-graduate epidemiology units and the tailored epidemiological modules
delivered for professional disciplines (e.g. optometry). Clickers were used to apply several pedagogical
approaches of active learning including peer-instruction and real-world simulation. Students were also
assessed for their gain in knowledge within the lecture (pre-post) and their perceptions of how the use of
clickers helped them learn. The routine university-wide end of semester Insight Survey provided further
information of the student’s satisfaction with the approach.
Results: The technology was useful in identifying deficits of knowledge of key concepts either before or
after instruction. Where key concepts were re-tested post-lecture, as expected, knowledge increased
significantly and provided immediate feed-back to students. Across the lecture series, typically 85% of
students identified the technology helped them learn, increased their opportunity to interact with the lecturer,
and recommend their use for future classes. The Insight Survey report identified 93% of respondents
identified the unit in which clickers were consistently used provided good learning opportunities. Numerous
student comments supported the teaching method.
Conclusions: Epidemiological subject matter lends itself to incorporation of audience response technology.
The use of the technology to facilitate interactive voting provides an instant response and participation of
everyone to enhance the classroom experience. The pedagogical approach increases students’ knowledge and
increases their satisfaction with the unit.

Poster 1 (ID288)
Alcohol Consumption and Health Status of Family Members: Health Impacts Without

16
 Ingestion
Wenbin Liang and Tanya Chikritzhs
National Drug Research Institute, Health Science, Curtin University, Perth, Australia

Background: Over several decades, many cohort studies from the medical epidemiology literature have
observed that compared to abstainers, moderate drinkers experience lower risk for a range of diseases. It was
very difficult to separate the hypothesised physiological protective effect of moderate drinking from its well
correlated confounders in observational study settings.
Method: Poisson regression models of the association between randomly selected key respondent alcohol
consumption and health status of co-habiting family members using data from the 2008, 2009 and 2010
National Health Interview Surveys. Self-reported alcohol consumption of randomly selected key participants
and self-reported health status of adult and child (parent reported) family members living in the same
household were measured and compared.
Results: After controlling for a large range of commonly reported confounders, inverse associations were
evident between light and moderate alcohol consumption of key participants and the prevalence of adverse
health status among their family members, including children.
Conclusions: The superior health status attributed to family members of light and moderate drinkers is
highly likely to be spurious and due to residual confounding rather than physiologically protective effects of
alcohol. Unaccounted for confounding is likely to underpin apparent ‘protective effects’ due to moderate
drinking commonly reported from observational studies of all-cause mortality, heart disease, stroke, and
other chronic diseases.

Poster 2 (ID1008)
A Physical Activity Chart to Reduce Misclassification of Activities by the Global Physical
Activity Questionnaire
Thirunavukkarasu Sathisha,b, Elezebeth Mathewsa
a AchuthaMenon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology,
Thiruvananthapuram, India
b Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash

University, Melbourne, Australia

We hypothesize that measuring the frequency and duration of each activity performed during work, travel
and leisure could reduce misclassification of the levels of physical activity. We developed a physical activity
chart to supplement the Global Physical Activity Questionnaire (GPAQ) and used it during follow-up of a
cohort study among 451 individuals (15-64 years) in rural Kerala, India. In the baseline data (original GPAQ
version), the correlation values between MET (metabolic equivalents task)-minutes/week and body mass
index, waist circumference, systolic and diastolic blood pressure were bi-directional across work, travel and
leisure. In the follow-up data, the correlation was negative for all physical measures in all three domains.
This physical activity chart could reduce misclassification of physical activity.

17
Bangladesh（孟加拉国）

18
Oral 2(ID929)
Masculoskeletal Disorders (MSDs) Among Bangladeshi Type 2 Diabetics Subjects
Palash C. Banika, Manisha Dasb, Sanjida R. Sultanac, MSA Mansur Ahmeda, Liaquat Alid
a Department of Community Medicine, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
b Department of Physiology and Genetic engineering, BIRDEM, Dhaka, Bangladesh

c Department of Physiotherapy, State College of Health Sciences (SCHS), Dhaka, Bangladesh

d Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences (BUHS), Dhaka,

Bangladesh

Background/objective: Musculoskeletal Disorders (MSDs) are common conditions seen in diabetic patients.
It has major cause of morbidity, mortality and hospitalization. But for some unknown reasons, these
problems have been under-discussed in literature. Prevalence of connective tissue disorders varies from
population to population with their profession. Two studies have been conducted in our population five years
ago but present situation is unknown to us. The aims of the study were determining the prevalence of
musculoskeletal disorders and associated factors among the study subjects.
Method: Under a cross-sectional study design a total of 180 type 2 diabetic patients were screened from
BIRDEM hospital in 2013. Data was collected purposively by semi-structured questionnaire and check-list
through face to face interview. Appropriate univariate, bivariate and multivariate analyses were done
accordingly by SPSS software version 16.
Results: The mean (±SD) age of the respondents was 52.6(±11.7) and 55% (n=99) were male. The mean
(±SD) duration of diabetes was 10.5(±7.1). Proportion of musculoskeletal disorder of the study subjects was
77.8% (n=136) whereas 68.6% (n=110) subjects had experienced of muscle pain as well as referred pain,
75% (n=120) subjects had abnormal sensation in various part of their body and 62.5% (n=100) subjects had
experienced of muscle cramp. Mean differences were significant for monthly family income (p<0.001),
systolic blood pressure (p<0.001), diastolic blood pressure (p<0.001), fasting blood sugar (p<0.05) and
random blood sugar (p<0.05) whereas significant difference was found for depression (p<0.001) of the study
subjects, high BMI (p<0.05) and for hypertensive patients (p<0.001). Due to musculoskeletal disorder
62.8% (n=113) had been modified of their lifestyle for activity of daily living (ADL).
Conclusions: Almost eight in every ten diabetic subjects are suffering from musculoskeletal disorders like
pain, abnormal sensation and muscle cramp in their body. Monthly family income, blood pressure, blood
sugar, depression, high body weight and hypertension are the major associated factors for MSDs.

Oral 3(ID980)
Characterization of Areas of Deficient Knowledge About DM Among Type 2 Bangladeshi
Diabetic Subjects Attending A Tertiary Care Hospital
Farida Jasminea, Ferdouse Arab, Farzana Salehb, Pro.Liaquat Alic
a Department of Health promotion and Health Education, Bangladesh University of Health Sciences, Mirpur, Dhaka,
Bangladesh
b Department of Community Nutrition, Bangladesh University of Health Sciences, Mirpur, Dhaka, Bangladesh

c Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences, Mirpur, Dhaka, Bangladesh

Background/objective: Bangladesh has the highest number of diabetic population in the world and
knowledge-based education is the most feasible strategy to prevent diabetes and its complications. The
19
present study aimed to identify the deficient areas of diabetes related knowledge among type 2 DM subjects
and to characterize patients with the lowest levels of knowledge.
Method: Under an observational cross-sectional design 500 type 2 DM subjects (M 58%, F 42%; age
49.4±8.8 years, M±SD) were purposively selected from the OPD of BIRDEM Hospital (the central hospital
of the Diabetic Association of Bangladesh). Data were collected by a pre-designed, pre-tested,
interviewer-administered questionnaire.
Results: Although 81% subjects had fairly good idea about the basic definition of DM, 98% had no correct
knowledge about its risk factors. About 34% subjects did not know the normal fasting blood glucose level.
About 24% subjects had no idea about the principles of dietary management. Virtually all subjects (97%) did
not know about the food exchange system. About 81% subjects had no knowledge about the basic rules of
foot care. The male group (15%) had comparatively less knowledge about the principles of dietary
management compared to female (9%). Occupation played a more consistent role in determining the
area-wise knowledge level with house-wives having very low level in all areas; 27% in basic definition of
DM, 36% in its risk factors, 16% in the normal fasting blood glucose level, 8% in the principles of dietary
management, 36% in food exchange system and 31% in the basic rules of foot care.
Conclusions: Bangladeshi patients with diabetes have some knowledge of DM although the overall
knowledge level is poor. The risk factors of diabetes, monitoring, principles of dietary management, food
exchange system and basic rules of foot care are the commonest deficient areas.
Oral 4(ID1001)
Determinants of Dyslipidemia Among Bangladeshi Type 2 Diabetic Subjects
Jesmin Aktera, Mohammad S. Bukhtb, Kazi R. Ahmedc, Hasina A. Chowdhuryd, Sharmin Hossainc, Md N
Karime
a Department of Reproductive and Child Health, Bangladesh University of Health Sciences, Dhaka, Bangladesh

b BRAC Health Program, BRAC, Dhaka, Bangladesh

c Department of Health Promotion & Health Education, Bangladesh University of Health Sciences Dhaka, Bangladesh

d Department of Biostatistics, Bangladesh University of Health Sciences Dhaka, Bangladesh

e Directorate General of Health Services, Dhaka, Bangladesh

Background/objective: Diabetes Mellitus is associated with a clustering of interrelated plasma lipid and
lipoprotein abnormalities. Dyslipidemia is one of the modifiable risk factors for T2DM. Each of the
dyslipidemic features is associated with an increased risk of cardiovascular disease. The aim of the present
study was to assess the determinants of dyslipidemia among Bangladeshi T2DM patients.
Method: This cross-sectional study addressed the dyslipidemic status of 366 subjects with type 2 diabetes
mellitus (T2DM) attending the outpatient department, BIRDEM diabetic hospital, during the period from
July to December 2010. Physical examination, diabetic profile, lipid profile and serum createnine were
examined. Univariate and multivariate analyses were performed in this study.
Results: About three fourth of the respondents were female and majority (44.5%) of them were in the age
group of 50 to 59 years. Most frequent form (59.3%) of dyslipidemia is low HDL. About half of the
participants had high level of LDL and TG. The mean (±SD) of TC and TG were found 182.1±47.2 mg/dl
and 171.4±66.9 mg/dl respectively. The mean (±SD) of LDL and HDL were 108.9±31.9 mg/dl and 41.8±8.4
mg/dl correspondingly. Men had elevated level of mean TG with wide variation (178.6±65.1 mg/dl) than
women (167.2±67.8 mg/dl). The mean (±SD) of HDL was significantly differed between men and women
(41.3 ± 7.1 vs. 42.1 ± 9.1 mg/dl, p<0.001). Glycemic control in terms of HbA1c >7% appeared as risk factor
of dyslipidemia (P<0.01). Duration of T2DM is associated with increased risk of having higher TC (P<0.05),

20
LDL (P<0.05) and lower HDL (P<0.01) and doesn’t seem to affect triglyceride (P>0.05). T2DM with
co-morbid hypertension seems to be a risk factor of hyper tri-glyceridemia and lower HDL.
Conclusions: The study revealed that uncontrolled glycaemic status, duration of DM and hypertension are
the determinants of dyslipidemia among Bangladeshi T2DM subjects.

Oral 5 (ID1006)
Prevalence of Metabolic Syndrome in Bangladeshi Population: A Comparative Study of
Different Recommendations
Manisha Dasa,b, Zahid Hassanb, Liaquat Alic
a Instituteof Biological Sciences (IBSc), Rajshahi University, Rajshahi Bangladesh
b Dept of Physiology and Molecular Biology, BIRDEM, Dhaka, Bangladesh

c Dept of Biochemistry and Cell Biology, BUHS, Dhaka, Bangladesh

Background/Objective: Metabolic syndrome (MS) is an important public health issue in this 21st century.
Since people are unaware of presence of any metabolic disorder, silently they progress to full-blown disease
and its complications. International and professional bodies have suggested recommendations to define MS
however, heterogeneity regarding phenotypic presentations exist in regards to ethno geographic variations.
The present study was aimed to find out prevalence of MS using criteria by different bodies and chose the
rational criteria for the Bangladeshi population.
Methods: Under a cross-sectional observational design, 1529 [mean±SD of age, male (884) vs female (645),
43.1±9.9 vs 41.8±9.2] apparently healthy subjects (excluding subjects with any known disease) were
recruited through open invitation. Anthropometric and Biochemical parameters were measured using
standard methods. MS was defined using the criteria recommended by IDF, WHO, AHA and NCEP-ATPIII.
Data were analyzed using statistical Package for Social Program (SPSS) for Windows version 17.
Results: The prevalence of MS was 32.6% according to IDF; 37.5% WHO; 30.7% AHA and 31.4%
NCEP-ATPIII. However, the values were 19.6%, 10.9%, 21.8% and 19.0% respectively when with primary
criteria any variables were considered and thus giving rise to confusion about the guidelines and number or
type of variables to be included. Of the total subjects 44.5% and 76.1% had abnormal TG and HDL-c level.
Inclusion of variables like TG and HDL-c possible resulted in the difference in prevalence of MS.
Conclusions: Data concluded that i) prevalence of metabolic syndrome in Bangladeshi population is high; (ii)
The present cut-off value for TG and HDL-c may not be used and need to be redefined.

Poster (ID1016)
Co-existing Hypertension as Independent Risk Factor in Diabetic Retinopathy in Type-2
Diabetes
Kazi R. Ahmeda, Mohammad S. Bukhtb, Jesmin Akterc, Bishwajit Bhowmikd, Md N Karime, Akhtar Hussaind
a Departmentof Health Promotion & Health Education, Bangladesh University of Health Sciences Dhaka, Bangladesh
b BRAC Health Program, BRAC, Dhaka, Bangladesh

c Department of Reproductive and Child Health, Bangladesh University of Health Sciences, Dhaka, Bangladesh

d Department of Community Medicine, University of Oslo, Oslo, Norway

e Directorate General of Health Services, Dhaka, Bangladesh

Background/objective: The risk factors for the development of diabetic retinopathy are duration of diabetes
mellitus, hyperglycemia, hypertension, pregnancy, and serum triglyceride level. Systemic hypertension
21
exacerbates diabetic retinopathy and other coexisting ocular disorders. The aim of the present study was to
assess coexisting hypertension as a risk factor for diabetic retinopathy (DR) in type 2 diabetes mellitus.
Method: A total of 977 type-2 diabetic patients recruited retrospectively in 2008 from Bangladesh Institute
of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM) based on hospital
records for determining the incidence of diabetic retinopathy (DR), who were naı¨ve type-2 diabetes during
1993. At the end of 15 year follow-up 495 patients were diagnosed as DR by retinal colour photography.
Data on diabetes and lipid profile with serum creatinine, blood pressure and biophysical measures were
obtained at baseline, 5, 10 and 15 years follow-up. Binary logistic regression model was used to assess the
associations of co-existing hypertension with retinopathy risk adjusting for clinical, biochemical and
anthropometric variables.
Results: In all three follow-up points, including at baseline, mean systolic and diastolic blood pressure were
found to significantly higher among patients who developed DR (P<.001). Binary logistic regression model
confirmed coexisting hypertension (OR 3.2; 95% CI 2.2 -4.7) as a significant risk factor of DR adjusting for
possible confounders; serum creatinine (OR 21.9; 95% CI 14.0 -35.4) and glycemic control status (OR 17.2;
95% CI 9.4 -31.4). Interaction between hypertension, glycemic control and raised serum creatinine did not
appear to be statistically significant (P>0.05).
Conclusions: Co-existing hypertension is a significant risk factor of DR irrespective of nephropathy or
glycolic control status among Type 2 diabetes mellitus.
Poster (ID1026)
Association of Complications with Disproportionately High Intake of Dietary Carbohydrate
in Bangladeshi Type 2 Diabetic Subjects
Sharmin Hossaina, Jesmin Akterb, Hasina A. Chowdhuryc, Kaniz Fatemad, Liaquat Alie
a Departmentof Health Promotion & Health Education, Bangladesh University of Health Sciences Dhaka, Bangladesh
b Department of Reproductive and Child Health, Bangladesh University of Health Sciences, Dhaka, Bangladesh

c Department of Biostatistics, Bangladesh University of Health Sciences Dhaka, Bangladesh

d Department of Epidemiology, Bangladesh University of Health Sciences Dhaka, Bangladesh

e Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences Dhaka, Bangladesh

Background/objective: Amount and nature of dietary carbohydrates are known to play important roles in
modulating glycemic status among diabetic subjects. The aim of the present study was to investigate the
association of carbohydrate intake with the prevalence of hypertension, diabetic nephropathy and
dyslipidemia in type 2 diabetic subjects.
Method: A total of 2511 type 2 diabetic subjects (823 male and 1688 female), aged 18 years and above,
attending various health centers of the Diabetic Association of Bangladesh, were included in this
observational exploratory study. Data were collected in a pre-structured questionnaire. Logistic regression
analysis was done by taking, in turn, hypertension, nephropathy and dyslipidemia as dependent variables,
and total calorie, carbohydrate, protein, fibre, BMI and waist-hip ratio as independent variables.
Results: Mean age of the subjects was 49.89±12.45. The prevalence of hypertension, nephropathy and
dyslipidemia among the subjects were 25.7%, 2% and 9% respectively. Daily calorie consumption (M±SD)
of subjects was 2559±1014 out of which carbohydrates contributed 67% of the total and, fat and protein were
15% and 18% respectively. Daily carbohydrate intake(g) between hypertensive and non-hypertensive
(375±127 vs 353±125); Nephropathy and Non-nephropathic (349±126 vs 359±126); Dyslipidemic and
Non-dyslipidemic (359±148 vs 358±12) subjects did not differ with each other. On logistic regression
analysis hypertension and diabetes (but not nephropathy or dyslipidemia) were significantly associated
22
(p<0.0001 and p<0.0001 respectively) with higher intake of carbohydrate even when the other confounders
were adjusted.
Conclusions: Disproportionate intake of carbohydrate in Bangladeshi diet may have an association with
diabetes and its complications in this population.

Poster (ID198)
A comparative study on Traditional and Skill Based Health Education on hand washing
among Secondary school children in Bangladesh
Bilkis Banua, Khurshida Khanoma, Liaquat Alib
a Dept of Health Promotion & Health Education, Bangladesh University of Health Sciences
b Dept of Biochemistry and Cell Biology, Bangladesh University of Health Sciences

Background/ objective: Educational intervention through Traditional Health Education (THE) is the usual
practice for promoting hygiene among people. In recent years a relatively demanding and costly technique,
termed as Skill Based Health Education (SBHE), is being generally advocated as a superior method.
Comparative studies between these two methods are relatively rare particularly in developing countries. The
present study was undertaken to test the hypothesis that SBHE is a better method for promoting hand
washing in school going children as compared to the THE.
Method: Under a comparative interventional design two groups of children [n=119 for THE and n=109 for
SBHE], collected from classes VI and VII of two schools in Dhaka city, were given education on hand
washing on a single day by using the respective methods. The study was conducted over a period of 6
months. The components of education included necessity, appropriate timing, materials and techniques of
hand washing. An overall knowledge score was also compiled and data were compared using appropriate
tests between baseline and final values in each group as well as between the two groups at each time points.
Results: Overall knowledge score (percentage) showed significant increase in both the THE (Baseline vs
Final, M±SD, 36±8 vs 74±14, p<0.001) and SBHE (37±9 vs 81±12, p<0.001) groups. SBHE showed a
significantly higher knowledge score (p<0.001) as compared to THE at the final time point. Analysis on
individual components showed a result similar to the overall knowledge score.
Conclusions: SBHE seems to be superior to THE as a short-term interventional tool for promoting health
education on hand washing among secondary school children. The difference between the two methods on
longer term intervention remains to be seen.

Poster 1 (ID1002)
Undiagnosed Diabetes and Dyslipidemia in Bangladeshi Population
Zahid Hassana, Manisha Dasb, Liaquat Alib
aBirdem,
Department of Physiology and Molecular Biology, Birdem, Dhaka, Bangladesh
bBangladesh Institute of Health Sciences, Department of Biochemistry and Cell Biology, Dhaka, Bangladesh

Aims: Due to lack of awareness and routine health check, there is a substantial chance that a large proportion
of people remain undiagnosed for metabolic abnormalities and its consequences. The present study was
undertaken to explore the proportion of subjects with undiagnosed diabetes, impaired glucose regulation
(IGR) and dyslipidemia as well as to explore their determinants in Bangladeshi population.
Methods: Under a cross-sectional observational design, 1303 [mean (±SD) age, 42.2(±9.6)] apparently

23
healthy subjects (excluding subjects with any known disease) were recruited through open invitation from
the Dhaka city. Anthropometric and biochemical parameters were measured using standard methods and
obesity, diabetes and dyslipidemia were defined and classified as per WHO criteria.
Results: Of the subjects Type 2 diabetes mellitus (T2DM) was present in 14.3% [19.2% vs 5.1% in urban vs
rural]. T2DM subjects were significantly older (p<0.001) compared to the Controls. In Controls and T2DM
subjects, 43.4% and 48.6% were obese (judged by BMI). In the two groups, central obesity (by WHR) was
present in 71.9% and 93.8% cases respectively. Hypertriglyceridemia was present in 36.5% and 69.1% of
Controls and T2DM subjects respectively. Similar trend was observed for cholesterol, HDL-c and LDL-c.
On the basis of cut-off levels of all lipid components, 6.7% and 19.3% had dyslipidemia in Controls and
T2DM respectively. However, when any three lipid components were considered, it was 41.2% and 75.1%
respectively. Pearson correlation analysis revealed positive correlation of fasting glucose with age (p<0.001),
WHR (p=0.006), triglyceride (p<0.001), cholesterol (p<0.001) and LDL (p<0.001), and a negative
correlation with HDL (p=0.03). Multinomial regression showed significant association of T2DM subjects
with WHR (p=0.002), triglyceride (p<0.001) and area of residence (p=0.003).
Conclusion: A high proportion of Bangladeshi subjects had undiagnosed T2DM and dyslipidemia whereas
age, central obesity and urbanization are among the major determinants of metabolic abnormalities among
these subjects.

Poster 2 (ID1019)
Determinants of Antenatal Care Utilization in Rural Areas of Bangladesh
Hasina A. Chowdhurya, Md Shahjahanb, Jesmin Akterc, Kazi R. Ahmedd
aDepartment of Biostatistics, Bangladesh University of Health Sciences Dhaka, Bangladesh
b Department of Public Health, Daffodil International University, Dhaka, Bangladesh

c Department of Reproductive and Child Health, Bangladesh University of Health Sciences, Dhaka, Bangladesh

d Department of Health Promotion & Health Education, Bangladesh University of Health Sciences Dhaka, Bangladesh

Background/objective: Utilization of ANC services was low in Bangladesh despite the significant efforts to
maximize its services. The prevalence of received this services among rural mothers is lower than the urban
mothers. The objective of this study was to assess the status of Antenatal care service utilization and
associated factors among rural women.
Method: A total of 360 postnatal mothers were randomly selected from Madhupur upazila of Tangail district
of Bangladesh with a community based cross-sectional study. Both bivariate and multivariate approaches
were used to determine the associated factors for receiving ANC services.
Results: Among the respondents 55.1% had at-least one antenatal care visit during the pregnancy of their
last delivery. In case of accessibility to mass-media, about 83%, 90%, 40% and 54.4% had never read
newspapers, listened to radio, watched television and had no mobile phones respectively. Mothers who had
one living child had the highest percentage of adequate ANC use compared to those who had two or more
living children. Access to mass-media had a positive significant (p<0.001) effect on the use of ANC services.
After adjusting other factors in logistic regression, respondents who had secondary-level education were 4.5
times more likely to use ANC adequately compared to those who had no education.
Conclusions: Lack of awareness, low educational status and socio-economic characteristics are the common
factors observed affecting antenatal care service utilization in the zone.

Poster 3 (ID1078)
24
 Prevalence and Risk Factors of Childhood Overweight and Obesity in Primary School
Children of Dhaka City
Shuhana Sultana
Bangladesh University, Dhaka, Bangladesh

Aims: The aim of the present study is to determine the prevalence of childhood overweight and obesity and
its risk factors in Bangladeshi urban primary school children.
Materials and methods: A cross-sectional study was conducted in primary school children. This study
included 1200 participants (both boys and girls aged 6 to 13 years old) collected by following a simple
random procedure. On the basis of predefined scoring, subjects were classified as underweight, normal,
overweight and obese if their weight-for-height values were within the following ranges of the recommended
median values (<90.99% under weight, 91-110% normal weight, 111-120% overweight and > 120% obese).
Data were analyzed by appropriate univariate as well as multivariate analysis.
Results: The prevalence of overweight was found to be 13.2% (95% CI: 11.33 - 15.17) and obesity 17.8 %
(95% CI: 15.59 - 19.91) among the study subjects. The prevalence of overweight and obesity among boys
were13.6% (95% CI: 10.83 - 16.41), 22.1% (95% CI: 18.69 - 25.45) and among girls these were 12.9% (95%
CI: 10.26 - 15.54) and 13.7% (95% CI: 11 - 16.42), respectively. There were significant difference found in
weight for height (p = 0.015) and weight (p < 0.001) between boys and girls. Mean fat intake of the obese
group was significantly higher in overweight and underweight group (p=0.008). The odds for obesity were
higher for boys than their counterparts. The study showed that associated risk factor for developing obesity
was 1.65 times higher for boys compare to the girls (p=0.003 and CI% 1.19-2-29). The household monthly
income and parents education has a significant risk for obesity, even after being adjusted with, age, income,
parent’s education and physical activities compared to the reference groups. Mean fat intake of the obese
group was significantly higher compared to the overweight and underweight groups (p=0.008). Fat intake
was significantly and positively associated with the children’s weight for height.
Conclusion: The data suggest a high prevalence of overweight and obesity in urban primary school children
in Bangladesh. Positive energy balance with higher fat intake, high income of the family and higher
education level of the parents (probably reflecting higher socioeconomic class) seem to be among the major
underlying factors for the increased prevalence of childhood obesity in this society.

Poster 4(ID1082)
Prevalence of Frozen Shoulder Among Type 2 Diabetic Subjects in Bangladesh Attending
Health Care Centre
Shanawaj Shahina, Palash C. Banikb, Farida Jasminec, Moniruzzamana, Liaquat Alid
a Department of Applied Health Sciences, Bangladesh University of Health Sciences, Dhaka, Bangladesh
b Department of Community Medicine, Bangladesh University of Health Sciences, Dhaka, Bangladesh

c Department of Health promotion and Health Education, Bangladesh University of Health Sciences, Dhaka,

Bangladesh
d Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences, Dhaka, Bangladesh

Background/objective: Frozen shoulder is a major musculoskeletal disorder of the diabetic patients and its
prevalence varies from population to population, but in our population no study has been conducted yet to
determine the prevalence. The aim of the study was to determine the prevalence frozen shoulder among
diabetic patients.
25
Method: Under a cross- sectional study design a total of 320 diabetic patients were screened from BIRDEM
hospital randomly. Data were collected by interviewer administered structured questionnaire and check list.
Appropriate univariat and multivariate analyses were done accordingly by SPSS software version-16.
Results: The mean (±SD) age of the respondents was 49.9(±6.6) years and predominantly female diabetic
patients. The prevalence of frozen shoulder among the respondents was approximately 9% (29/320). The
diabetic patient between the age of 40 to 50 years old tend to be associated with frozen shoulder significantly
more, than those between the age of 51 to 60 years old (χ 2 = 5.770, p=0.016). The primary school completed
patients were particularly prone to develop frozen shoulder, than other level of education of the respondents
(χ2 =18.594, p=0.017). Frozen shoulder was found to be significantly higher in patients who suffering from
diabetes above 10 years, than those who had diabetes below10 years (χ2 = 5.125, p=0.024). The female
gender, homemaker & diabetic patients from urban area are most frequently affected by FS. Diabetic patients
suffer from frozen shoulder due to frequently exposure to certain risk factors such as cardio-vascular
diseases, trauma, subluxation, heavy weight lifting, dislocation, vigorous intensity activities said by the
respondents.
Conclusions: Less than one- third of the diabetic patient develops frozen shoulder and duration of diabetes
& high fasting blood glucose level are the risk factors of developing frozen shoulder in diabetic patients.

26
Brazil（巴西）

27
Oral 1(ID1075)
Reflections of Transport and Mobility in the Quality of Urban Health
Ana Maria Girotti Sperandioa, Beatriz Leme Passos Carvalhob, Erica Passos Baciukc, Vanessa Cristina Cabrelon
Juseviciusd, Luiz José Maria Iriase, Bruna Risquioto Batonif, Thays Cristina Rodrigues Dutraf, Johnny Wallace
Dal’Bó Husch Pereiraf, Alessangela Maria Sorianif, Anelize Sgorlon Pinheiro Torresf, Patrick Pereirag
a Academic Advisor at Faculdade Jaguariúna (FAJ) and MASSUR Project Coordinator, Professor Contributor at the

College of Civil Engineering, Arquitecture and Urbanism at Universidade de Campinas (UNICAMP), Researcher and
Academic Advisor at the Laboratory of Urban Investigations - LABINUR/UNICAMP
b Physical Education Department Chairwoman at Faculdade Jaguariúna (FAJ)

c Physiotherapy Department Chairwoman at Faculdade Jaguariúna (FAJ), Master's Program Staff in Sustainable

Development and Quality of Life at the University Center of the Associated Education Colleges of São João da Boa
Vista - UNIFAE
d Psychology Department Chairwoman at Faculdade Jaguariúna (FAJ) and contributor to the MASSUr Project.

e Contributor to the MASSUr Project

f Undergrad Psychology and MASSUr project student

g Contributor to the MASSUr Project

Background/objective: The MASSUr project (Sustainable Mobility and Accessibility in Urban Health)
from the College in Jaguariúna is an unfolding of the SMART program (Sustainable Mobility &
Accessibility Research & Transformation) from the University of Michigan-UM, which contributes to the
health public policies of mobility and accessibility. The global tendency indicates that in 2030 two thirds of
the world population will be residing in urban areas, therefore contributing to a constant increase of the
vehicle fleet. This increase leads to higher non-communicable disease rates and accident mortality rates. Its
objective is to define, reflect and relate results that deal with improving the quality of urban health in the
MASSUr project.
Method: Through bibliographical research, brainstorming was done linking urban health to pollution, mental
health and non-communicable diseases.
Results: From the data presented, the Massur project established partnerships with local governments,
created and applied two questionnaires about mobility, created a guide of sustainable transportation
initiatives (to be published), and participated in conferences related to the subject.
Conclusion: Traffic safety, air quality, comfort in transportation and travel time, among others, interfere
with the population’s quality of life. Routes done on foot or by bicycles indicate physiological and
psychosocial improvements. Healthy habits may lead to a better cardiopulmonary condition, increased
self-esteem, weight control, socialization and mood. Quality of life is related to physical activity, which
prevents 80% of diabetes and cardiovascular cases and 30% of cancer cases. Yet another connection is that
the utilization of bicycles as a sustainable means of transportation decreased the amount of vehicles, which
also happens when there is a prioritization of public transportation, especially quality ones. With smaller
vehicle fleets, there is less environmental pollution responsible for upper respiratory tract diseases, noise
pollution and traffic jams that cause stress.

28
China（中国）

29
Guest Lecture
Global Health – Challenges and Opportunities for Public Health Education & Research in the
Asia and Pacific
Xinguang Chen, MD. PhD, Professor
Global Health Research Center and School of Public Health, Wuhan University, Wuhan, China
Wayne State University School of Medicine, Detroit, USA

The twenty first century saw the rapid growth in global health. Like the rapid globalization being driven by
the unevenly paced economic development across the globe, the true driving force for global health is the
unevenly paced health development. Typical areas of uneven developments include, but are not limited to,
differences in access to and distribution of health resources, demographic and epidemiological transitions,
mortality and quality of life. Economic globalization has generated many new health challenges, but it
creates ample opportunities to address health issues from a new angle. Despite much debating, global
health can first be considered as a thought and guidance, offering great freedom to tackle significant health
issues anywhere. Global health can further be considered as a branch of cross-disciplinary science to
advance etiological, preventive and therapeutic research by incorporating knowledge, methods and
techniques from all related disciplines. Lastly, global health as an academic division must emphasize
global epidemiology and cross-cultural competency training to produce qualified manpower for global
health.
Great opportunities exist for the Asia-Pacific Countries (APC) to develop global health. APCs as a whole
grow most rapidly in the world with a highly uneven health development. People in APCs face multi-health
challenges, including infectious and non-infectious diseases, and new health problems associated with
economic globalization. Effectively dealing with these challenges requires a global health strategy. APCs are
tightly linked to the rest of the world, particularly Europe and North America where much progress has been
made in global health. Despite controversy over “what global health is”, a number of schools in medical and
health fields offer workshops, formal courses and degree programs on global health. Distance teaching and
e-learning are also emerging. The World Health Organization, for which APCs are long-term players, acts as
a new leader for global health. A number of APCs have also established global health education and research
institutions and programs, including China. The 45th APACPH Conference creates an invaluable opportunity
to exchange thoughts, data and experience in global health teaching, research and practice. Global health is
still in its early stage, and its development depends on all of us, our efforts, creativity and wisdom.

Guest Lecture
Air pollution, Health Outcomes and Possible Mechanism
Tangchun Wu
State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College,
Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China

Non-communicable diseases (NCDs) account for about 80% of death and 70% of disability-adjusted
life-years lost in China, which are related to the changes of environments, lifestyle and diet, and an increase
of life expectancy. There are three main types of pollutions such as air, water and soil pollutions and air
pollution causes the biggest risks of cardiopulmonary diseases such as coronary heart disease (CHD) and
lung cancer, and adverse health such the decrease of heart rate variability (HRV) and the increase of
micronuclei frequency. Lifestyle and diet changes, environmental pollution and their interaction with
30
genetics or epigenetic are involved in the process of NCDs and adverse heath’s epidemic. It is the major
scientific challenge for the next few decades to understand the interaction between genetic susceptibility and
environments (metals, polycyclic aromatic hydrocarbons (PAHs) in the etiology and potent mechanism in
such cardiopulmonary diseases and such early damages as genetic damage, HRV. PAHs are the main
products of air pollutions produced during incomplete combustion of natural or synthetic fuels and are very
common carcinogens in our living environments. Long-term exposure to PAHs by air and food had been
reported to be associated with high DNA damage, high incidence of lung cancer and CHDs. Here, we firstly
present that many results from our previous studies show that there is a individual difference in plasma,
lymphocyte Hsp70 levels and that levels of Hsp70, Hsp27 and their genetic variations in lymphocytes is
negatively correlated with the level of genotoxic damage, which suggest that the difference of Hsp70 levels
may contribute to the susceptibility of DNA damage in the workers exposed to similar concentrations of
PAHs by external and internal exposures. Secondly, we present new results about the possible role (risk and
prognosis) of genetic variations in hsp genes and their corresponding expressions in patients with lung cancer,
CHD and discuss the possible mechanism. Finally, we will present the data about elder cohort for studying
environments, genes and their interaction and for future cooperation. This was supported by the funds from
NSFC (30872092) and 973 program (2011CB503800).

Guest Lecture
Zhijie Zheng Ph.D.
Professor, Dean of School of Public Health, Shanghai Jiaotong University. Dr. Zheng is an expert of
epidemiology in NIH, dean and coordinator in Project of Global Health.
Dr. Zheng will give a lecture at Chronic Non-Communicable Disease on October 27, 2013.

Oral 1(ID152)
The Relationship Between Lifestyle and Gestational Diabetes Mellitus
Rongxian Xua, Weiqin Wanga, Jinhua Jiea, Li Xionga, Jian Lic, Colin Binnsb
a School of Public Health, Fujian Medical University, China

b School of Public Health, Curtin University, China

c Maternal & Child Hospital, Xiamen,China

Objective: To study associations between lifestyle, prenatal care, dietary patterns and gestational diabetes
mellitus in Xiamen mothers, and to provide references to and prevention of adverse obstetric outcome of
pregnant women.
Methods: A prospective cohort study of second trimester women attending for prenatal care in Xiamen City,
Maternal and Child Health outpatient department. Mothers were randomly recruited between January 2009
and October 2010. Women were asked to complete questionnaires which included questions on lifestyle and
dietary history. Obstetric examination results and birth outcomes were tracked and recorded. Dietary patterns
were analysed using using principal component analysis. Potential risk factors of gestational diabetes
mellitus were analyzed with logistic regression.
Results: A total of 1009 questionnaires were completed, but 113(11.2%) of the mothers were lost to
followup before delivery. The non-conditional logistic analysis showed that age (P <0.001), pre-pregnancy
body mass index (P = 0.001), systolic blood pressure (P = 0.034), number of pregnancies (P = 0.037) were
associated with gestational diabetes. Physical activity (P = 0.018) during pregnancy has a protective effect on
the occurrence of gestational diabetes. It was also found in the study that gestational diabetes mellitus is
31
associated with oligohydramnios (P=0.021), placenta praevia (P ＜0.001) and postpartum hemorrhage
(P=0.026). No significant association was found between dietary patterns and gestational diabetes.
Conclusion: Gestational diabetes is increasing in prevalence in China and other Asian countries and further
studies are needed to understand the best strategies for prevention.

Oral 2 (ID194)
A Time-stratified Case-crossover Study of Flooding and Waterlogging and Number of Cases
of Malaria in Mengcheng County, China
GuoyongDinga,b, Lu Gaoa, BaofaJianga
aDepartment of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan City,
P.R.China
bDepartment of Occupational and Environmental Health, School of Public Health, Taishan Medical College, Taian City,

P.R.China

Background: Malaria is a highly climate-sensitive vector-borne infectious disease that still represents a
significant public health problem in some subtropical regions. However, little comprehensive information
about burden of malaria caused by the flooding and waterlogging is available from subtropics. In late June
and July 2007, the persistent and heavy rainfall in the Huaihe River Basin caused several floods or
waterlogging. It was the largest floods since the 1954 Huaihe River floods in this region. This study aims to
quantitatively assess impact of the flooding and waterlogging on malaria in a subtropical area, China.
Methods: Mengcheng County, one of the worst hit areas, was selected asour study area.A time- stratified
case-crossover study was performed to evaluate the relationship between daily cases of malaria and the
flooding and waterlogging from June to August 2007. Lagged effects were explored by univariate
conditional logistic regression models. Odds ratios (ORs) of the flooding and waterlogging risk were
quantified by multivariate conditional logistic regression.
Results: A total of 2398 malaria were notified during the study period in Mengcheng County. The strongest
effect was shown with a 26-day lag (OR=3.618, 95% CI: 3.110-4.210) in the flooding and a 6-day lag
(OR=2.588, 95% CI: 2.238-2.993) in the waterlogging. Multivariable analysis showed that the risk of
malaria was significantly associated with the two meteorological disasters (OR=1.457, 95% CI: 1.204-1.762
in the flooding; OR=1.550, 95% CI: 1.307-1.838 in the waterlogging).
Conclusions: Our findings firstly confirm that flooding and waterlogging in the study area contribute to
unusually high incidence of malaria. In addition, risk of malaria caused by waterlogging is greater than that
by flooding. Therefore effective preventive and treatment interventions should be developed to avoid and
control a potential risk of an outbreak of malaria in exposure effect-period of the two disasters. (Funded by
China 973 Program: 2012CB955502)

Oral 3(ID196)
Contraceptive Use and Impact Factors Among Reproductive-age Women Seeking Abortions
in Southeast of China: A Hospital-based Study
Xiangjing Song a, Rong Liao a, Jie Zhou b, c, Hanfeng Ye a, Xiaodong Tan b, Xuyang Pan a, Ruiyu Peng a,
Zhuojun Zhou d
a Yunnan Institute of Population and Family Planning Research, Kunming, China

b School of Public Health, Wuhan University, Wuhan, China

32
 c Kunming Medical University, Kunming, China
d Maria Hposital, Kunming, China

Background: In China, it was estimated that the number of abortions reached 13 million cases in 2011.
Meanwhile, one third of these women had the history of abortion. Repeated medical abortions extremely
harm women`s health.
Objective: To determine the situation of contraceptive use and impact factors among reproductive-age
women seeking abortion in Kunming which was in the southwest of China in order to provide information
for improving contraceptive use.
Methods: A hospital-based study was conducted among 397 women of reproductive age, seeking abortion in
hospitals of different levels in Kunming from June 2011 to December, 2011. They were face to face
interviewed by the trained investigators with the questionnaires.
Results: Among 397 women, there were 229 cases (57.68%) which had experienced induced abortion and
the median times of induced abortion was 1(0-2). Abortion account for 61.71% of married women, and
unmarried accounted for 39.29%. About 36.27% never used any contraceptives, and only 21.41% of
respondents used contraceptives at every intercourse. The mainly contraceptive before this pregnancy was
condom (68.90%). The use of contraceptives was mainly decided by couple (73.35%). The main reasons for
contraceptive nonuse or discrete use including “thought occasional sex could not result in pregnancy
(47.98%)”, the side effect (9.09%) and partner refused (5.05%). The average score of contraceptive
knowledge was only 75.00±15.13 points (100-point scale) among all women. The scores of contraceptive
knowledge achieved no significance between married and unmarried women (P=0.542). Multivariate logistic
regression analysis indicated that respondents` age, educational level and access to the contraceptives in
hospital were associated with the use of contraceptive.
Conclusions: Both the low rate of contraception and the misunderstanding for the use of contraception are
the main reasons for induced abortion. Fewer reproductive-age women seeking abortion use contraceptives.
It is necessary to increase their awareness of contraception and abortion related knowledge, provide feasible
contraceptive to enable women to avoid unwilling pregnancy. Further more, it is important to promote male
involvement in contraception.

Oral 4(ID209)
Soy Isoflavone Protect Learning and Memory Ability of Rats Through Alleviating the
Cerebrovascular Damage Induced by β-amyloid
YuanD. Xia, XiaoY. Lib, Juan Dinga, RongXiaoa
aSchoolof Public Health, Capital Medical University, Beijing P.R.China
bXuanwu Hospital, Capital Medical University, Beijing P.R.China

Objective: The neuroprotective properties of soy isoflavone (SIF) have been demonstrated by our previous
studies and others, but its potential mechanism is not clear. Because of the key role of neurovascular
dysfunction in the pathogenesis of Alzheimer's disease (AD), we hypothesized neurovascular tissue might be
one neuroprotective target of SIF.
Methods: In the present study, learning and memory ability, β-amyloid (Aβ) expressions both in
neurovascular tissue and plasma, the receptor for advanced glycation end products (RAGE), low-density
lipoprotein receptor-related protein (LRP)-1, nuclear factor-κB p65 (NF-κB p65), tumor necrosis factor-α
(TNF-α) and interleukin-1β (IL-1β) expressions in neurovascular tissue were measured in Wistar rats
33
following lateral cerebral ventricle administration of Aβ1-42 by miniosmotic pump with or without
intragastric administration of SIF from 14 days before surgery to the end of experiment.
Results: The results showed that SIF could improve the impairment of learning and memory of rats induced
by Aβ1-42, maintain Aβ homeostasis in brain, regulate the disordered expressions of RAGE/LRP-1 and
restrain RAGE related NF-κB and inflammatory cytokines activation in neurovascular structure.
Conclusion: These results suggested that SIF could protect Aβ-impaired learning and memory in rats, and its
mechanism might be associated with the regulation of vascular Aβ transportation and vascular inflammatory
reaction.

Oral 5(ID258)
Risk Factors for HIV Infection in MSM: A Cross-sectional Study in Central China
Ying Wang, Xiao-Dong Tan
School of Public Health, Wuhan University, Wuhan, China

Backgrounds: Men who have sex with men (MSM) are at high risk of human immunodeficiency virus
(HIV)/acquired immunodeficiency syndrome (AIDS) transmission because of risk behaviors such as multiple
partners and unprotected anal intercourse. The major purpose of this study was to identify the risk factors for
HIV infection among MSM in Wuhan City of central China.
Methods: Based on a cross-sectional study, 898 objects recruited from homosexual bar accepted anonymous
investigation.
Results: Of the 898 objects enrolled, 73.7% identified themselves as gay, and the majority of subjects had
AIDS-related knowledge. 2.6% used psychotropic drugs, 15.2% developed symptoms of sexually-
transmitted diseases (STD), and 58.9% received STD/AIDS-associated interventions. 70.3% had one or more
same-sex couples. The rate of use of condoms was 59.8% and 14.8% during anal and oral sex. 9.8% had
group sex, and the percentage of use of condoms was 71.2% during the last group sex.
Conclusion: It is concluded that AIDS-associated risk behaviors are commonly present in MSM.

Oral 7(ID280)
A Survey of Brain Fitness Products Consumption Practices Among High School Students
Yonghong Mana,b, Dongxian Zhangb, Wei Zhangb, Weina Wanga,b, Shipeng Xueb, Yan Zhaoa,b, Libin Fengb,
Fangfang Lib , Yongyi Bia
a School of Public Health and Wuhan University, Wuhan, China

b Nanyang Medical College, Nanyang, China

Background/objective: Commercial marketing aimed at promoting the purchase of brain fitness products by
high school students, and by parents for children, is ubiquitous in China and has been associated with
negative health consequences such as adverse drug reactions. The aim of this study was to explore the
prevalence of brain fitness products consumption among senior three high school students selected from
first-class senior high schools in Nanyang. The study assessed the brain fitness products consumption
patterns, types usually consumed, frequency of consumption and reasons why such brain fitness products
were consumed.
Method: A total number of one thousand and eighteen senior three high school students gave their consent to
participate in the study and completed a questionnaire which was administered during the recess.
34
Results: Most of the participants (67.1%) reported consuming at least one brand of brain fitness products in
a week. A high proportion (48.2%) of the respondents who consumed brain fitness products indicated that
they did so to relieve mental fatigue during studying. Other reasons given as to why brain fitness products
were consumed by the study participants included to enhance memory (31.3%), to improve sleep (13.8%)
and to provide psychological suggestion (6.7%).
Conclusion: These results suggest that greater emphasis needs to be placed on increasing sustained brain
health education programmes which may defend against significant misconception regarding the benefits of
brain fitness products among high school students and their parents and also create awareness among kid and
parent with the side effects of excessive consumption of such products.

Oral 8(ID301)
Study on the Protective Effect of Lycium Babarum Polysaccharides on Human Glomerular
Mesangial Cells in High Glucose
Xu Zhang, Qiong Luo, Wei Tang, Jun Yan
Public Health School of Wuhan University, China

Background: Diabetic nephropathy (DN) is one of the most severe complications of diabetes. Many
discoveries have been made to demonstrate the central role of hyperglycemia in the progression of
microangiopathy through oxidative stress reaction, activate PKC and activate cell signaling pathways which
promote cytokine production. Cytokines like TGF-β1, VEGFR-2, IGF-1 and fibronectin (FN) may contribute
to the process of glomerular thickening.
There are many bioactive functions in the functional substance of wolfberry, Lycium barbarum
polysaccharides (LBP), like oxidation resistance, hypoglycemic, etc. But the mechanisms of protective effect
of LBP on glomerular mesangial cell are still unclear. The study is to explore LBP’s intervention effect on
mesangial cells in proliferation , generation of ROS , activation of PKC and the expression of TGFβ1,
VEGFR2, IGF-1, FN ,in high glucose environment, Aiming to provide theoretical basis for prevention and
treatment on diabetic nephropathy.
Methods: Culture human Mesangial cells and divide it into six groups: control, normal glucose, high glucose,
LBP with different concentration (200 mg/L, 400 mg/L, 800 mg/L). And culture for 48h. Test cell growth by
trypan blue stain assay. Measure proliferation by MTT colorimetric method, intracellular ROS by
fluorometric assay, and the concentration of PKC by ELISA. The expression of TGFβ1, VEGFR-2, IGF-1,
FN were detected by immunocytochemistry.
Result: The proliferation of the groups of LBP was lower than the high glucose group (P< 0.05). The OD
values of LBP groups are lower than high glucose group (P<0.05). The PKC and ROS is decreased in high
glucose on cells.
TGFβ1, VEGFR2, IGF-1 and FN express less in LBP groups (P<0.05), and the medium concentration is
optimal.
Conclution: LBP can protect the cellular damage caused by high glucose for LBP could inhibit the growth
of the cells and reduce TGFβ1, VEGFR2, IGF-1 and FN express.

Oral 10(ID365)
Are There Associations Between Lifestyle Behaviors and Quality of Life in Cancer Survivors?

35
 Xiao-huan Gonga, Ji-wei Wanga, Xue-fen Chena, Chang-hong Shia, Li Suna, Qing-yun Zhanga, Zheng-nian Luob,
Jing-rong Gaoc, Li-Qiang Zhangc, Zheng-ping Yuand , Jin-ming Yua
a Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety of Ministry of Education, School of Public

Health, Fudan University, Shanghai, China

b Shanghai Health Education Association, Shanghai, China

c Shanghai Health Education Institute, Shanghai, China

d Shanghai Cancer Rehabilitation Club, Shanghai, China

Background: Due to the worldwide increasing incidence and survival rate of cancer, more cancer survivors
face long-term challenges brought by cancer diagnosis and treatment. Unhealthy lifestyle behaviors increase
the risk for recurrence and may affect cancer survivors’ quality of life. This study was to identify the
relationship between lifestyle behaviors and quality of life in cancer survivors.
Methods: A cross-sectional study was conducted among cancer survivors between April and May 2013, in
Shanghai, China. Cancer survivors were randomly sampled from community cancer rehabilitation
organizations. Data was collected using a questionnaire developed specifically for this study, which included
questions about cancer survival and health behaviors, EORTC QLQ-C30 Simplified Chinese version and
FACT-G Simplified Chinese version. Quality of life scores were compared between different lifestyle
behaviors.
Results: 998 cancer survivors were analyzed with mean age of 60.41 years (SD=9.02). Cancer survivors
who exercised in the past month reported higher EORTC physical function subscores (±4.42,
95%CI=1.50-7.33, P=0.0032), EORTC emotional function subscores (±3.41, 95%CI=0.27-6.56, P=0.0337),
EORTC cognitive function subscores (±4.38, 95%CI=0.42-8.34, P=0.0304), EORTC global health subscores
(±8.24, 95%CI=3.83-12.65, P=0.0003), FACT-G functional well-being subscores(±1.39, 95%CI=0.18-2.60,
P=0.0240), and FACT-G total scores(±3.92, 95%CI=1.07-6.77, P=0.0071). Cancer survivors who ate more
vegetables were more likely to report higher FACT-G social well-being subscores (P=0.0151), FACT-G
functional well-being subscores (P=0.0025), and FACT-G total socres (P=0.0071). No significant differences
were observed when comparing scores between different fruit intakes.
Conclusions: There are active associations between lifestyle behaviors and quality of life in cancer survivors.
Healthy lifestyle behaviors, including engagement in exercise and proper diet should be valued in improving
quality of life in cancer survivors.

Oral 11(ID411)
Tooth Brushing Practices and Related Factors Among 4th and 5th Grade Students of Migrant
Schools in Shanghai
Qun Wang, Hui-Jing Shi, Xiao-Xiao Jiang, Zhe Zhang, Bo-Lin Zhang
School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai,
China

Background: Health promotion of oral hygienic practices such as tooth brushing among migrant children is
of public health priority. The purpose of this study was to investigate the tooth brushing practices and related
factors among 4th and 5th grade primary students of migrant schools in Shanghai.
Methods: In 2011, 2,995 participants of 4th and 5th grade students were selected form 9 migrant schools
located in Jiading and Baoshan districts in Shanghai by using multi-stage cluster sampling. Self-administered
questionnaire was used to collect participants’ habitual tooth brushing practices and related factors including

36
social-demographic characteristics, knowledge of oral health, perceived severity of dental caries, perceived
barriers to tooth brushing, self-efficacy and social cues to tooth brushing, based on Health Belief Model.
Appropriate way of tooth brushing was defined as tooth brushing at least twice a day by vertical and
horizontal brushing for at least 2 minutes suggested by scientific evidence.
Results: The mean age of participants was 10.5±1.2 years old, with 58.2% being male, 76.6% living with
siblings, 53.8% residing in Shanghai since school entrance. 975 participants (32.8%) were found to have an
appropriate way of tooth brushing, and the rates were significantly higher among groups of 5th grade, girls,
who had higher expectation from parents or themselves. After controlling potential confounders, independent
associations were found between perceived barriers, self-efficacy, and social cuing and the appropriate
brushing habit, with adjusted ORs (95%CI) being 1.47(1.21-1.78), 1.36 (1.12-1.64), and 1.82 (1.51-2.20),
respectively. Whereas, no statistically significant association was found for knowledge about oral health care
and perceived severity of dental caries.
Conclusions: The way of teeth brushing among most migrant children does not meet the recommendations.
Further oral health behavior intervention among migrant children should take social-demographics,
perceived barriers, self-efficacy, and social cues into account apart from basic knowledge education about
oral health.

Oral 12(ID417)
Breastfeeding Methods Before 6 Month and Child Development Zhejiang Province, China
Liqian Qiua, Yuanying Maa, Weiwei Wua, Meiyun Chenb, Lei Jinb
a Women’s Hospital, School of Medicine Zhejiang University, Hangzhou, China
b The Women’s Federation of Zhejiang Province, Hangzhou, China

Background: WHO recommends exclusive breastfeeding for six month and then continue to breastfeeding
plus complementary food till 2 years old. This infant feeding model could prevent infant infection disease
like pneumonia and diarrhea, also avoid child even adult obesity and diabetes. China National Program of
Action for Child Development in China (2011-2020) requested exclusive breastfeeding rate should be 50%
in the 6 month of baby. But previous survey found that 6 month exclusive breastfeeding rate was less than
10%. Big gap existed for infant feeding situation.
Methods: 2000 questionnaires designing by Women’s Hospital, Zhejiang University were distributed in
kindergartens. The kindergartens are located in 11 districts of province. After training by local health workers
mothers who had 3-4 years old children filled the questionnaire. Total 1277 qualified questionnaires were
completed. The survey contents include parent general information, breastfeeding methods in the first 6
month, child health and development.
Results: The average age of child is 37.15±6.11month, 39.9% (509) mothers could exclusive breastfeeding
till 6 month. 79.3% mothers exclusive breastfeeding in the first month. Elder and having higher education
mothers are more likely formula feeding their babies. Baby which had exclusive breastfeeding within 6
month had fewer incidences of respiratory disease, diarrhea and being in hospital. Comparing child
development exclusive breastfeeding boy average weight is 14.4 Kg in 30 months and is significant lower
then non-exclusive breastfeeding boy which is average weight 15.7 Kg. But no much weight difference was
found in girl and also no much difference is found for height either in boy and girl.
Conclusions: exclusive breastfeeding within 6 month play important roles for child health in their early life.
It has a lot of benefits for preventing respiratory and gastrointestinal diseases and also for controlling child
overweight.
37
Oral 13(ID419)
Effect of A School-based Nutritional and Oral Health Promotion Program on Students of
Migrant Schools in Shanghai: A 2-year Quasi-experimental Study
Hui-Jing Shi, Qun Wang, Xiao-Xiao Jiang, Bo-Lin Zhang, Zhe Zhang
School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai,
China

Background/Objectives: Schools are perhaps the best setting for promoting migrant children's healthy
eating behavior and oral hygienic practices. The purpose of this study was to investigate whether a
school-based intervention program can improve dietary and oral behaviors of migrant school children in
Shanghai.
Methods: A 2-year school-based intervention program on nutrition and oral health named “Happy Children”
was initiated in all 15 migrant schools in 1 district of Shanghai in 2011 by using strategies of WHO
health-Promoting School. Meanwhile, migrant schools in another socioeconomiccomparabledistrictreceived
no intervention and served as the control group. By using multi-stage cluster sampling, 2019 and 981 4th-5th
grade studentswere surveyed by self-administered questionnaire at baseline in the intervention group and
control group respectively, and 1152 and 1049 subjects of the same grade after 2-year trial respectively. The
effects of the intervention on dietary and oral health related behaviors were evaluated while adjusting for
potential confounders.
Results: After 2 years intervention, self-reported rates of eating breakfast increased significantly from 65.8%
to 77.5% in the intervention group (aOR=1.83, 1.54-2.19), and 65.2% to 68.2% in the control group
(aOR=1.14, 0.93-1.39). Frequencies of fruit (aOR=1.42, 1.22-1.65) and vegetables (aOR=1.65, 1.42-1.92)
consumption were significantly increased, and frequencies of carbonated sweet beverage (aOR=0.70,
0.59-0.82) and fried food (aOR=0.49, 0.40-0.61) were significantly decreased in intervention group, while
such significant improvement was not seen in the control group. And, a higher proportion ofsubjects in the
intervention group had learnt tobrush their teeth by using vertical and horizontal techniques for at least 2
minutes than those in the control group.
Conclusion: Promising results are seen when the dietary and oral health were the targets of health promotion
for migrant schools in metropolitan Shanghai. Sustainability of the program should be examined in future
study.

Oral 14(ID447)
The Short-term Effects of Particulate Matter on Lung Function of College Students in
Autumn and Winter in Wuhan
Yun-quan Zhanga, Lu Maa, Jiao-yuan Lia, Masayuki Shimab, Kenji Amurac
a School of Public Health of Wuhan University, Wuhan, China

b Department of Public Health, Hyogo College of Medicine, Japan

c National Institute for Environmental Studies, Japan

Objective: To evaluate the effects of indoor and outdoor PM2.5 on lung function of college students in
autumn and winter in Wuhan.
Methods: In this panel study,37 college students (excluded subject of respiratory disease and smoking
history) aged 19-21 were investigated by cluster sampling in a university in Wuhan. The follow-up study
38
lasted for 28 days in total, including 14 days of autumn and winter in 2009 respectively, the peak expiratory
flow(PEF) of the college students were measured daily in the morning and evening in the university. The
effects of PM on lung function were analyzed by using generalized estimating equation (GEE).
Results: Average daily concentrations of indoor, outdoor PM2.5 in autumn were (91.3±43.7) and
(104.2±49.4)μg/m3 respectively, while in winter that were (110.6±42.3) and (143.5±51.2)μg/m3. The single
pollutant model showed that in winter, the evening PEF decrement was significantly associated with
increasing outdoor PM2.5. With an increase of 10μg/m3 outdoor PM2.5, the PEF measured in the evening
decreased 1.27L/min (95%CI:0.02—2.52L/min).Meanwhile, the results showed that 2-days lagged outdoor
PM2.5 was also significantly associated with morning PEF. An increase of 10μg/m3 2-days lagged outdoor
PM2.5 caused the decrease of 1.82L/min (95%CI:-3.53—0.11L/min) of PEF measured in the morning.
Controlling the influence of gaseous pollutants and building the two pollutants models, the results indicated
that no significant changes of PEF of students being exposed to PM2.5 on same day (lag 0) were observed.
However, under consideration of SO2 effect, significant association between an increase of 10μg/m 3 2-days
lagged outdoor PM2.5 and changes of morning PEF (-1.81L/mnin, 95%CI:-3.51—0.11L/min, P=0.037) was
found. The relationship between changes of concentrations and PEF was not observed in autumn in this
study.
Conclusion: In our panel study, exposure to outdoor PM2.5 is significantly associated with PEF among
college students in winter, but not in autumn.

Oral 15(ID451)
Implementation of National Essential Medicines Policy and Its Influencing Factors in China:
A Cross-sectional Study of Township Health Centres
Lianping Yang, Yuqing Tang, Xinping Zhang
School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and
Technology, Wuhan, China

Background: Access to affordable essential medicines in developing countries is one of the Millennium
Development Goals. This study evaluated the current situation of primary care institutions regarding to the
goals of the China’s National Essential Medicines Policy (NEMP).
Methods: A systematic sampling strategy was employed to select 90 township health centres (THC)
covering six provinces of China. A questionnaire was designed to collect data of eight core NEMP indicators
and institutional characteristics for the period of January to September 2011. Overall, 9000 prescriptions
were selected systematically to analyze. An exploratory factor analysis and multivariate regression models
were performed in statistics analysis.
Results: An average of 193 national essential medicines (X1) and 85 provincial essential medicines (X2)
were available. About 26.84 Yuan and 592.58 Yuan for medicines were charged for per visit of outpatient
(X3) and inpatient (X4), respectively. The average expense per prescription (X5) was 33.38 Yuan. Some
38.23% prescriptions required injections (X6); 21.96% contained two or more antibiotics (X7); and 11.42%
contained hormone (X8). The factor analysis extracted three factors, reflecting “availability” (loading:
X1=0.812, X2=0.795), “affordability” (loading: X3=0.888, X4=0.787, X5=0.777), and “rational use”
(loading: X6=0.837, X7=0.517, X8=0.755). The total factor scores differentiated the THCs effectively (from
-0.981 to 2.983), which was negatively associated with the number of medical workers (p = 0.029) and
positively associated with the number of outpatient visits (p = 0.003). Further regression analyses showed

39
that the number of outpatient visits was associated with better affordability and rational use of medicines.
The longer a THC implemented the NEMP, the more likely it performed better in rational use. Higher
income of doctors was associated with rational use of medicines and poor availability.
Conclusions: The NEMP is a complex system, encompassing availability, affordability and rational use of
medicines. Institutional-level structural and managerial measures are associated with the achievements of the
NEMP goals, but not always in a consistent way.

Oral 16(ID458)
Research on the Economic Evaluation Method of Standard-Unit-Epidemic-Disease
Shibing You, Lili Bao, Zhenghua Su
Economics and Management school, Wuhan University, Wuhan, China

Background: The outbreak of major diseases such as avian influenza and H7N9 not only bring certain
economic losses to economic and social development, but also give threats to ecological environment, public
health security as well as human health, they affect the overall economic income directly and indirectly
through a variety of ways. Therefore, it is of great significance to conduct economic evaluation to the loss
caused by the outbreak of epidemic and understand its possible impact.
Method: Based on the research results of avian influenza, this paper proposes the economic loss evaluation
method of standard-unit-epidemic-disease (SUED) and determines the economic loss content of the standard
regions and areas to be evaluated; it also tries to elicit the concept of disease-degree-coefficient (DDC) so as
to provide a reference for the epidemic areas to evaluate the economic losses quickly.
Results: It builds a standard-unit-epidemic-disease (SUED) evaluation system from the loss of life,
production and operation, traffic and Environmental Governance for the standard area, and establishes the
avian influenza risk loss evaluation framework which consists of evaluation indicator system and
disease-degree-coefficient (DDC).
Conclusions: The theme of this paper is Methodology study. Based on the research results of avian influenza,
it uses economic evaluation method standard-unit-epidemic-disease (SUED) to realize the risk loss
evaluation of bird flu. The focus and difficulty of this method lies in the choice and computation of indicators
and the analysis to disease-degree-coefficient (DDC). It is not only able to analyze the epidemic loss of the
same category in different areas, but can also calculate the loss of different epidemic categories, it can play a
role in the regional epidemic loss evaluation.

Oral 17(ID475)
Sodium Ferulate Inhibits High-fat Diet-induced Inflammatory Factors Expression in Human
Umbilical Vein Endothelial Cells
Junliang Taoa,b, Dongxian Zhangb, Yonghong Manb, Weina Wanga,b, Shipeng Xueb, Yongyi Bia
a School of Public Health and Wuhan University, Wuhan, China

b Nanyang Medical College, Nanyang, China

Background/objective: Vascular inflammation plays a crucial role in atherosclerosis development caused by

high-fat diet. Oxidized low-density lipoprotein (ox-LDL) is a key initiator of inflammatory processes as it
activates vascular endothelial cells to induce inflammatory genes expression. Sodium ferulate (SF), an
effective component from Chinese medicines, was reported to have potential anti-atherosclerotic activity.

40
However, the mechanism of SF on the prevention of atherosclerosis is still unclear. Here, we evaluated the
effects of SF on cellular gene expression profile, atherosclerosis-related inflammatory factors mRNA and
protein expressions in ox-LDL stimulated-endothelial cells. As a possible alternative mechanism, we also
investigated SF’s effect on transcription factor NF-κB (nuclear factor κB) activation.
Method: Cultured human umbilical vein endothelial cells were treated with ox-LDL (50µg/ml) in the
absence or presence of SF (5μM). Cellular gene expression profile, inflammatory genes expression,
inflammatory factors production and NF-κB activation were studied. Ox-LDL incubation led to increased
gene and protein expressions of inflammatory factors, including IL-1β, CCL20, IL-6, IL-8 and CXCL1. SF
treatment prevented ox-LDL-induced increases in inflammatory factors expressions. Meanwhile, SF
treatment significantly suppressed the ox-LDL-induced translocation and activation of NF-κB.
Results and Conclusion: Collectively, SF appears to be able to suppress inflammatory factors expression in
ox-LDL-stimulated endothelial cells, and transcription factor NF-κB may be involved in such process.

Oral 18(ID476)
Factors Influencing the Health of Employees in the Furniture Market
Dongxian Zhangb, Junliang Taoa,b, Yonghong Manb, Weina Wanga,b, Shipeng Xueb, Yongyi Bia
a School of Public Health and Wuhan University, Wuhan, China

b Nanyang Medical College, Nanyang, China

Background: To master status of indoor air pollution and impact factors of pollution furniture market,
understand factors influencing the health of employees in the furniture market, analyze the occupational
health risk factors of employees and discuss the effective preventive measures to reduce the occurrence of
occupational hazards.
Method: Indoor air quality was determined by standard method. Self-designed questionnaire were conducted
in on-site investigations, all the results were imputed in Excel 2003 database and data were analyzed by
SPSS13.0 software. The Data of knowledge, attitude, behavior and health status levels were measured
according to the actual number of scores. Classification of information was described by the frequency, rate
or constituent ratio and χ2 test was used. Measurement data was described by using mean, standard deviation,
and maximum, minimum impacting the health status were analyzed by multiple linear stepwise regression
analysis.
Results: The major indoor air pollutants in the furniture market was formaldehyde in the city, which in
winter and summer are 0.58 and 4.17 times higher than average health standards in public places respectively.
The maximum are 14.25 and 4.67 times higher than hygiene standards in public places respectively, the rate
exceeded standard were 76.19% and 92.47%. The indoor formaldehyde concentration in summer was
significantly higher than in winter due to the temperature. Practitioners in the furniture market lacked the
knowledge of occupational health, whose average score was 44.9±12.87. Average score of practitioners who
have relatively positive attitude towards occupational health was 69.5±12.24. Average score of practitioners
who have the low rate of occupational health behavior was 34.1±11.15. And there were significant difference
in various types of scoring in terms of age, education, residence, personal income and the number of years in
this career. Occupational health status of practitioners were related with age, education, residence, personal
income, experience, scores of occupational health knowledge, attitude and behavior.
Conclusion: Indoor air pollution of the furniture market in the city was serious, andthe major of the
pollutions was formaldehyde which was significantly high in winter. Though practitioners of furniture
market lacked knowledge of occupational health and had the high level of occupational health needs, but
41
they seldom took protective measures. To maintain the health of practitioners, we Proposed to strengthen the
supervision of the industry, take practical measures to control indoor air pollution of the furniture market,
carry out a variety of occupational health education and regular medical examination.

Oral 19(ID477)
Comparison on Syphilis Epidemiology Among Local Residents and Floating Pregnant Women
in Zhejiang Province
Xiao-Hui Zhang, Li-Qian Qiu, Jing-Yi Jiang
Women's Hospital School of Medicine Zhejiang University, China

Background: We compared epidemiology of pregnancy syphilis in local residents and migrant in Zhejiang
province. It’s beneficial to improve prevention for mother to child transmission of syphilis.
Methods: Data is from provincial maternal health care system. We chose the syphilis positive pregnant
women from January 1, 2012 to December 31, 2012. The characteristics about health service utilization,
pregnancy outcome and their infants health status were analyzed.
Results: The average age of infected women was 27.30±0.30 in migrants, which was younger than that in
residents (29.10±0.27) (P<0.01). Significant differences were observed in age, ethnicity, education,
employment, marital status, number of children, early antenatal care and delivery methods between two
groups, but no different for route of infection, medication and perinatal outcome. Most migrant women were
jobless, under 20 years old, only having primary level education and high proportion of ethnic minorities. In
both groups, multiple partner sexual intercourse were the major route of transmission. The mean gestation
weeks of getting first prenatal care in local women were earlier than migrants (13.79±7.45 VS 18.48±9.63,
P<0.01). Migrants women with syphilis usually were identified very late even after labour starting (20.47％)
comparing in residents (11.95％). Approximately 90% positive women gave birth, migrants had more
proportion delivered vaginally (56.58%) in contrast to local resident women (46.24%) (P<0.01). While,
resident women with elective Caesarean section were reported more than floating group (37.81% VS 26.32%,
P<0.01).
Conclusions: Syphilis positive pregnant women have many different characteristics between local residents
and migrants. These findings will indicate that more attention should be given to migrants，especially to
women with lower education, unemployed and no early maternal health checking. Timely intervention is
important for them to stop mother to child transmission.

Oral 20(ID496)
Different Patterns and Trends of Thyroid Cancer Incidence in Chinese Population of
Shanghai, Hong Kong, Singapore and Los Angeles
XuanDeng, JingjingZhou
School of Public Health of Wuhan University, China

Background: World widely, thyroid cancer has been identified with anincreasing trend. This study analyzed
thethyroid cancerincidence of Chinese ethnicity from Los Angeles (LA), Shanghai, Singapore and Hong
Kong to derive evidences for thyroid cancer control.
Methods: The Cancer Incidence in Five Continents (CI5) database which is so far the most updated,
completed and detailed world cancer incidence database could be used to extract the thyroid cancer
42
age-standardized incidence of Chinese population from Shanghai, Hong Kong, Singapore and LAbetween
1988 and 2002. Detailed analysis has been conducted to investigate incidence diversity by gender, age,
ethnicity and various histological types.
Results: In 2002, the ASRs of Chinese male were 3.4/105 in LA, 2.5/105 in Singapore, 2.1/105 in Hong Kong
and 1.8/105 in Shanghai and that of Chinese female were 7.6/10 5, 6.8/105, 7.5/105 and 5.5/105, respectively.
The annual average increasing speed of thyroid cancer ASRs of Chinese male from 1988-2002 were 2.52%
for LA, 1.25% for Singapore, 1.96% for Hong Kong and 5.08% for Shanghai and that of Chinese female
were 3.98%, -0.98%, 1.37% and 6.43%, respectively. There was a striking fact that The ASR of femalecould
be threefold higher than male. The most common histological type diagnosed was papillary carcinoma for
both sexes. The data also demonstrated the thyroid cancer incidence hold great variation among different
ethnicities in the same area.
Conclusion: The thyroid cancer in Chinese of many different regions was getting higher. Studying
geographic and ethnicity difference could provide candidate influential factors for investigation. Currently,
the risk factors have been recognized includinghormone, ionizing radiation, a previous history of thyroid
benign disease. Improved diagnostic techniques also led to raising incidence. Carrying out study in the
region where thyroid cancer is concerned to disclose specific and important factors for intervention could
facilitate the thyroid cancer prevention.

Oral 21(ID505)
The Relationship Between Prior School Bullying/Victimization Experiences and Current
Depression of College Students in Shanghai
ZheZhanga, Hui-Jing Shia, Xiao-Xiao Jianga, Zhi-Juan Xiab, Yuan Yuanc
aSchool of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University,
Shanghai, China
bShanghai Jiaotong University, China

cShanghai Aurora Vocational College, China

Background/objective: There has been limited evidence of population based quantitative research on
childhood bullying victimization versus later health problems. The purpose of this study was to investigate
the relationship between prior bullying/victimization experiences during school years and depression of
college students in Shanghai.
Method: By using multi-stage cluster sampling, 2410 students from 1 technical college and 1 first-class
comprehensive university in China were invited to participate an anonymous questionnaire survey in
Shanghai in 2012.Bullying/victimization experiences during elementary, junior and senior high school were
measured by separate questions involving different forms of the behaviour. The current degree of depression
was measured using SCl-90 scale.
Results: There were totally 1992 valid responses with 1007 (52.4%) male, and 57.4% of them were
freshmen, 25.4% sophomores and 17.1% junior or senior students. Of all participants, 38.3% respondents
(boys: 43.0%; and girls: 33.1%) suffered from at least one type of bullying, and 31.3% of the participants
experienced bullying/victimization during elementary school years (31.3%), followed by junior (23.7%) and
senior (15.0%) high school. 25.7% of all participants (30.5% in boys and 20.3% in girls) had ever bullied
others before college, especially in elementary school (20.9%). Malicious teasing, threats and intimidation
were the most common types of bullyingbehaviours. After controlling for potential confounders including
school type, sex, grade, parents’ educational level, family economic status, stressful life events and social
43
support, those who have been victimized were more likely to have a higher score of depression at 2-3
(aOR=2.16, 95% CI: 1.54-3.02) and 3-5 (aOR=3.37, 95%CI: 1.51-7.51), especially for those who
experienced victimization in senior high school.
Conclusions: School bullying and victimizationduring primary and middle school is highly reported by
college students.A strong independent association were found between childhood victimization and current
depression in early adulthood.

Oral 22(ID530)
Noise Monitoring in Different Functional Areas of Luzhou and the Effects of Noise on the
Health of Residents
Ping Hua, Qingbi Zhangb, Xiaoyin Zhanga, Juan Hub, Yu Luob, Zangheng Leib
a PublicHealth & Management College, Chongqing Medical University, Chongqing, China
b Public Health & Management College, Luzhou Medical College, Sichuan, China

Background and objective: Noise pollution has become the second killer of human public health. To
understand the effects of noise in different functional areas of Luzhou on the health of residents, and to
provide reference for the formulation of noise pollution prevention and control measures.
Methods: AWA6218C noise measuring instrument had been used to understand noise-level in different
functional areas; we had selected 100 residents in each functional areas of Luzhou (total 400 residents)
randomly and used self-made questionnaires in the survey on their health effects of noise; Pittsburgh sleep
quality index (PSQI) had been used to evaluate of noise impact on sleep quality of residents in different
functional areas.
Results: 400 questionnaires had been issued and 381 questionnaires has been returned, the effective recovery
rate was 95.25%; There had been noise pollution in LuZhou: Residential, Commercial, Transportation and
Construction areas all had more noise than the national standards (standards for acoustic environmental
quality GB3096-2008) regulation limit of noise; The effects of sleep quality of different functional area noise
on residents had been caused by different factors ( x 2 =11.556, P=0.009), There had been differences in
cardiovascular damage ( x 2 =17.457, P=0.001), differences in nervous system damage ( x 2 =83.232, P=0.000),
differences in attention ( x 2 =68.816, P=0.000); Residents of the cognition situation investigation of noise
pollution on human health hazards had showed: more people had not been aware of hazards about the noise
pollution on human health (40.95% of people had not known, 33.69% of the people had thought that the
noise will not cause harm to human health).
Conclusion: There are noise pollution in four different functional areas of Luzhou, The transportation area’s
noise pollution harm on human health (sleep quality, cardiovascular, nervous system, attention) is the most
serious, so we should vigorously strengthen the prevention of noise.

Oral 23(ID537)
Passive Smoking During Pregnancy and Age of Menarche in Daughters
Bo-Lin Zhang, Hui-Jing Shi, Dan Li, Qun Wang
School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University,
Shanghai,China

Background/objectives: As early as in 1990s, studies had raised the concern that exogenous exposures may
44
be a contributor of girls’ early puberty. Tobacco smoke contains numerous reproductive toxins and appears to
have endocrine reactive properties. However, few studies have made vertical comparisons of age of
menarche between subgroups divided by the status of maternal passive smoking. The objective of this study
was to examine whether passive smoking during pregnancy cause age of menarche to occur early in
offspring.
Methods: This retrospective study enrolled 1444 6-18 years old students in Shanghai, who were selected by
stratified cluster sampling. Data was obtained with structured self-administered questionnaires and physical
examinations. All the students were divided into different groups according to the status of maternal passive
smoking.
Results: Mothers who were smoked during pregnancy were tended to be younger, with higher risk of
miscarriage, having lower socioeconomic status and less educated husband, comparing to those who were
not. Maternal exposures to smoke was found to be associated with higher weight (46.65±15.46kg vs.
44.8±15.87 kg), higher BMI (18.8VS18.5) in offspring. Daughters with frequent prenatal tobacco smoke
exposure had a younger average age at menarche, comparing to who haven´t (12.26years vs. 12.46years, OR
=1.84 CI[1.05,3.22]), and the results did not change after adjusting for birth weight, birth body length,
maternal age at menarche, present weight and height, which suggesting that prenatal exposure to tobacco
product is associated with early menarche even after considering potential confounders and effect modifers.
Conclusion: Our study indicates that passive smoking during pregnancy is not only associated with adverse
pregnancy outcomes but also independently related to menarche age in offspring. An education about the
harm of tobacco to the pregnant women should be recommended in the future to protect pregnant women
from the adverse health effect cause by tobacco use.

Oral 24(ID553)
An Information Platform for Global Health
Jing Zhoua, Chaozhen Lva, Donghong Jia, Xiaohui Liangb
a School of Computer Science, Wuhan University, Wuhan, China

b School of Public Health, Wuhan University, Wuhan, China

Background: With the rapid development of the internet information technology, various environmental and
global health issues have become hot topics in the forums, news sites or micro-blocs in the internet. Recently,
tweets and micro-blocs have been major sources for various emergencies in global health. To efficiently mine
and capture such hot topics on time is important for global health, e.g., food safety, disease control and
environment protection.
Method: This paper proposes building an information platform for global health, which can identify the
main topics, outbreaks as well as the technology advance regarding global health. The main methods include
building a large-scale global health ontology mainly covering the environment protection, food safety and
chronic diseases, information crawler to acquire the information from various internet resources, topic
identification from the information, and the semantic mining mechanism.
Results: Experiments show that the platform can 1) crawler various information from the internet regarding
global health; 2) automatically generalize the hot topics regarding either the general global health or specific
domain, e.g., food safety or chronic diseases, e.g., high blood; 3) automatically capture outbreaks or
significant events regarding global health; 4) acts as a meta-search engine to integrate Medline and Zhiwang.
Conclusion: The platform helps both professionals and administration to grasp the current situation and
recent advance for various global health issues quickly and accurately, and serves as a kind of information
45
portals for the global health domain.

Oral 25(ID577)
A Three-week Multi-focus Psychosocial Residential Rehabilitation Intervention for Cancer
Survivors in Shanghai, China
Xuefen Chena,b, Jiwei Wanga, Xiaohuan Gonga, Changhong Shia, Li Suna, Qingyun Zhanga, Zhengnian Luoc,
Jingrong Gaod, LiQiang Zhangd, Zhengping Yuane , Jinming Yua
a Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety of Ministry of Education, School of Public

Health, Fudan University, Shanghai, China

b Department of preventive medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China

c Shanghai Health Education Association, Shanghai, China

d Shanghai Health Education Institute, Shanghai, China

e Shanghai Cancer Rehabilitation Club, Shanghai, China

Background: Millions of Chinese cancer survivors are at risk of poor quality of life outcomes. As a national
survivorship improve plan, Shanghai Cancer Rehabilitation Center is striving to support cancer survivors
throughout their cancer experience with multi-focus psychosocial intervention. Although various
interventions have been developed to address these concerns in china, such psychosocial interventions have
not yet been evaluated in this population.
Methods: 44 cancer survivors participated in a three-week multi-focus psychosocial residential rehabilitation
intervention in Shanghai Cancer Rehabilitation Center in April 2013, including rational nutrition lectures,
traditional Chinese medicine methods such as Guolin qigong and Tai Ji, musical therapy and
cognitive-behavioral treatment. They were asked to fill in the 30-item version of the EORTC QLQ-C30 and
the FACT-G (Chinese version) before and after the intervention. The questionnaire data were analyzed on
subscales basis using paired-samples t-test or Wilcoxon signed ranks test.
Results: Physical well-being mean score of FACT-G in 44 participants after intervention was significantly
higher than before (21.7±3.8 v 23.3±3.2; P=0.002). After intervention, both the EORTC emotional
functioning scale and Global Health status mean scores increased (79.9±19.4 v 84.8±13.6, P=0.037 and
59.3±18.2 v 67.5±18.1, P=0.007), whereas the three symptom scales of fatigue, pain and insomnia decreased
(32.6±16.7 v 28.8±14.6, P=0.010; 14.7±14.0 v 12.9±14.8, P=0.032 and 28.8±31.0 v 24.2±27.2, P=0.025).
Conclusions: cancer survivors may benefit from psychosocial interventions by improving quality of life,
especially in the domain of emotional functioning. A further study should be conducted with larger sample
size; the longer-term effects of the interventions need to be tracked.

Oral 26(ID585)
The Impact of Chronic Medical Conditions on Quality of Life in Cancer Survivors
Wang Jiweia, Gong Xiaohuana, Chen Xuefena,b, Shi Changhonga, Sun Lia, Yu Jinminga
a Key Laboratory of Public Health Safety, Ministry of Education School of Public Health, Fudan University
b Department of preventive medicine, Shanghai University of Traditional Chinese Medicine

Background: There has been considerable research into the impact of chronic medical conditions on quality
of life (QOL) in generalpopulation. However, few studies have assessed the impact of different chronic
conditions on QOL in cancer survivors. The objectiveof this paper was to compare QOL in cancer survivors
across nine chronicmedical conditions.
46
Methods: Using data from a cross-sectional survey of multi-community cancer rehabilitation centersof
shanghai, China in 2013.The EORTC-30 and FACT-G were employed as generic QOL instruments.
Results: Among 998 subjects, about 80 percent of the subjects had one or morechronic medical conditions.
The most common problems involved high blood pressure, cholesterol, diabetes. Subjects with
cardiacdisease, stroke, diseases of the respiratory system, disease of the musculoskeletal system and
connective tissue, diseases of the digestive system, experienced furtherlowering ofEORTC-30scores at all 6
scales, andfurtherlowering of FACT-G scores at all 5 scales, compared with no disease. Multiple
co-morbidities were associated withgreater decrements in QOL.
Conclusions: The findings highlight the need to monitor cancer survivors for chronic medical conditionsthat
can betreated to improve quality of life.

Oral 27(ID588)
Using Medications Sales Surveillance for Early Detection of Infectious Diseases Outbreaks in
Rural China
Li Tana, LihongTiana, YunzhouFana, Ying Wanga, WeirongYana,b, LijingYua, HongboJianga, Li Liua,
Sheng Weia, ShaofaNiea
a School of Public Health, Tongji Medical College, Wuhan, China

b Division of Global Health, KarolinskaInstitutet, Stockholm, Sweden

Background: Early detection of infectious diseases outbreaks has great significant for mitigating potential
damage. Some studies suggested that medication sales data could be used as an early indicator for outbreak
detections. However, few previous researches were conducted in developing countries or areas. After 8
months pilot study, a medications sales surveillance has been formally conducted in rural China.
Methods: The formal study was conducted in 23pharmacies from two counties in Hubei Province. 98 drugs
were selected under surveillance, including 15 antibiotics, 15 antidiarrheal medications, 5 antipyretics, 30
compound cold medicine, and 33 cough suppressants. Daily sales volume of each selected drug were
recorded and reported into a web-based database by pharmacies staff. Quality control measures were
regularly taken during implementation. Data from April 1st 2012 to March 31st 2013 were extracted to
generate descriptive statistics and conduct abnormal detection by using CUSUM models.
Results: During the 12 months, sales of 397515.2 units of medicationswere reported and 75.39% of them
from county pharmacies, with 1.60% missing report rate and 15.59% late report rate.The correlation
coefficient (rs) between the top 5 drugs ranked by sale volume and the total sale volume was more than 0.90
(P<0.001) in each drug category. The daily time trends of different kinds of drugs showed seasonal
fluctuations (figure 1). Totally 20, 21 and 59 signals were generated by C1, C2 and C3 respectively (figure 2),
however, no real outbreak was found except some extreme value wasdue topromotions or wholesales.
Conclusions: The present analysis provides a basic description of medications sales data for a better
understanding of this potential surveillance tool. This study might provide timely information on infectious
diseases outbreaks for rural areas. More comparisons are warranted to evaluate the system comprehensively.

A B

47
Figure 1 Time trends of daily sale volume by different kinds of drugs

Figure 2 The distribution of alert signals generated by CUSUM Models

Oral 28(ID591)
Application of Seasonal ARIMA Model in Forecasting Incidence Cases of HFMD in
Shenzhen, China
Lijing Yu, Li Tan, Lingling Zhou, Ying Wang, Shaofa Nie
School of Public Health, Tongji Medical College, Wuhan, China

Background: During the last decades, hand-foot-mouth disease (HFMD) has been reported for many times
in China. This emerging disease is typically benign and common self-limiting among children under
five-year old, however, severe cases with complications of central nervous system lead to neurological
sequelae or subsequent quick death. Early detection and response using mathematical statistics method
during the epidemic will be helpful to generate preventive strategies.
Method: We proposed a seasonal auto-regressive integrated moving average model, ,
where is the order of the auto-regressive model, is the order of the moving average model, is the
order of regular differencing and is the order of seasonal differencing, to forecast the expected incidence
cases from December 2012 to May 2013 using the retrospective observations from January 2008 to August
2012 as training set, and observations from September 2012 to November 2013 as validation set obtained
from China Information System for Disease Control and Prevention (CISDCP). All ARIMA procedures were
implemented via SAS9.2 system.
Results: After one order of regular differencing and twelve order of seasonal differencing, the transformed
series achieved stationary. The best fitted model was ARIMA with the lowest BIC value. Model parameters
had significant differences (P<0.05) and the series of residuals considered to be white noise ( =14.88,
P>0.05). This indicated that the best fitted model extracted the useful information of the series. Predictions
and observations were very close to each other and showed a good forecasting performance.
Conclusions: The ARIMA model we proposed can be an effective way to forecast the incidence cases of
HFMD. The usefulness of forecasting expected numbers of HFMD performs not only in giving public-health
officials a probable trend of the variability to be expected in the future, but also in detecting outbreaks and
providing probability statements and guidance to policy makers.

Oral 29(ID602)
48
Psychopathological Profile of Breast Cancer Patients Based on the Symptom Checklist-90-R:
A Hospital-Based Survey
Xiong-Fei Pana,b,c, Man-Dong Feia,c, Kenneth Y. Zhangd, Feng-Huan Fuc, Jin-Hu Fanc
a West China School of Public Health, Sichuan University, Sichuan, China

b Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom

c Cancer Institute & Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing,

China
d University of California, San Diego, United States

Background: With effectiveness of early treatments, many breast cancer patients suffer from psychological
distress due to adverse effects of treatments and physical disfigurement in prolonged life time. Our study
evaluated the psychopathological profile of breast cancer patients in comparison with healthy women and
explored demographic correlates.
Method: 291 breast cancer patients who were followed up and 531 healthy controls who were relatives or
friends of inpatients were recruited from the Cancer Hospital of Chinese Academy of Medical Sciences
between August 30, 2010 and January 1, 2012. Psychopathological profile was assessed based on the
Symptom Checklist-90-R (SCL-90-R) for patients and controls. We compared demographics such as age,
ethnicity, education, marriage, and occupation between them, and incorporate these data plus cancer status
for the association with general mean score on the SCL-90-R and scores for 9 major symptom dimensions in
multiple regression analysis.
Results: The mean age was 55.1±6.4 years for breast cancer patients and 43.1±12.8 for healthy controls
(P<0.001). The mean survival was 5.2 years for cancer patients (range, 0.6-9.9 years). There were
statistically significant differences in education, marriage, and occupation between two groups (P<0.001).
General mean score (1.45±0.45 versus 1.32±0.37) and 8 dimension scores (excluding the anxiety dimension)
on SCL-90-R were significantly higher in patients (P<0.05). Multiple regression analysis showed that the
breast cancer status was positively correlated with SCL-90-R mean score and 6 dimension scores (excluding
the anxiety, phobic anxiety and paranoid ideation dimensions) (P<0.05). Regression coefficients ranged from
0.10 (depression) to 0.19 (somatization). Lower interpersonal sensitivity was noticed in single women
compared to married women.
Conclusions: Chinese patients with breast cancer demonstrate psychopathology compared to healthy
controls. The breast cancer status is an independent contributing factor to the general psychopathological
profile. Breast cancer patients should be given particular counseling and care to alleviate the psychological
distress.

Oral 30(ID682)
A Research of Social Support on the Effects of HIV/AIDS Patients Living Quality
Guilian Lan, ZhaokangYuan, Qunying Xu, Hongying Jiang, Huilie Zheng, Li Wang, Lianlian Yuan
Department of epidemiology and health statistics, school of Public Health, Nanchang University, Nanchang, Jiangxi,
China

Background: AIDS as a heavy worldwide public healthy problem has attracted national attention recently.
The social support is one of the most potential key indicators to measure the quality of life which is one of
the key indicators of clinical treatment and Nursing care. The social support has benefits to the patients
physically and emotionally. In order to study the quality of life, the social support and their influencing

49
factors among patients living with HIV/AIDS (PLWHAS), the relativity of the quality of life and social
support was analyzed, which would provide some evidences to make an improvement of the quality of life
among patients with HIV.
Method: Cross-sectional investigation was used to choose the total of 371 PLWHAS. The questionnaires,
are a simple health condition survey questionnaire (SF-36) and the social support rating scale (SSRS), were
carried out face-to-face. The Epidata3.1 and the SPSS 19.0 was used to do the data input and statistical
analysis, respectively.
Results: 371 available questionnaires were finished during January 2013 to February 2013. 1. PLWHAS get
a low social support score (29.41±7.808/66) and quality of life score (64.67±13.48/78.18±15.88). 2. Age,
marital status, education, occupation, income, residence, subjective support and the exploitability of social
support are all factors that could affect quality of life. 3. The canonical correlation of social support and
quality of life is 0.535, the quasi likelihood test has statistical significance (P<0.05). The score of social
support has a positive correlation with the factors of living quality, such as general health vitality, role
physical and role emotional and a negative correlation with body pain.
Conclusions: PLWHAS get less social support and bad quality of life. This analysis shows that the more
social support the PLWHAS get, the better quality of life they have.
Oral 31(ID748)
The Relationship Between Parental Child-rearing Behavior and Mental Health in Chinese
College Students
Yongling Ye, Jian Zhan, Qiqiang He
Wuhan University, Wuhan, China

Objective: This study aimed to explore the relationship between parenting styles and mental health in
Chinese college students.
Methods: A cross-sectional study was conducted in a univeristy of Wuhan from May to June 2013.
Perceived parental behavior was obtained by self-report questionnaires-Egna Minnen Beträffande Uppfostran
(EMBU). Mental health status was measured by General Self-Efficacy Scale (GSES) and The Distress
Disclosure Index (TDDI).
Results: A total of 1279 college students (576 male and 703 female, aged 20.34±1.04 years) were included
in this study. After adjusted for potential confounding factors, including age, gender, physical activity and
BMI, subjects with perceived higher levels of parental emotional warmth and parental preference were more
likely to report good general self-efficacy than groups with lower levels of the factors (odd ratio (OR=1.92),
95% confidence interval (CI): 1.51-2.46, P<0.001; OR=1.36, 95%CI: 1.03-1.80, P=0.029, respectively).
Subjects who perceived higher levels of parental rejection and denial (OR=0.74, 95%CI: 0.58-0.94, P=0.014),
parental preference (OR=0.68, 95%CI: 0.51-0.90, P=0.007), and parental punishing tendency (OR=0.69,
95%CI: 0.53-0.89, P=0.005) were less likely to express emotions in response to a specific, unpleasant event.
Furthermore, there was a positive association between parental emotional warmth and study subjects’
emotional express (OR=1.85, 95%CI: 1.46-2.35, P<0.001).
Conclusion: Parental rearing behaviors were significantly associated with Chinese college students’ mental
health.

Oral 32(ID752)
A Systematic Review: Prevalence Rate of Hypertension in China in 2000-2010

50
 Jie Baia,b, Zhiliu Tangc, Lan Lia, Lina Guc, Di Xuea
a School of Public Health, Fudan University, Shanghai, China
b Pudong Institute For Health Development, Shanghai, China

c Sanofi-Aventis(China) Znvestment Co.Ltd.in Shanghai, Shanghai, China

Objective: To systematically review the prevalence rate of hypertension from 2000 to 2010 in China.
Method: One hundred and forty researches from January 2000 to October 2010 were selected from the
database of China Biology Medicinedisc (CBM), China National Knowledge Infrastructure (CNKI) and
PubMed according to the inclusion and exclusion criteria and were reviewed systematically in this
paper．The overall prevalence rates and their 95% CI of certain populations were calculated in random effect
modelby using Comprehensive MetaAnalysis 2.0. And the forest plots of the population at the age 15 and
over from 2000-2004 and 2005-2010 were also drawn respectively.
Results: The prevalence rate of hypertension in the population at the age ≥15 was 23.33% in 2000-2010,
with 22.63% in 2000-2004 and 23.95% in 2005-2010. The prevalence rate of hypertension was the highest in
northeast area (28.19%) while was the lowest in south china area. The prevalence rate of hypertension was
about 6% in the population at the age 6-24, was about 29% in the population at age 35 or older, and was over
40% in the population at age 40 or older. The prevalence rates of hypertension for male were higher than
female at every age segments in this study.
Conclusions: The prevalence rate of hypertension in China was above average level in Asian counties and
increased in past 10 years, and were vary between different ages，sexes，regions and races．The epidemical
analyses on the prevalence of hypertension is helpful to explore the risk factors and control strategies.

Oral 34(ID785)
Correlations Between Dietary Habits and Sleep Quality in Chinese College Students
Jian Zhan, Qiqiang He
School of Public Health, Wuhan University, Wuhan, P. R. China

Objective: This study aimed to explore the association between dietary habits and sleep quality in Chinese
college students.
Methods: A cross-sectional survey was conducted in two colleges of Wuhan, China from April to June 2012.
The dietary habits were assessed by a 22-item self-administered Food Frequency Questionnaire while the
sleep quality was determined by the Pittsburgh Sleep Quality Index Questionnaire (PSQI). We divided the
students’ sleep quality into two groups (good or poor quality of sleep) based on the PSQI.
Results: Among a total of 2422 college students (1433 male and 989 female, aged 19.7±1.2 years) included
in this study, 453 (18.7%) students were identified as having poor sleep quality. Compared with the lowest
level of food consuming frequency (<1 times/week), significantly protective effects on sleep quality were
found in students who consumed fish more than 7 times/week (odd ratio (OR=0.53), 95% confidence interval
(CI): 0.31-0.91, P=0.021), and fruit 1-3 times/week or 4-6 times/week (OR=0.66, 95%CI: 0.47-0.94,
P=0.020; OR=0.66, 95%CI: 0.50-0.88, P=0.005; respectively), after adjusted potential confounders including
gender, age, physical activity and body mass index, etc. Furthermore, significantly increased risks for poor
sleep quality was found in students who consumed instant food 1-3 times/week, 4-6 times/week, >7
times/week (OR=1.52, 95%CI: 1.03-2.26, P=0.037; OR=1.38, 95%CI: 1.06-1.81, P=0.017; OR=2.28, 95%CI:

51
1.28-4.06, P=0.005; respectively), and sugary drinks 1-3 times/week, 4-6 times/week, > 7 times/week
(OR=1.94, 95%CI: 1.34-2.80, P<0.001; OR=1.54, 95%CI: 1.17-2.01, P=0.002; OR=2.13, 95%CI: 1.31-3.46,
P=0.002; respectively). In addition, a significant trend towards increasing prevalence of poor quality sleep
was found for increasing consumed instant food (Ptrend=0.001) and sugary drinks (Ptrend=0.001), while there
was a reverse significant trend with respect to fish (P trend=0.016).
Conclusions: There is a close link between dietary habits and sleep quality in Chinese college students.

Oral 37 (ID1095)
The Relationship Between Parental Rearing Styles and Internet Addiction Disorder in
Chinese College Students
Tao Xie, Qiqiang He
School of Public Health, Wuhan University, Wuhan, P. R. China

Objective: To investigate the association between college students’ parental rearing styles and Internet
addiction.
Method: A cross-sectional study was conducted in one college of Wuhan, China from April to May, 2013.
Information for parental rearing styles and Internet Addiction Test were obtained by self-administered
standardized questionnaires (Young Internet Addiction Scale and EMBU).
Results: Among a total of 1279 students (21.0±0.9 years old, 575 boys) included in the final analysis.
352(27.5%) were identified as Internet Addiction Disorder (IAD). After adjusting for confounding factors
and comparing with the referent groups, we found that increased risks for IAD in students who came from
single parent family (Odds Ratio (OR): 2.33, 95% confidence interval (CI):1.22-2.05, p＜0.000); students
with father‘s severe punishment (OR: 1.93, 95%CI:0.90-1.54, p=0.018); students with father’s excessive
interference (OR: 1.41, 95%CI:1.37-4.25, p=0.027); students with mother‘s excessive intervention and
overprotection (OR: 2.13, 95%CI:1.07-1.82, p=0.018);students with mother’s severe punishment (OR: 1.99,
95%CI:1.32-3.26, p=0.008).
Conclusions: There was a significant link between parental rearing styles and internet addiction in Chinese
college students.

Oral 37(ID1128)
An Investigation into Perception of Meaning of the Term “Unintentional Injury” Among
Some Health Professionals and University Students
Guoqing Hu, Lin Gao, Aichun Tan, Xiaotao Zhang
Department of Epidemiology and Health Statistics, School of Public Health, Central South University, China

Objective: To examine the perception of the Chinese translation of ‘unintentional injury’ among health
practitioners and university students.
Methods: Stratified sampling and cluster sampling were used to select health practitioners and university
students. A survey was carried out to explore participants’ beliefs of the preventability of unintentional injury.
Chi-square test was used to compare the beliefs between two kinds of population. ‘α= 0.05’ was selected as
the significant level of statistical test.
Results: 335 and 684 valid questionnaires were collected among health practitioners (males, 46.0%) and
university students (males, 46.5%). There were 10% of health practitioner respondents and 19% of university

52
student respondents answering that the occurrence of unintentional injury was due to bad luck. Another 12%
of health practitioner respondents and 19% of university student respondents replied that they did not know
whether unintentional injury can be prevented. The belief proportions of the preventability of unintentional
injuries between two groups were statistically different, χ2=24.793, P<0.05. Differences by sex, age group in
the belief of the preventability of unintentional injury for both health practitioners and university students
were not statistically significant, P>0.05.
Conclusion: The injury-related governmental departments and professional institutions should replace “意外
伤害” with “无意伤害” or “非故意性伤害” as soon as possible.

Oral 38 (ID1134)
Changes of Health Status and Institutionalization Among Older Adults in China
Rong Penga, Bei Wub
a Guangdong University of Business Studies, Guangzhou, China
b
Duke University School of Nursing, Durham, United States

Background/objective: There is an increase in rate of institutionalization among older adults in China

mainly due demographic transitions and socio-economic development. The objective of this study is to
examine factors predicting admission to long-term care facilities among Chinese community-dwelling older
adults.
Method: Using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2002, 2005,
2008 and 2011, we applied multiple logistic regressions to examine factors related to institutionalization.
Results: Baseline variables that predicted institutionalization were found as following: advanced age, urban
residents, living alone, had less visiting children, higher level of education, and lower cognitive function
score. Respondents lived alone had three times of higher risk of institutionalization than those not living
alone. Respondents’ changes of marital status, decline of Activities of Daily Living (ADLs) and decline of
cognitive function were found to be significant predictors of institutionalization. The risk of
institutionalization increased 2 times or more if the married individuals lost their spouse over the 3-year
period. In comparison to their counterparts, the risk of institutionalization increased 61% and 45%
respectively for elders who had declined ADLs and cognitive function.
Conclusions: Decline of health status and changes of marital status were main predictors of
institutionalization among Chinese older adults. Policies and programs should be developed to improve older
adults’ health status and social support systems in order to delay admission to long term care facilities.

Oral 39 (ID1136)
Analysis of Birth Defects Status in Hubei Province form 2003 to 2011
Hao Wanga, Quan Wangb, Hong Xub, Ying Liub
a Health and Family Planning Commission of Hubei Province, China
b School of Public Health /Global Health Institute, Wuhan University

Background: Birth defects have become the primary causes leading to infant death directly or indirectly in
many countries.
Methods: Data used in this study were collected from 2003 to 2011 using Hubei province hospital-based
registry, the Hubei Province Birth Defects Monitoring Network. A total of 607,392 newborns (live or still

53
births with 28 weeks of gestation or more) delivered in member hospitals were assessed for birth defects
within 7 days following birth.
Results: (1) 8,024 newborns have birth defects, with the prevalence 132.1 per 10,000. (2) The prevalence of
birth defects has been constantly rising. (3) As of 2003, cleft lip has been at the top of birth defects, with
rising yearly. The prevalence of congential heart disease has been in a rising fashion sharply as well, from
sixth to second place. While, the prevalence of neural tube defects has dropped. There was no sign that
showed a clearly change about the prevalence of other malformations. (4) In 2011, the prevalence of birth
defects was 150.5 per 10,000 in the rural areas, and 116.5 per 10,000 in the urban areas. The difference had
statistical significance between urban and rural areas (p<0.001). The prevalence of birth defects reaches its
peak with women over 35 who had offspring. The difference had statistical significance among different age
groups (p<0.001).
Conclusion: Hubei province should strengthen birth defects prevention in the rural region, especially for
elderly pregnancy women, to improve birth population quality.

Oral 40(ID1138)
Analysis on Burden of Cardiovascular Diseases in Residents of Shiyan During 2007-2009
Liu Rui, Wang Jing, Liu Ying, Chen Jin, Zhou Shang-cheng
Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, Hubei, China

Objective: To investigate the death and burden of cardiovascular diseases in residents of Shiyan.
Method: The mortality and disability-adjusted life year (DALY) was calculated.
Results: From 2007 to 2009, the crude death rate and standardized mortality of cardiovascular diseases was
201.9/100 000 and 173.9/100 000 respectively. The standardized mortality of male and female were
211.9/100 000, 137.6/100 000 respectively. Among males, the intensity of DALYs was 31.7, whereas was
20.9 for females. The male had greater DALYs per thousand population than female. The people aged above
60 years old had the highest death rate and intensity of DALYs. The cerebrovascular diseases, ischaemic
heart disease and hypertension were three leading causes of the burden of cardiovascular diseases.
Conclusion: The prevention and treatment of cardiovascular diseases for males and people aged ≥ 60 years
should be enhanced in Shiyan country.

Oral 41(ID1139)
Mandarin Version of A Face Version of the Modified CFSS-DS: Transcultural Adaptation and
Psychometric Properties Analysis
ZHAO Weia, LU Jiaxuana, LIN Jiachenga, XIAO Xiaofenb, LIU Zifengc, JIANG,Fangfangc, YU Dongshengc
a Department
of Pediatric Dentistry, Guanghua School of Stomatology & Institute of Stomatological Research, Sun
Yat-sen University, Guangzhou, China
b Department of Stomatology, Shenzhen People's Hospital, China

c Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China

Objectives: A novel version of the Modified Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS)
was developed by addition of faces rating scale to the original numeric form. This research aimed to translate
the original English version of CFSS-DS into Mandarin Chinese and investigate its psychometric properties，
which we could adapt to specific circumstances of Chinese children in inland China and to explore the
factors associated with Dental fear/anxiety.
54
Methods: The Mandarin-version CFSS-DS was derived through a forward-backward translation, pre-tested,
and cross-culturally adapted, using a focus group. The routine patients attending Outpatient Department
of Pediatric Dentistry, Guanghua School of Stomatology，Sun Yat-sen University, Guangzhou，China (n=263,
aged 5-12 years old) were evaluated for the Mandarin-version CFSS-DS which was filled by the
children and their parents before dental examination. The children’s behavior during the examination was
recorded and rated using the Frankl Behavior Rating Scale (Frankl scale). The reliability of the translated
scale was evaluated in terms of internal consistency using Cronbach’s alpha and corrected item-total
correlation. Construct validity was evaluated by factor analysis, and criterion-related validity was evaluated
using the parental-report of the Mandarin Chinese modified CFSS-DS and Frankl scale. Formal
psychometric properties were tested according to the standard procedure of the translation of English version
scales. Children who returned for a second dental appointment during the study period completed the
Mandarin Chinese modified CFSS-DS a second time.
Results: The Mandarin Chinese modified CFSS-DS was derived. A total of 263 children were surveyed,
among whom 280 questionnaires were collected. The Cronbach’s alpha of the translated scale was 0.89. 147
patients completed the questionnaire twice at two separate visits, and test-retest reliability was 0.70. The 15
items were divided into four domains. Corrected item-domain correlation ranged from 0.58 to 0.90. A certain
logical relationship between the items among the same domains was observed. A significant association
among the self-report of the Mandarin Chinese modified CFSS-DS, the parental-report of the Mandarin
Chinese modified CFSS-DS, and the Frankl scale was also observed.
Conclusion: The developed Mandarin Chinese modified CFSS-DS demonstrates acceptable reliability and
validity. The CFSS-DS is associated with self-rated Dental fear/anxiety.

Oral 42(ID1145)
Multiple Correspondence Analysis on Cohort Maintenance of Pre-exposure Prophylaxis in
MSM
He Jia-tonga, Zhong Xiao-nia, Peng Bina, Zhang Yana, Liang Haob, Huang Ai-longc
aDepartment of Medical Statistics, School of Public Health, Chongqing Medical University, Chongqing, China
bDepartment of Epidemiology and Medical Statistics, School of Public Health, Guangxi Medical University, Nanning,

China
cKey Laboratory of Molecular Biology for Infectious Diseases of Ministry of Education, Chongqing Medical

University, Chongqing, China

Objective: To explore the influence factors of cohort maintenance of Pre-exposure Prophylaxis (PrEP)
among man who has sex with man (MSM) in Chongqing, Sichuan and Guangxi province by applying
multiple correspondence analysis.
Method: 202 qualified subjects were recruited by snowball sampling in 2010. Each subject was randomly
given a tablet everyday (group A) or twice a week (group B). The PrEP cohort maintenance was observed
from week 0 to week 28 by every 4 weeks. Chi-square tests and multiple correspondence analyses were used
for selecting variables and exploring correlation.
Results: Only 61.88%(125/202) of MSM completed the trial and the expulsion rate were 44.12% in group A
and 32% in group B. Data suggested that the cronbach α were 0.565 and 0.481 while eigen values were
1.940 and 1.701 in two dimensions on the PrEP cohort maintenance and its influence factors. Multiple

55
correspondence analysis diagram showed that the MSM who failed to be followed up strongly correlated
with taking a tablet everyday , having no worries or difficulties and having no need for medical service.
MSM who completed the trial strongly correlated with secondary education, taking a tablet twice a week,
having worries or difficulties and having need for medical service.
Conclusion: The expulsion rate or PrEP clinical trials was relatively high which affected by self-health
cognition and the way of taking medicine. The result could provide a theoretical basis and a new idea for the
study of PrEP and other clinical trials.

Oral 43(ID1146)
Association Between miR-33a Levels and Chronic HBV-induced Liver fibrosis
Chengcao Sun, Dejia Li, Ting Zhang, Lei Pan, Ruilin Xue, Cuili Yang
Department of occupational and environmental health, School of public health, Wuhan University, Wuhan, China

Background: Increasing evidences show that microRNAs (miRNAs) may be involved in biological process
by regulating their target gene expression. MiR-33a, one of microRNAs, has been extensively studied in
hepatocarcinogenesis. However, the mechanism of miR-33a in liver fibrosis remains unknown.
Methods: Real-time PCR was used to assess the mRNA expression levels of miR-33a, REBP, and nuclear
factor kappa B (NF-κB). Western blot and immunofluorescence were used to analyze the protein expression
levels of REBP, NF-κB and collagen, type I, alpha 1 (COL1A1). Cell proliferation was assessed by MTT
assay. The binding activity of NF-κB to miR-33a promoter was examined by chromatin immunoprecipitation
(ChIP) assay.
Results: In transactivated HSCs and livers of mice treated with CCl4, the expression of miR-33a was
significantly reduced. The proliferation of LX2 cells was inhibited by overexpression of miR-33a. Further,
our work revealed that NF-κB was a target gene of miR-33a. NF-κB inversely correlated with miR-33a in
HSCs and in the mouse liver in terms of mRNA expression level. The expression of NF-κB was remarkably
attenuated by overexpression of miR-33a via targeting a binding site located at 30-UTR of NF-κB mRNA.
While overexpression of miR-33a resulted in the reduction of collagen maturation and ECM production.
Furthermore, there was a significant reduction in the binding activity of NF-κB to miR-33a promoter in
activated HSCs.
Conclusions: Altogether, these results suggest that miR-33a may negatively regulate collagen production in
HSCs and targeted expression of miR-33a in HSCs may represent a new therapy strategy for liver fibrosis.

Oral 44(ID1150)
Correlation of ERG Over-expression with Adverse Clinicopathologic Features of Prostate
Cancer in a Chinese Patient Cohort
Yanan Zhanga, Zixuan Yangb, Pengcheng Zhub, Xuan Denga
aSchool of Public Health of Wuhan University

bTongji Medical College of Huazhong University of Science and Technology

Background: ERG over-expression has been detected in 20-70% prostate cancer patient bio-speciman. This
overexpresssion was caused by the chromosomal rearrangement that results in the fusion of ERG and other
genes, most predominantly, TMPRESS2. Although controversial prognosis indication of ERG have been
reported, present biology experiments show that ERG correlates with the aggressiveness of the tumor,

56
therefore it is interesting to further explore the relevance of ERG in specific clinical settings.
Method: 185 prostate cancer cases and 16 benign prostate hyperplasia cases that had prostatectomy or
biopsy between 2005 and 2012 were included in the study. ERG N-terminal mouse monoclonal antibody was
used in immunohistochemistry staining to show ERG overexpression. ERG positive status was illustrated by
causes for patients to see doctors, bio-specimen sources, patient age, preoperational PSA, Gleason scores,
invasion status and bone metastasis.
Results: Among 185 cases, 16 of them have been found positive in ERG immunohistochemistry staining.
The positive rate was only 8.5%, while the information on the neoadjuvant therapy was not available. Among
49 Prostatectomy cases, 7 (14.29%) of them were ERG positive. ERG expression was associated with
Gleason score (p=0.004) and invasion (p=0.045) of the tumor. In this study cohort, ERG positive patients
were of highest proportion (87.5%) with Gleason score 7 group.
Conclusion: Though only 8.5% ERG expression could be detected in our study cohort, this expression was
associated with Gleason score and invasion. Since the malignance functions of ERG have been characterized
in cancer biological studies, ERG expression could serve as an indicator for needs of aggressive therapy. The
analysis of causes for patients to see doctors also suggested the importance of introduction of PCa screening
in high risk population.

Oral 45(ID1152)
Effect of Chalcones Extracted from Angelica Keiskei on the mRNA Expression of Insulin
Signal Molecules in Hepatocytes of Rats with Diabetes
Bei Liu a, Xiaodong Tan a, Jinyi Zhong b
a Schoolof Public Health, Wuhan University, Wuhan, China
b Medical College of Qingdao University, Qingdao, China

Backgroud: Angelica Keiskei has been popularly used in the treatment of diabetes in many countries. The
chalcones extracted from Angelica Keiskei (AC) as effective ingredient have shown antioxidant,anti-cancer,
anti-diabetes.
Methods: The diabetes of rats was induced by streptozotocin with intraperitoeal injection as well as with
high-fat diet feeding. The rats were randomly divided into 3 groups with 10 rats in each group，diabetic
control group,high-dose AC group and low-dose AC group.All the rats were fed with high-fat diet.0, 30 and
10 mg/kg·BW AC per day were given to high-dose AC,low-dose AC and the diabetic control
groups,respectively. Another 10 normal rats fed with regular diet was used as the normal control group. After
4 weeks, serum insulin levels were evaluated by radioimmunoassay. The mRNA expression levels of InsR,
IRS-2, PI3K and Akt were determined by reverse transcription polymerase chain reaction (RT-PCR).The
protein expression levels of insulin receptor in hepatocytes were detected by immunohistochemistry.and the
phosphorylation levels of Akt in hepatocytes were detected by western blot.
Results: Compared with rats in the diabetic control gruop, the levels of blood glucose 、serum insulin,
HOMA-R and TG in rats of high-dose AC gruop were decreased and the InsR, IRS-2, PI3K and AKT
mRNA expression levels were increased. Akt phosphorylation level of the high-dose group compared with
diabetic control group increased. All the difference was statistically significant (p< 0.05).
Conclusion: AC may up-regulate the expression levels of InsR, IRS-2, PI3K and Akt mRNA and decrease
the level of blood glucose and improve insulin resistance of rats with type 2 diabetes.

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Oral 46(ID1157)
The Study of the Influence Factors of the the in Hubei Province Based on Quantile Regression
Model
LianXiaoa,b, Yuchuan Huaa,b
a School of Public Health, Wuhan University, China
b Global Health Institute, Wuhan University, China

Objective: Usingquantileregression model to study the influence factors of total health expenditure (THE) of
Hubei province, so as to help the health administrative departments to control the growth of THE as well as
to provide evidence for health policy-making.
Metheds: First, pick out the factors that may affect the THE in hubei provincefrom 2000 to 2011refer toa
large number of literature and combined with actualsituation, then use the method of stepwise
regressiontestcollinearityamong theindependent variables, and screen the explanatory variable, finally,
establishquantileregression model of total health expenditureand its influencing factors in the R language
environment, and determine the impact factors after parameter estimation.
Results: The test result of coefficient of GDP from 10% -75%fractile aresignificant, and all the quantile
regression coefficient is positive.
Conclusion: GDP is the influence factors of the growth of total health expenditure, and the growth of GDP
promote the growth of THE in hubei province.

Oral 47(ID1159)
Study on the Health-related Quality of Life and Influential Factors Among Left-behind
Children in Rural China
Yun Huanga, Qing-Ying Lia, Dan Xua, Xuan-Lin Zhanga, Chao Fenga, Guo-Xiu Yanga,
Yun-Yun Boa, Bing Denga, Xiao-Ni Zhongb
a Chongqing Medical University, Chongqing, China

b Department of Health Statistics, School of Public Health, and Viral Hepatitis Research Institute, Chongqing Medical

University, Chongqing, China

Objectives: To investigate the living status and analyze the influential factors of health-related quality of life
(HRQOL) among left-behind children in rural China.
Methods: A cross-sectional study was performed with 1363 children recruited by the snowball sampling
approach in in rural areas of 6 provinces in China, considering the proportion of the floating population.
HRQOL was detected using the Pediatric Quality of Life Inventory (PedsQL).
Results: 608 (44.61%) of total were left-behind children. The left-behind children scored significantly lower
on the HRQOL synthesis score (F=6.14, P<0.05), Physical Functioning (t= -5.60, P<0.05), Emotional
Functioning (t= -5.50, P<0.05), Social Functioning (t= -3.45, P<0.05) and School Performance (t=-2.15,
P<0.05) subscales compared with non-left-behind ones. Multivariate logistic regression indicated that
uncle-raised children performed lower HRQOL in Emotional Functioning and School Performance, and
children whose father come back home once in every 1 to 3 months get poorer HRQOL scores in Social
Functioning compared to those father returning home once over 12 months.
Conclusions: The HRQOL scores of left-behind children were significantly lower than the non-left-behind
ones both in physical and psychological aspects. Influence factors should be considered for future policy
making and intervention practice, to improve HRQOL of left-behind children.
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Oral 48 (ID1160)
Analysis of the Willingness to Participate in the Pre-Exposure Prophylaxis Clinical Trial
among Chinese Men Who Have Sex with Men
Fei F Gaoa,b, Xiao N Zhonga, Bin Penga,Yan Zhanga, Hao Liangc, Yun F Zoud, Ai L Huange
a Department of Medical Statistics, School of Public Health and Management, Chongqing Medicial University,
Chongqing, China
b Department of Epidemiology and Health Statistics,School of Public Health and Management, Liaoning Medical

University, Jinzhou City, Liaoning Province, China

c Department of Epidemiology and Medical Statistics, School of Public Health,Guangxi Medical University, Nanning,

China
d Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, China

e Key Laboratory of Molecular Biology for Infectious Diseases of Ministry of Education, Chongqing Medical

University, Chongqing, China

Objective: To understand the Willingness to participate in the Pre-exposure Prophylaxis (PrEP) clinical trial
and its influencing factors among Men Who Have Sex With Men (MSM) in Chongqing city, Sichuan and
Guangxi provinces of China.
Method: Face-to-face anonymous questionnaire was conducted to 1318 qualified objects by non-randomly
sampling method.  2 test was employed to conduct univariate analysis, multivariate analysis was conducted
using logistic regression .
Results: Awareness of PrEP among MSM was 31.53% and elevated to 40.97% after being taught on PrEP
related knowledge by investigators. Logistic regression showed that factors influencing the willingness to
participate in the PrEP clinical trial among MSM were type of household (urban / rural: OR = 0.782, P =
0.0611), whether have child or not (yes / no: OR = 1.746, P = 0.0005), and family relations (good / bad: OR
= 0.441, P = 0.0139; normal / bad: OR =0 .519, P =0.0606), commercial sex transaction (yes/no: OR = 0.672,
P = 0.0624), HIV virus detection (never done / done: OR=0.703, P=0.036), any acquaintances using drugs to
prevent AIDS (yes / no: OR = 3.606, P = 0.0014).
Conclusion: The willingness to participate in the PrEP clinical trial among MSM in Chongqing city, Sichuan
and Guangxi provinces are relatively high, propaganda of PrEP should be strengthened when recruiting the
objects of clinical trial in the future thus to improve their awareness. In the meanwhile particular attention
should be paid to recruit those MSM who are with urban household, having no children or commercial sex
transaction. In addition, peer education could be tried in MSM population, which may be an effective way to
promote PrEP.

Oral 49(ID1162)
Association between Sleep and Risk of Work-related Injuries among Farmers in Heilongjiang
Province, People’s Republic of China
Huiping Zhua, Yunfeng Hanb, Yaowu Sunb, Zhiping Xieb, Huiyun Xiangc, Xueyan Qianb, Lorann Stallonesd,
Limin Wange
a School of Public Health, Capital Medical University, Beijing, China

b School of Public Health, Qiqihar Medical University, Qiqihar, China

c College of Medicine, The Ohio State University, Columbus, Ohio, USA

d Colorado State University, Fort Collins, Colorado, USA

59
 e Chinese Center for Disease Control and Prevention, Beijing, China

Background: Previous studies provided evidence that lack of sleep is a risk factor for work-related injuries
in many occupations. Yet, the association between sleep and risk of work-related injuries in farmers has not
been well studied. This study examined the impact of sleep deprivation on the agricultural work-related
injuries among a sample of farmers in China.
Methods: Data were from a cross-sectional survey of farmworkers (N   =   2050) conducted in the
northeastern region of China in 2008. Information was obtained on injuries occurred in the previous 12
months prior to the survey, eight sleep-related variables, and a number of social-demographic variables.
Multivariable model was conducted to test the research hypothesis that lack of sleep significantly increased
the risk of work-related injuries after controlling for demographics and other potential injury risk variables.
Results: Of a total of 2050 eligible farmers, 579 (28.2%) farmers reported having difficulty to fall asleep at
night. Farmers who reported sleeping less than six hours per night had an increased risk of injury by 58%
compared with those who reported sleeping eight hours per night. Farmers who reported sleeping less than
six hours per night, having difficulty to fall asleep at night or after waking at night frequently, often having
nightmare, or often having daytime sleepiness were at higher injury risk compared with the reference group
after controlling for age, gender and alcohol consumption factors. Farmers who reported going to sleep after
0 p.m. at least once a week were over two times more likely to having injuries comparing with those who
reported going to sleep after 0 p.m. once a month.
Conclusions: Reduced sleep hours and quality significantly increased the risk of work-related injuries in
Chinese farmers. Sleep hours and quality must be considered in future research that assesses the occupational
safety in farmers.

Oral 50(ID1164)
A study on Recovery Effect of the Maternal of Episiotomy by Systematic Nursing Intervention
Yuxiu Liua, Ailing Yub, Xia Xiub, Yingying Mub, Jinmei Yub
a Medical College of Qingdao University, China

b W.F. Maternity and Child care hospital, Weifang,China

Background: Episiotomy is a common surgical procedure in childbirth. Timely episiotomy can prevent
severe perineal laceration, reduce neonatal asphyxia, and reduce perinatal mortality. In recent years, the rates
of episiotomy became significantly higher, the episiotomy rate reported in China is more than 80% .
Episiotomy postoperative complications, such as wound edema, pain, difficulty urinating affect not only the
rest of the maternal but lead to breastfeeding failure. Therefore, a good preoperative and postoperative
preventive care intervention is particularly important.
Objective: To explore a systematic nursing intervention method, using this method on nursing of maternal of
episiotomy, and observe the effect.
Methods: We formulated the details of nursing intervention measure by article reviews and Delphi method.
That is Episiotomy preoperative and postoperative care routine. We divided the maternal into experimental
group (200) and control group (200). The differeces between two groups lie in the individual, systematic,
continuous nursing in experimental group. We trained nurses to provide systematic continuity of care,
especially for postpartum complications, including, to guide its side lying position and effective pain relief;
routine postpartum povidone-iodine scrub to prevent infection; individualized guidance to induce urination;
magnesium sulfate deposition or perineal physiotherapy to prevent postpartum edema; demonstrate
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postpartum activities to prevent wound dehiscence. We compared the pains after delivery, voiding time,
perineal edema, disruption of perineal wound and infection rate.
Results: The two groups have significant differences in pain scores, voiding time, perineal edema, P<0.05,
and experimental group has obvious advantage. There have no significant differences in disruption of
perineal wound and infection rate.
Conclusions: The systematic nursing intervention has great advantage in maternal recovery of episiotomy,
worthy of promotion in the clinical practice.

Oral 51(ID1165)
Determinants and Status on Mental Health Among the Persons Living in Yunnan Unexplained
Sudden Death Areas
Te Denga, Jianqiong Zhangb, Jinyong Wangb, Jianying Liuc, Baiyun Chend, Wuxiang Shia
a Guilin Medical University, Guilin, China

b Dali University, Dali, China

c Guilin Medical University unions, Guilin, China

d Dali Center for Disease Control and Prevention, Dali, China

Background: Yunnan Unexplained Sudden Death, a sudden onset, sudden death and family clustering
indigenous disease occurred in Yunnan ethnic minority mountain areas, has brought great harm to local
residents’ health. This article was aimed to understand the determinants and status on mental health among
the persons living in Yunnan Unexplained Sudden Death Areas.
Methods: A cross-sectional household survey was conducted in selected epidemic areas and control areas.
Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were applied to measure status on
mental health among the local residents, and a multivariate non-conditional Logistic model was used to
identify the risk factors of mental health.
Results: The scores of SAS and SDS of 728 persons in the epidemic areas were 44.15±9.69, 43.69±8.85
respectively, with prevalence rates 28.7% and 16.2%. The scores, prevalence rates and constitution of
moderate-severe disease of the persons with anxiety or depression among the epidemic areas were all
statistical significantly higher than the control areas. After controlling of confounding factors by Logistic
regression, the risk ratio (OR) of the persons with anxiety or depression among the endemic areas was 3.34
or 2.51 times compared to the control areas.
Conclusion: The problem of mental health among the persons living in the epidemic areas of Yunnan
Unexplained Sudden Death was severe, which needed more emphasized attentions.

Oral 53(ID1169)
The Effectiveness of the Self-management of Regular Physical Activity Program: Using a
Randomized Controlled Trial
Jie Gonga, Fang Lia, Niannian Yanga, Yaqiong Yana, Huiling Suna, Chaoyang Zhua, Sijian Lib
a Wuhan Center for Disease Prevention and Control, China

b School of Nursing of the Hong Kong Polytechnic University, China

Background: Hypertension is a major public health issue and regular physical activity (PA) has been proven
and highly recommended by World Health Organization (WHO) as an effective measure to improve
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substantially the prevention, treatment and control of hypertension. However, the notion of regular PA has
been appeared to be largely ignored due to traditional model of care (i.e. to administer medications only) and
lack of culturally relevant care approach. It is becoming an urgent need to develop a culturally sensitive care
intervention to encourage and support participants with hypertension to adhere to regular PA in the
community setting. The aim of this study is to evaluate the effectiveness of The Self-management of Regular
Physical Activity trial (SRPA), based on Trans-theoretical Model (TTM), focusing on participants’
perceptions and behaviors through six months.
Method: 559 participants with hypertension from 12 communities with two per district in urban Wuhan were
recruited and randomly assigned to the intervention and control group. Baseline and two follow-up surveys
were conducted at 3-month intervals. Intervention effects were assessed and analyzed using the mixed
model.
Results: Through 6 months of follow-up, the interventions significantly increased the scores in TTM-related
constructs including Process of Change, Decisional Balance (including Pros and Cons), Family Support,
Friend Support and Self-efficacy. Same increasing trend were found in stages of regular PA at each follow-up
interval after controlling age, gender, educational level, family income and baseline differences.
Conclusions: The program was effective to improve participants’ perception and maintain changes of regular
PA behaviors in six months. To our knowledge, this was one of the community studies to examine changes of
PA behaviors using TTM model to guide our community health practice in a systematic manner.
Consideration should be given to observe the sustained effects of PA behaviors in a longer period of time.

Oral 54(ID1170)
Preliminary Study on Risk Evaluation Model of Breast Cancer Among Women in Western
China
Li Huia, Zhao Yinga, Wang Qionga, Huang Yuana, Pang Yib, Li Jiayuana
aWest China School of Public Health, Sichuan University, Chengdu, P.R.China
bJiangjiang CDC, Chengdu, P.R.China

Objective: To identify the high-risk population of breast cancer who need further mammography screening.
This had been recognized as cost-effective breast cancer screening strategy in developing areas.
Method: This was a cross-sectional study among Chinese community women aged 30 years or older in
Chengdu. The breast cancer risk factors investigation and mammography screening were conducted from
year 2009 to 2012. The original data was randomly divided into training group and testing group with the
proportion of 4:1. The subjects with BRIAD Grade 4~5 were defined as mammography positive. Logistic
regression analysis was used to filter the risk factors and develop a new predictive model. Diagnostic
accuracy was appraised by the area under the ROC curve, the cut-off point was distinguished by the ROC
curve, and the sensitivity, specificity, positive and negative predictive value were calculated.
Result: A total of 13,607 eligible community women were surveyed. The average age was 44.13±7.75 years
old, and 191 cases were detected as the positive by mammography. Factors including age (50~59 years old,
OR=2.948, PAR%=20.94%; ≥60 years old, OR=4.773, PAR%=15.33%), BMI (≥28 kg/m2, OR=2.132,
PAR%=4.23%), age of first full-term pregnancy (25~29 years old, OR=1.519, PAR%=17.72%; ≥30 years old,
OR=1.759, PAR%=6.46%) and nipple discharge (OR=7.131, PAR%=2.39%) were risk factors, while age of
menarche (≥17 years old, OR=0.190) was a protective factor. The predictive probability more than 3.56%
indicated high risk, the sensitivity and specificity of the logistic regression model were 51.4% and 73.82%

62
respectively, the positive predictive value and negative predictive value were 2.50% and 96.55% respectively,
the area under the ROC curve was 0.651(95%CI: 0.558-0.744).
Conclusion: According to our present research, the effectiveness of the predicted model should be improved,
so dietary factors and genetic factors were considered in the further study.

Oral 55 (ID1180)
Estimate of A Predictive Cut-Off Value for Neck Circumference Reflecting Abdominal
Obesity in Elderly Chinese Men
Hai-Ying Xiao, Yan-Hui Lu, Chun-Lin Li, Yu Pei, Hui Tian, Jian Li, Min-Yan Liu, Fu-Sheng Fang, Ban-Ruo
Sun, Li-Chao Ma. Xiao-Ling Cheng.
Department of Geriatric Endocrinology, Chinese PLA General Hospital

Background: Neck circumference (NC), as a good indicator reflecting the accumulation of the upper body
subcutaneous fat, is a simple measure of obesity. However, using NC to predict abdominal obesity in elderly
subjects is rarely reported and thus this study aimed to identify the best predictive cut-off value of NC to
reflect abdominal obesity and to investigate the association between NC and metabolic syndrome (MetS) in
elderly Chinese men.
Methods: A total of 572 males were recruited, aged 60-96 years. Main indicators studied included NC, waist
circumference (WC), body mass index(BMI), systolic and diastolic blood pressure (SBP and DBP,
respectively), and fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), and high-density
lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c). MetS was defined by the
International Diabetes Federation criteria (2005).
Results: The prevalence of abdominal obesity and MetS were 55.24% and 27.45% respectively. Pearson’s
correlation coefficients indicated that NC correlated positively with WC and BMI (r = 0.682, r =0.695,
respectively, p＜0.0001). Receiver operating characteristic (ROC) analysis showed that NC of ≥37.25cm for
elderly men was the best cut-off value to determine subjects with abdominal obesity. After adjustment for
potential factors, for subjects with NC≥37.25cm , the risk of having abdominal obesity or MetS increased
10.03 and 5.41- fold respectively compared with those with NC<37.25cm.
Conclusion: Neck circumference may be used as an additional anthropometric marker to predict abdominal
obesity. Higher neck circumference was significantly associated with the risk of abdominal obesity,
overweight or obesity and MetS among elderly males.

Oral 56(ID1184)
Analysis of Psychology Factors of Insulin Resistance and Treatment on Patients with Type 2
Diabetes in China
Yiming Mu, Zhixue Tan, Lilong Huo, Kai Chen, Chuang Sun, Jingdong Ma
Tongji Medical Colledge of Huazhong University of Science & Technology

Objective: Through analysis of psychology factors of insulin resistance and treatment on patients with type
2 diabetes, understand the main influence factors, treatment interruption and abscission. And provide
scientific basis for improving the compliance of insulin therapy.
Methods: Use the unified questionnaire to collect data of one months and three months after insulin

63
treatment in 11898 cases of patients with type 2 diabetes. Adopt appropriate method to analyze the data.
Results: The consistency of severity of the disease, body weight changes, economic influence and family
support is good (Kappa value is greater than 0.61) between one months and three months after insulin
treatment. The overall treatment interruption rate is 21.78% (2577/11831) in China. The treatment
interruption rate is at a high level in most of the provinces in northern area. There has statistical difference in
abscission rate of insulin treatment between different educational levels (χ2=121.66, P<0.001), different
income levels (χ2=111.58, P<0.001) and different insurance status (χ2=158.13, P<0.001).
Conclusion: Most patients with type 2 diabetes have misunderstandings about insulin therapy. There are
some differences in abscission rate of insulin treatment between different types of patients. The overall
situation of insulin treatment compliance is not optimistic. We must take effective measures to correct these
situations, and improve treatment effect.

Oral 57(ID1194)
The Value of Echo-contrast RT3DE for Assessment of Left VentricularFunction in Patients
with Left Ventricular Non-compaction
Linli Qiu, Mingxing Xie
The Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China

Background/objective: Heart failure is the most common clinical manifestation in patients with left
ventricular non-compaction (LVNC), and is usually caused by severe global systolic dysfunction of the left
ventricle. Although Real-time 3-dimensional echocardiography (RT3DE) is accurate for the evaluation of
cardiac function, but it is hard to trace the true endocardial border in noncompacted segments with the deep
endocardial recesses. The aim of the present study was to evaluate the value of echo-contrast RT3DE for the
assessment of left ventricular function and volumes in patients with LVNC.
Methods: Twenty-one patients of LVNC were involved (mean age, 29.95 ± 15.53 years, 12 men) and
underwent non-enhanced and contrast-enhanced 3DE to evaluate left ventricular end-diastolic volume
(LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF). The
endocardial border definition of LV was graded for each of the 16 LV segments as follows: 0=border
invisible, 1= border visualized only partially, and 2=complete visualization of the border. Three
image-quality groups (good, fair, and uninterpretable) were identified.
Results: In contrast-enhanced 3DE, the number of segments with complete visualization of the endocardial
border increased from 55% to 82% (P <0.01); and the number of patients with a good-quality
echocardiogram increased from 33% to 81% (P <0.01) compared with non-enhanced 3DE.
Contrast-enhanced 3DE provided significantly larger values of LVEDV (P<0.01) and LVESV (P<0.01)
compared with non-enhanced 3DE; but there is no difference of the values of LVEF between the two
techniques (P=0.07). Intra- and inter-observer agreement for assessment of LV volumes and systolic function
enhanced in contrast-enhanced 3DE compared with non-enhanced 3DE.
Conclusions: Contrast-enhanced 3DE can improve the endocardial border visualization, and increase the
prevalence quality of echocardiograms. Volumes measured by 3DE are significantly larger when ultrasound
contrast is used. The reproducibility of the measurements of LV volumes and function enhanced in
Contrast-enhanced 3DE.

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Oral 58(ID1199)
Evaluation of Arterial Alterations and Associated Factors of Chronic Kidney Disease
Ziming Zhang, Ling Li, Mingxing Xie, Linyun Fang
Department of Ultrasonography , Union Hospital of Tongji Medical College, Huazhong University of Science and
Technology, China

Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with
chronic kidney disease (CKD). Results of cross-sectional studies emphasized the role of arterial stiffness as
an independent cardiovascular risk factor in ESRD. However, there is little data available on PWV in
mild-to-moderate CKD. In the study we evaluated vascular stiffness of CKD patients at different disease
stages predialysis by PWV and explored the associated factors.
Methods: Thirty-nine CKD patients predialysis enrolled the study and were subdivided into CKD stage 1-3
group (n=19) and stage 4-5 group (n=20). Forty healthy subjects were selected as the control group. The
parameters of arterial structural and stiffness measured by ultrasound and echo-tracking technique were
compared among groups. Stepwise multiple linear regression analysis the associated factors of arterial
stiffness.
Results: Compared with healthy group, the intima-media thickness (IMT) and diameters in stage4-5 group
were significantly increase (P<0.05), while IMT and diameters in stage1-3 group were insignificantly
increase (P<0.05). PWVcf increased in both stage2-3 group and stage 4-5 group, and PWVcf higher in stage
4-5 group than stage1-3 group. Stepwise multiple regression analysis demonstrated that age, estimated
glomerular filtration rate (GFR) per 1.73m2 were independent impact factors of PWVcf．
Conclusions: Arterial stiffness begin early in the course of chronic kidney disease, and correlated to the
degree of renal insufficiency significantly. Arterial structure and function assessment at early stage in
patients with chronic renal insufficiency is helpful to clinical treatment and prevention of cardiovascular
disease.

Oral 59(ID1202)
Development and Validation of a Tuberculosis Medication Adherence Scale
Xiaoxv Yin, Yanhong Gong, Xinyue Tong, Zuxun Lu
School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P.
R. China.

Objective: This study aimed at developing and validating a Tuberculosis medication adherence scale
(TBMAS).
Methods: An initial 41-item TBMAS was designed through review of literature, consultation from an
8-member clinical expert panel and a 15-patient focus group, and pilot-testing in 25 TB patients. The
questionnaire was validated in 438 patients who visited 23 community health centers for TB treatment in
Wuhan from September 1, 2010, to August 31, 2011, using pharmacy refill records in a 15-week period as
external criteria for medication adherence. After removing redundant and cross-loading items, the internal
consistency, reliability and validity of TBMAS in identifying non-adherents were examined.
Results: The final TBMAS included 30 items scored on a 5-point Likert scale, and these items were loaded

65
in nine distinct factors that explained 65% of cumulative variance among respondents (Table 1). Cronbach’s
alpha, test-retest reliability and split-half reliability were 0.87, 0.83, and 0.85, respectively. Convergent
validity was supported by statistically significant associations between TBMAS scores and adherence
measured by pharmacy refill records. Receiver Operating Characteristics curve analysis suggested a cut-off
point at 113, with which TBMAS showed a positive predictive value of 65.5% and sensitivity of 82.9% in
identifying non-adherents (Figure 1).
Conclusion: TBMAS demonstrated satisfactory internal consistency, reliability and validity in identifying
TB patients with poor adherence and potential causes for non-adherence.
Table1. Nine factors and thirty items of TBMAS.
Item
Factor I: communication with healthcare provider
I am satisfied with healthcare worker’s attitude.
Healthcare worker described TB to me clearly.
Healthcare worker explained my condition to me clearly.
Healthcare worker explained the method of taking medicine clearly.
Healthcare worker explained the side-effects of medicine clearly.
Healthcare worker led me to believe that my TB can be cured.
Factor II: personal traits
I often keep my things neat and clean.
I am strict with myself to follow my plan.
I often seek the most effective way in doing things.
I often set clear target.
I am organized and systematic in approaching my target.
Factor III: confidence in curing TB
I am very confident to completely cure TB.
My treatment regimen is very simple.
I am very confident in taking TB medicine regularly for 6 months.
I am very confident in tolerating side-effects.
Factor IV: social support
I am satisfied with the support between our family members.
My family members often remind me to take medicine.
My friends often remind me to do things.
People around me often give me necessary help.
Factor V: mood disorders
I sometimes feel depressed.
When I do something wrong, I feel frustrated and want to give up.
I sometimes feel helpless and want other people’s help.
Factor VI: living habits
I sleep and wake up regularly every day.
I have meals regularly every day.
Factor VII: active coping behavior
I actively pursued knowledge on TB when I knew I had been infected.

66
I often ask the doctor about my condition since I know I have been infected.
Factor VIII: forgetfulness
I sometimes forgot to do important things I planned to do.
My memory is good.
Factor IX: access to healthcare
It’s convenient to refill my TB medicine.
The TB control institution I visit meets my need.

Figure 1. ROC curve for TBMAS total score using pharmacy refill records as criteria.

Funding: This research was funded by National Natural Science Foundation of China (70973041). Available:
http://www.nsfc.gov.cn/.

Oral 60(ID1203)
Professional Spirit of Medical Staff
Huang Mingana, b, Chen Dana, b
a Hubei
University of Chinese Medicine
b Development Research Center of Traditional Chinese Medicine

The building of medical staff's professional spirit is the key point of the wholeheartedly for the people's health
service. Professional spirit of medical staff is defined as the integration of medical scientific and humanistic
spirit of the ideals and beliefs for the medical practitioners. This professional spirit is the soul of the medical
staff, which not only reflects the personal ideological training, practitioners ideas, values, personality, career
professional standards, professional fashion, the degree of civilization and mental outlook, but also affects the
overall image of the hospital. The professional spirit of medical staff is extremely important for the hospital's
development. This professional spirit requires in any case that the medical staff has to always put the patients
first, adhere to the patient as the center, take big attention to the patient's personality and rights and safeguard
the patient's well-being. In this paper, several points are discussed, including the concept of medical staff's
professional spirit , the meaning of the construction of this professional spirit, the characteristics and the
elements of this professional spirit, the main behavior of the lack of medical staff's professional spirit, how to
enhance professional spirit of medical staff. This discussion has great reference value for the university
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education of the medical staff for students, the vocational training for the medical staff and the self-education
for the medical staff.

Oral 61(ID1204)
trans, trans-Muconic Acid as A Biomarker of Occupational Exposure to High-level Benzene in
China
Ling Zhang
Thchnology Universuty of Wuhan, Wuhan, China

Benzene is a one of the ubiquitous environmental pollutant and has been known as a carcinogen. Therefore,
many countries’ occupational health legislature has sought to revise benzene occupational exposure limits.
Occupational exposure to benzene usually occurs in a wide variety of industries, once exposed, about 20 %
of the absorbed benzene dose is eliminated passively in breath and urine, in which urinary trans,
trans-muconic acid (t,t-MA) and S-phenylmercapturic acid (SPMA) are suitable biomarkers for monitoring
benzene exposure in occupational settings at levels as low as and even below 3.2 mg/m3. Recent studies
showed that SPMA was superior to t,t-MA as a biomarker for low level of benzene exposure, on account of
background levels of MA being attributed to sorbic acid. However, whether the pattern is applicable to
evaluate high-level benzene exposure needs further investigation.
The work aimed to study the potential correlation between the high-level benzene exposure and its urinary
metabolites SPMA and t,t-MA in Chinese shoe-making workers, and investigated the correlation between
personal exposure to airborne benzene levels and concentration of the two metabolites.
Individual benzene-exposed levels from 44 high-level benzene exposed workers were determined by gas
chromatography analysis. The 44 samples included 13 males and 31 females, and their mean age was 32.9 ±
5.3 years, as well as mean exposure history was 9.8 ± 6.3 years. The analytical determination of urinary
t,t-MA and SPMA were determined by HPLC-UV and LC-ESI-MS/MS method, respectively.
The results showed that airborne benzene level, measured in the breathing zone of the subjects, ranged from
2.57 to 146.11 mg/m3 (0.80 - 45.70 ppm) with a geometric mean (GM) value of 27.91 mg/m3. Urinary Cr
levels were used to adjust the variations in the metabolites concentration of all urine samples due to
differences in liquid uptake between subjects. The levels of urinary t,t-MA in post-shift were in the range
from 527.80 to 33 991.70 μg/g Cr, and the levels of urinary SPMA in post-shift were in the range from 20.16
to 2 942.22 μg/g Cr. A statistically significant correlation was found in all subjects between airborne benzene
concentrations and levels of t,t-MA or SPMA in urine. its correlation coefficient was 0.905 and 0.537 (P＜
0.01) for t,t-MA and SPMA, respectively, which showed that the correlation between airborne benzene and
t,t-MA was significantly higher than that of SPMA.
Moreover, biotransformation efficiencies of benzene to urinary metabolites are commonly expressed by
relative internal exposure index (RIE), which is regarded as a measure of the direct comparison of the
internal exposure in workers. The relative internal exposure (RIE) index of t,t-MA (0.28 mg/g Cr: mg/m3)
was more similar to the data supplied by ACGIH compared to the index of SPMA (0.25 mg/g Cr: mg/m3).
In conclusion, t,t-MA appeared to be a more specific biomarker than SPMA at high-level benzene exposure.

Oral 62(ID1205)
Study on Etiology and Epidemiology of Severe Fever with Thrombocytopenia Syndrome in
Hubei Province, China
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 Faxian Zhan, Xuhua Guan, Junqiang Xu, Yongzhong Jiang, Xuesen Xing, etc.
Hubei Provincial Center for Disease Control and Prevention, Wuhan, China, 430079

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease
discovered in 2010, which is caused by a novel bunyavirus(SFTSV). SFTS occurs in north-eastern and
central China, such as Hubei, Henan, Shandong, etc. SFTS causes high fatality rate of 12% and as high as
30% in some areas. This study was also conducted to identify the epidemic characteristics and risk factors of
SFTS in Hubei province in order to provide scientific evidence of control and prevention.
Methods: Active surveillance on SFTS was processed in monitoring sites that were set up in township
hospitals and above in Suizhou, Huanggang and Wuhan in 2010 and 2011. Specific surveillance on SFTS
was launched in county hospitals and above across the province. Cases matching the definition of
surveillance case were identified and reported to CDCs. Acute-phase blood samples were collected from the
patients. All acute sera were used to detect viral RNA of SFTSV by real-time PCR, and then RT-PCR
positive samples were used to isolate viruses by inoculation of cell culture. The cultured isolates were
confirmed by indirect immunofluorescence and characterized nucleic acid sequencing. Further phylogenetic
analysis was conducted by comparison to strains with known geographical origin from other provinces. We
also conducted serum antibody surveys among healthy population and livestock and vector tick surveillance
in high-epidemic areas.
Results: From 2010 to 2011, a total of 355 blood samples were collected and tested by RT-PCR. Out of 135
samples in 2010, 90 (66.7%) were SFTSV positive f, while out of 220 samples in 2011, 85 (38.6%) were
SFTSV positive. The result indicated a high positive rate by RT-PCR. The results were consistent with those
from other provinces in China. In addition, from these PCR positive samples, we isolated 58 strains of the
bunyavirus and sequenced genomes of 32 strains. Phylogenetic analysis indicated that they were genetically
similar to previous isolates from other provinces and closely to Uukuniemi virus of Phlebovirus. An 4-fold
elevation in antibody titer or seroconversion was observed in 11 patients. The total antibody positive rate was
3.8% in healthy population, and 55.0%, 36.7% and 80.0% in dogs, sheep and cows respectively. The ticks
from grass, cattle and sheep could be detected positive by RT-PCR. Epidemiologic analysis showed that the
patients were from hilly areas at an altitude between 28-940 meters. The epidemic season was between April
and December with peak from May to September. The youngest case was 11-year old, while the eldest was
81-year old. 95.3% patients are farmers. All Patients did not have travel history two weeks before onset of
SFTS. 93.8% patients engaged in agriculture. 52.8% patients had exposure of the ticks. 22% patients were bit
by ticks. And skin injury was found in 64.2% patients.
Conclusion: A new bunyavirus-SFTSV was discovered as the main pathogen of SFTS in Hubei province.
Meanwhile, very few cases were caused by HFRS and Brucella, which suggested other pathogens could also
cause SFTS-like disease. High viral RNA positive rate indicates that RT-PCR test was a valuable tool in the
early diagnosis of SFTS in annual epidemic season. Different geographical distributions of SFTSV were
genetically similar to each other. Most SFTS cases and some of their livestocks in Hubei could be tested
SFTS virus positive. Ticks might be one important vector. Skin injury, contact with or bit by ticks might be
risk factors.

Oral 63(ID1206)
Defining the Role of Hpv in Cervical Adenocarcinoma: A Multi-Centre Study in China
Chen Wa, Molijn Ab, Wu En Qia, Jenkins Dc, Zhang Xa, Schmidt JEd, Yin LYa, Pirog Ee, Qiao YLa, Chinese HPV
Typing Groupf
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 a Cancer Institute/Hospital, Chinese Academy of Medical Sciences (CICAMS), Beijing, China
b DDL Diagnostic Laboratory, Rijswijk, the Netherlands

c University Hospital and University of Nottingham, Queen's Medical Centre, Nottingham, UK

d GlaxoSmithKline Biologicals, Wavre, Belgium

e Weill Cornell Medical College, New York, USA

f Wang J, Li LY, Liu JH, Wang CY, Zhou Q, Wang P, Zeng L, Yu XH, Zhang Y, Liu D, Tang Y, Yuan Y.

Background: Cervical cancer is the third most common cancer in women around the world. About 530,232
new cases are diagnosed and 275,008 women die of cervical cancer worldwide annually. Cervical
adenocarcinoma (CADC) develops from the mucus-producing gland cells of the endocervix. Over a period
of approximately 20 years, the proportion of CADC has risen from approximately 5% to 8-27%. The
etiology of CADC is not well understood: the reported prevalence of human papillomavirus (HPV) DNA
varies significantly from 32% to 100% depending on the detection method used, limited sample size and the
level of expertise of pathologist.
Objective: This study employed clinical data, multiple validated sensitive HPV DNA detection methods,
DNA quality control and histopathology classification by multiple experts to investigate HPV in routinely
managed CADC across China.
Methods: The specimens collection was done by 9 central hospitals from 7 geographical regions covering all
China. Paraffin-embedded CADC specimens were sectioned by sandwich technique for H&E, p16 and
progesterone receptor stained and PCR sections; and a algorithm developed for histologic diagnosis. HPV
DNA was detected using SPF10 PCR-DEIA-LiPA25 version 1(*1) and type-specific HPV16/18 testing.
RNaseP/PhHV qPCR was used to evaluate DNA quality and PCR inhibition. We determined overall HPV
prevalence and type, regional variation, age distribution and contribution of HPV to each histological
subtype.
Results: In total, the H&E slides for 1051 CADC were submitted to CICAMS: 170 excluded due to
regulatory reason, 170 excluded due to no demographic information, no cancer tissue, etc. We included 731
cases (average age 46.0 ± 10.59): 426(58.28%) cervical adenocarcinoma (ADC-CX), 26(3.56%)
endometrioid adenocarcinoma (ADC-ENDO), and 279 (38.17%) other histological subtypes or unclassifiable.
Overall HPV prevalence was 70.31% of which 89.69% were single and 10.31% multiple infections.
HPV16 (246, 47.86%) and HPV18 (211, 41.05%) predominated and were present in 50/53 (94.34%)
multiple-infections. HPV 16 was more prevalent than HPV 18 in 5 centres except for North (32.0% vs 52.7%)
and South(38.% vs 45.6%). By contrast, HPV52 (5.6%), HPV45 (3.9%), HPV59 (2.2%), HPV31 (1.9%) and
HPV58 (1.9%) were less prevalent types but more likely tended to be present in multi-infections. HPV
prevalence was 77.93% (332/426) in confirmed ADC-CX, 48.39% (15/31) in Clear-cell adenocarcinoma,
26.92% (7/26) in ADC-ENDO, 48.94% (23/47) in minimal deviation, 18.75% (3/16) in Serous ADC and
36.21% (21/58) in unclassifiable cases.
Conclusion: HPV18 and 16 are found in approximately 90% HPV-positive CADC and HPV45 in another
4%. The study shows that understanding accurately HPV’s role in CADC as routinely diagnosed requires
assessing DNA quality, accuracy of diagnosis, variation in role of HPV by histopathological subtype and
multiple PCRs to detect HPV genome.

Oral 64(ID1207)
Transmission Risk and Genetic Diversity of Hepatitis C Virus Among Methadone
Maintenance Treatment Patients: A Case-Control Study
70
W. Zhoua, S. Zhoub, WH. Konga, JS. Penga, MQ. Liua, PL. Liua, RR. Songb, M. C. Chawarskic, R.S. Schottenfeldc
a Wuhan Centers for Disease Control & Prevention, Wuhan, Hubei 430015, China

b Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei 430030, China

cYale University School of Medicine, New Haven, CT 06519, USA

Background: We previously found a high rate (46.3%) of hepatitis C virus (HCV) seroconversion following
methadone maintenance treatment (MMT) entry and consequently set out to identify risk factors for HCV
transmission and evaluate genetic diversity of HCV among MMT patients in Wuhan, China.
Methods: A case-control study was conducted across HCV seroconverters (case-patients) and
non-converters (control-patients) on MMT. The demographic and behavioral information based on the
computerized database for groups was analyzed. HCV RNA was extracted from blood specimens from a
sample of 125 HCV seroconverters. HCV RNA loads were detected and the amplified sequences were
measured for computation of phylogenetic tree and genetic distance.
Results: Drug-related practices differed significantly across HCV seroconverters and non-converters on
MMT. Multivariate logistic regression identified that drug-injected administration method was the predictor
for HCV seroconversion among MMT patients (OR 3.541, 95% CI 1.470 - 8.526, p=0.005), and that
duration of MMT﹥2 years was a positively protective factor for HCV seroconversion (OR 0.297, 95% CI
0.114 - 0.771, p=0.013). Of 125 seroconverters, 3b (40%) was predominant subtype, followed by 6a (32%),
3a (12.8%), 1b (10.4%), 1a (4%) and 2a (0.8%); 45.6% was involved in clusters with genotypic distance of
0.000; the median HCV RNA load was 9.61×105 IU/mL, the median HCV RNA load of seroconverters by
drug-injected administration method differed significantly from that by drug-inhaled administration method
(1.94×106 IU/mL vs. 2.8×105 IU/mL, p=0.001).
Conclusions: The study indicated that concurrent drug-related practices among MMT patients could increase
risks of HCV infection, and that HCV genotypes among MMT patients in Wuhan presented a polymorphic
distribution. It also suggested a direct transmission of the virus among seroconverters and an elevated risk
with drug-injected administration method for HCV transmission.

Oral 65(ID1208)
Prevalence, Awareness and Control of Hypertension Among Elderly People in Wuhan, China
Fang Li, Yan Guo, Liang Wang, Chaoyang Zhu, Gang Zhang, Juan Dai, Jie Gong
Wuhan Centres for Disease Prevention and Control, China

Background: Hypertension has become a major public health concern due to enormous hypertensive
population, high risk for stroke, cardiovascular disease and kidney failure, especially among elderly people.
However, little was reported about awareness, treatment and control of hypertension among elderly people.
The aim of this study is to present the latest data about the prevalence, awareness and control status of
hypertension among elderly people with a sample of 368,870 elders aged over 65 in Wuhan, China.
Methods: Data for this study is from census of health status on all elder population aged over 65 in Wuhan,
China, funded by Wuhan Municipal Government. Data was collected by person to person interview with
structured questionnaire. The blood pressure was measured by standard method and procedure by 2010
Chinese Guidelines for the management of Hypertension. Hypertension was defined as systolic blood
pressure≥140mmHg, diastolic blood pressure≥90mmHg, or a self-reported diagnosis of hypertension and
taking antihypertensive medications. Totally 368870 elders aged over 65 participated in the study.
Results: The overall prevalence of hypertension was 60.17%. The prevalence of hypertension was
71
significantly higher in urban than in rural (62.71% vs 57.72%, p< 0.05), and significantly higher in women
than men (61.54% vs 58.59%, p<0.05), increasing with age. The awareness rate and control rate were
57.39% and 20.27% respectively, The awareness and control rates in urban were significantly higher than
those in rural (Awareness rate: 65.06% vs 49.34%; Control rate: 24.96% vs 15.34%, p < 0.05). The rate of
awareness and control were decreased with age increasing.

Conclusion: The prevalence rate of elderly people in Wuhan was high, while the rate of awareness and
control continued to be low. There is an urgent need for a comprehensive intervention program to improve
awareness and control for reducing the health threat of hypertension on elders.

Oral 66(ID1209)
Secret Inquiries About Tobacco-Free Implementation In Hubei Province
Xia Qing-hua, Yu Hui-hong, Li Ling, Qin Shi-long
Hubei Center for Disease Control and Prevention, Wuhan 430079, China

Objective: To understand effect and deficiencies of implementing tobacco-free in Hubei health system
through the secret inquires, and provide reference for this work.
Methods: Secret inquiries are carried out by taking secret shoot and filling questionnaires designed by
Ministry of Health. The analysis is made in two sides which are tobacco-free environment design and
smoking indoor phenomenon.
Results: The average score of all the health system was 42.1 point(total point:100 point). The rate of
smoking indoor was 88.6%. The average point of setting No Smoking logo was 40.3. 50.0% of the health
unites had tobacco control advertise. Only 10.5% of them provided smoking cessation service, and 17.0% of
them set smoking areas outdoor.
Conclusion: The overall status of tobacco-free in health system is not optimistic. Health administration
department should improve tobacoo control implementation and launch training and propaganda of tobacco
control.

Oral 77(ID1210)
Serum Selenium Status, Polymorphisms in Mitochondrial Superoxide Dismutase, and Risk of
Type 2 diabetes
Cheng Luo, Liegang Liu
Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of
Technology and Science

Background: Recent findings from observational cross-sectional studies and clinical trials indicate that high
selenium exposure may increase diabetes risk.
Objective: The study aimed to determine the association of serum selenium levels with the risk of diabetes
and impaired glucose regulation (IGR) in China which has areas of both excess and deficiency of selenium.
We also evaluated the relationship between diabetes and the polymorphism of MnSOD and its interactions
with serum selenium levels.
Research design and methods: We conducted a case-control study involving 2,130 T2DM patients, 809
patients with impaired glucose regulation (IGR), and 1,923 controls. Serum selenium was measured by
72
inductively coupled plasma mass spectrometry.
Results: Mean serum selenium levels were 96.6 ng/ml in participants with diabetes, 94.5 ng/ml in
participants with IGR, and 93.2 ng/ml in controls. High serum selenium level (>111.11 versus <77.60 ng/ml)
was associated with an odds ratio (OR) of 0.68 (0.50-0.94) for IGR&T2D. In spline regression models, a
U-shaped association between selenium and OR of IGR&T2D was observed. Increasing serum selenium
levels up to 85 ng/ml were associated with decreased IGR&T2D risk. Furthermore, the OR of genotypes AA
compared with VV was 3.16 for IGR&T2D (95% CI: 1.38-7.27).
Conclusions: In a sample has a wide range of selenium levels, we a U-shaped association between selenium
and OR of IGR&T2D. Participants with both low selenium level and genotypes AA are at higher diabetes
risk, further research is needed to confirm our conclusions.
Oral (ID1211)
Blood Pressure and Obesity Among Children and Adolescents
Zhong-qiang Cao, Liping Zhu, Tao Zhang, Li Wu, Youjie Wang
Huazhong University of Technology and Science, Wuhan, China

Background: There is little information regarding the obesity epidemical situation and risk factors of
childhood hypertension (HTN) in China. The present study aimed to determine the prevalence of
HTN/prehypertension (PHTN), as well as the associated risk factors, among adolescents.
Methods: A total of 88,974 adolescents from 49 middle schools in Changsha city between 12 and 17 years of
age were examined during 2009. Body weight, height, and blood pressure (BP) were measured in all
adolescents. HTN and PHTN were defined according to sex- and age-specific Chinese reference data.
Overweight and obesity were also defined according to sex- and age-specific Chinese reference data.
Results: It was determined that the prevalence of PHTN and HTN were 7.2 and 3.1%, respectively.
Furthermore, 14.6% of male adolescents were overweight and 7.0% were obese, whereas 8.6% of female
adolescents were overweight and 2.9% were obese. The risk ratio (RR) of HTN were significantly higher in
overweight (RR: 2.8, 95% confidence interval (CI): 2.6–3.2) and obese (RR: 8.7, 95% CI: 8.1–9.5)
adolescents adjusted for age, sex, and height.
Conclusions: Chinese reference data were used to evaluate BP and body mass index (BMI) of children and
adolescents. Higher prevalence of HTN was associated with higher BMI percentiles. Being overweight or
obese markedly increased the risk of both HTN and PHTN among adolescents between 12 and 17 years of
age

Oral (ID1212)
Introduction to Global Health Major Program for Undergraduates in China
Zongfu Mao, Xuan Long, Qiqiang He, Quan Wang, Lu Ma, Yuliang Zou, Xiang Hao
School of Public Health, Global Health Institute, Wuhan University , China

Wuhan University Global Health Institute established the first Global Health Major Program (GHMP) for
undergraduates in China. The goal of GHMP is to make students possessing multi-disciplinary background,
identifying major global health challenges and evaluating the critical health problems from home and abroad.
The authors defined the knowledge and competency modules for this new competency-based GHMP in the
present study. In 2011 and 2012, the authors reviewed training programs for global health undergraduate of
other universities, held several symposiums and conducted special investigations with 25 global health

73
leaders. They discussed the key roles and competencies for global health professionals in current situation.
The proceedings were analyzed and coded to identify themes. Paticipants emphasized that the education and
training priorities included the following five aspects. (1) To lay a basic foundation of medical and
sociological disciplines, and gain the capacity of knowledge integration. (2) To master multiple approaches
of epidemiology, sociology, economics and so on, and foster the ability to analyze and solve health problems
from various perspectives. (3) To understand the major disease burden and determinants of health, so as to
develop the ability of identifying and evaluating major health problems. (4) To understand the difference of
various backgrounds, work in diverse cultural and political settings. (5) To understand management theory
and practice, foster the capacity of coordination, communication and management. The curriculum will be
made according to evidenced-based education and training in these areas.

Oral (ID1213)
The Association of 23 Urinary Metals with Altered Heart Rate Variability and Coronary
Heart Disease
Wei Feng1*, Xiaosheng He1*, Siyun Deng1, Gaokun Qiu1, Chuanyao Liu1, Jun Li1, Qifei Deng1, Suli Huang1, Tian
Wang1, Jing Yuan1, Weihong Chen1, Meian He1, Xiaomin Zhang1, Haidong Kan2 and Tangchun Wu1#
*
All authors contributed equally to this work.
1Department of Occupational and Environmental Health and Ministry of Education Key Lab for Environment and

Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
430030, China; and 2School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan
University, Shanghai 200032, China.
#Corresponding author

Background: Exposure to airborne metals has been associated with altered heart rate variability (HRV) and
the development of coronary heart disease (CHD). However, studies on the association of internal
assessments of metals exposure with HRV and CHD are limited.
Objectives: We first sought to examine the potential association between urinary metals and HRV among
residents of an urban community in Wuhan of China, and then evaluated the effects of the HRV-related
metals on the development of CHD.
Methods: We measured 23 urinary metals and 5-min HRV indices (SDNN, r-MSSD, LF, HF, TP) among
1955 adults using an inductively coupled plasma mass spectrometer and a 3-channel digital Holter monitor,
respectively. Furthermore, the effects of HRV-related metals on the development of CHD were then
investigated based on a case-control study which included 112 cases and 109 controls (match on age, sex and
smoking status).
Results: After adjusting for other metals and covariates, titanium was associated with increased SDNN (P<
0.05), r-MSSD (P< 0.05), HF (P< 0.001) and TP (P< 0.001); vanadium was associated with increased LF
(P< 0.001); nickel was suggestively associated with increased HF (P< 0.10); strontium was associated or
suggestively associated with increased SDNN (P< 0.05), r-MSSD (P< 0.05) and HF (P< 0.10); and uranium
was associated with increased TP (P< 0.05). Conversely, cadmium and lead were associated or suggestively
associated with decreases in all HRV indices (all P< 0.10). Furthermore, these seven HRV-related metals
were associated with increased risk of CHD.
Conclusions: Our results indicated urinary titanium, vanadium, nickel, strontium, cadmium, lead and
uranium are associated with altered HRV. Our findings support a potential relationship between metals in air
particles and HRV. Future research is needed to elucidate the roles of multiple metals in cardiac autonomic
function and related health implications.
74
Key words: community residents, CHD, exposure, heart rate variability, urinary metals.
Funding: This study is supported by the National Key Basic Research and Development Program (973
project, 2011CB503806).

Poster 1(ID66)
Strategy to Administrate the Patient Ward of Respiratory System Far from Pollution Circle
and Polluted Streets
Han-You Xu
Workers hospital of Nanyang Textile Corporation, China

Objective: In order to promote and enhance the results of treatment and prevention for respiratory diseases
in the hospital, this research project has been done.
Methods: Summarizing the problems and shortcomings of the patient wards of respiratory system presented
at some hospitals and the pollution bad situation in China. Which the patient wards of respiratory system are
under pollution circle and polluted street. The environmental pollution can cause respiratory diseases. And so
arouses the creation of proposals for curing them.
Results: There are 6 points of proposals have been suggested. Which the main principles are that the patient
ward of respiratory system should be far from pollution circle and polluted street.
Conclusion: At the modern ecological environment or the present environmental pollution situation, the
pollution can cause diseases. Especially the respiratory patients are more easy to suffering from the
environmental pollution by the streets. In order to promote and enhance the results of treatment and
prevention for respiratory diseases in the hospital, the proposals that the patient ward of respiratory system
should be far from pollution circle and polluted street and its concrete 6 application points are suggested
which are very useful. It is much too imperative to create the law or regulations of health policy according to
the proposals to apply them at once and well. The proposals are worth to be referenced by China and foreign
countries.

Poster 2(ID163)
Prevalence of Hepatitis B Infection and Reexamination of Its Epidemiology
Deepak Singh Baisa, Chao Yanga, Liping Xub, Jyoti Singh Baisc
a Union Hospital, Tongji Medical College, HUST, Wuhan, China

b School of Electronic Information, Anhui University of Technology, Maanshan, China

c Vindhya Institute of Technology & Science, Satna, India

Background/objective: Hepatitis B is an endemic throughout the world, especially in tropical and

developing countries. Study aim was to quantify the current Prevalence of HBV infection and to reexamine
the epidemiology of HBV infection.
Methods: Review of current literature.
Result: More than 2 billion people worldwide have evidence of past or current HBV infection and 350
million are chronic carriers of the virus, which is harbored in the liver, and causes an estimated 620,000
deaths. The virus causes 60-80% of all primary liver cancer, which is one of the three top causes of cancer
death in East and South East Asia region infection with HBV is a major cause of morbidity and mortality in

75
the SEAR. More than one-third of the population has been infected with HBV, and it is estimated that there
are 80 million HBV carriers (about 6% of the total population). Many are lifelong carriers, although not all
are infectious and some clear the virus after intervals varying from many months to year. Between 5% and
10% of adults and up to 80% infants infected with HBV will become carriers. Among these, 25% will, in the
long term, develop serious liver disease. 14 to 16 million people are infected with HBV and 200,000 deaths
associated with acute HBV infection each year. HBsAg carrier’s rate is high in the general population (5 to
7%) in Bhutan, India, Nepal, Sri Lanka, Indonesia and Maldives. In India alone there are an estimated 43 to
45 million HBsAg carriers and among them 10 to 12 million also have HBeAg. Major risk factors for
Hepatitis B infection in this region are insufficient coverage of HBV vaccination, unsafe blood transfusion,
injection drug users sharing blood-contaminated equipment and inadequate health precautions.
Conclusion: Screening HBV infection during pregnancy, and follow-up of infants with HBV infected
mothers will reduce rates of perinatal HBV infection and implementing local strategies for hepatitis B
screening will reduce the infection rate in these countries.

Poster 3(ID193)
Using Case Vignettes to Assess HIV/AIDS-related Stigma Attitudes among Medical Students
in Beijing, China
Tang wenhaoa, Zheng Ziheb, Zhao Haipingc, Pang Chengd, He Yanb, Guo Xiuhuab, He Dianb
a Department of Urology, the Third Hospital of Peking University, Beijing, China

b School of Public Health, Capital Medical University, Beijing, China

c Chinese Association of STD and AIDS Prevention, Beijing, China

d Department of Medical Record, Perking Union Medical College Hospital, Beijing, China

Objective: To date, HIV/AIDS-related stigma is already deeply entrenched within Chinese people. However,
little is known about stigma attitude among medical students. Medical students are tomorrow doctors who
are on the forefront of fighting to prevent and care HIV/AIDS. This study is to assess HIV/AIDS stigma
attitudes and factors among medical students in China.
Methods: A cross-sectional study was conducted in six medical settings in Beijing. A total of 422 medical
students answered a self-administered questionnaire, which consisted of socio-demographic information,
items assessing stigma attitudes towards PLWHA and questions related HIV/AIDS knowledge. Multivariate
analysis was used to find possible factors of HIV/AIDS stigma among medical students.
Results: Despite with high level of HIV-transmission knowledge (median=11, max=13), these respondents
in this study had moderate levels stigma attitudes (median=28.6, max=60). HIV-transmission knowledge
score was not significantly correlated with HIV/AIDS-related stigma score. Participants, who were male,
from pre-clinical and had fewer self-effective score of protecting against HIV/AIDS were more likely to
discriminate against PLWHA. Medical students who majored in clinical medical had higher stigma score
than those majored in preventive medicine.
Conclusions: High level of HIV-transmission knowledge was not enough to reduce the HIV/AIDS-related
stigma, without personal experience and convincing practice model. Teaching in class and learning from
experience should be combined to improve doctors’ attitude towards PLWHA.

Poster 4(ID195)
Study on Indoor Air Quality of an University Classroom in China
Feng You, Yang Lv, Bailin Fu, Bin Che, Peng Dong, Zhiwang Ye, Qian Zhang
76
 School of Civil Engineering, Dalian University of Technology, Dalian, China

Indoor air quality not only affects the comfort and health of the human body, but also has a significant impact
on indoor work and learning efficiency. The research concentrates on the study of a university in China,
using MCH-383SD and TSI Dust Monitor to measure the air quality of classroom, with projects including
CO2 concentration, temperature, relative humidity and respirable particulate matter (PM10, PM2.5), in order to
explore the impact of CO2 concentration factors and their impact on students’ learning outcomes. The study
concludes that the biggest factor affecting college indoor air quality exceeded the indoor CO 2 concentration,
ventilation lacking and persons of the classroom overcrowding; proving that the indoor CO2 concentration
exceeded have a significant effect on students’ efficiency of learning. The continuous monitoring reflects the
growth of the indoor CO2 concentration of the number of ventilators, also higher in winter heating than in the
fall. Based on the premise of the feasibility, the paper proposed several new methods to better the indoor CO 2
concentration in college during winter.

Poster 5(ID197)
Post-abortion Care (PAC) Service Demand among Unmarried Women in Kunming: A
Hospital-based Study
Jie Zhoub, c, Xiangjing Songa, Rong Liao a, Zhuojun Zhoud, Xuyang Pan a, Hanfeng Ye a,
Ruiyu Peng a, Xiaodong Tan b
a Yunnan Institute of Population and Family Planning Research, Kunming, China

b School of Public Health, Wuhan University, Wuhan, China

c Kunming Medical University, Kunming, China

d Maria Hposital, Kunming, China

Background: Pooled literatures showed that the induced abortion in China faces many problems. The
number of induced abortion remains large and nearly half of the cases are young and unmarried women.
Routine and effective contraceptive method should be recommended and emphasized during induced
abortion meanwhile previous reproductive health service always focused on married women.
Objective: To explore unmet demands for post-abortion care (PAC) among unmarried women with induced
abortion.
Methods: A total of 156 unmarried women with induced abortion were selected from two hospitals in
Kunming from June 2011 to December 2011. All of them were face to face interviewed by the trained
investigators with the questionnaires in the hospital.
Results: The unmarried women with induce abortion was 39.29% (156) of all women with induce abortion
in these hospitals during this period. About 17.31% of these respondents had their sexual debut younger than
20 years old. Multiple induced abortions occurred in 50.00% of them. And 38.46% of current unintended
pregnancies resulted from no use of contraceptives. Among 67 unmarried women who used contraceptive,
there were 27 cases which used contraceptive in each sex intercourse. Emergency contraceptive has been
utilized by 65.38% of them, but nearly half of them had misunderstood of it. The rates of seeking for
counseling services and inquiring information about contraception from health professionals initiatively were
50.64% and 4.48%. 73.08% of these unmarried women got contraceptive form drug store or supermarket,
while 79.49% believed that they had acquired medical staffs` responses to contraceptives. Respondents` age,
educational background and initiative in counseling about contraception issues were not statistically
associated with use of contraception, while the knowledge of contraception was statistically associated with
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use of contraception.
Conclusions: Multiple-induced abortion was a serious problem among unmarried women. The unmarried
women had several misunderstanding of contraceptive providing and services. There are enormous unmet
demands for PAC services among unmarried women in China.

Poster 6(ID208)
Research on the Determinants of the Rural Disabled Person’s Behavior of Receiving
Rehabilitation
Xia Luo, Xiang Wu, Pu Bu
Anhui University, China

Background: The rural disabled persons form a special social group in straitened circumstances. They are
suffering from physical pain and mental aguish; and what makes their situation more severe, to some extent,
is the social exclusion. As a basic civil right for the disabled, rehabilitation service is an important approach
to the recovery of their health and a great help for them to step into society confidently. The objective of this
study is to survey the rural disabled people with regard to the important factors that affect their behavior of
receiving rehabilitation.
Method: 373 questionnaires were sent out and 360 questionnaires were returned (96.5% return rate). The
Regression analysis was used to analyze determinants.
Results: The Binary Logistic Regression Model showed that individual factors, family factors, disability
characteristic factors and cognitive factors had significant influence on the choice of rehabilitation for the
rural disabled. Among these factors, the variables like level of education (P<0.01), cognition of rehabilitation
demand (P<0.01), level of understanding of rehabilitation service (P<0.01), life not fully providing for
oneself (P<0.05), degree of satisfaction about work on the disabled (P<0.05) and net income of households
(P<0.1) had significantly positive correlation with the choice. While other variables like the number of the
disabled of family (P<0.01) and congenital disability (P<0.01) had significantly negative correlation with the
choice.
Conclusions: Rehabilitation for the rural disabled could be improved by raising the level of education,
paying more attention to impoverished disabled family, doing more work in publicity.

Poster 7(ID229)
Obesity, Adipose Tissue and Insulin Resistance, an Alarming Triad
Shahzad Khan, Chang Hua Wang
Wuhan University School of Medicine, Wuhan, China

Background: Obesity which is now a worldwide epidemic and is unanimously recognized as a leading cause
of Insulin resistance (IR) and its complications including type 2 Diabetes Mellitus (T2DM) cardiovascular
and cerebrovascular diseases.
Method: We review the most important revelations made during the past 2 decades related to insulin
resistance and its close relationship with the obesity and endoplasmic reticulum (ER) stress in adipose tissue.
Articles are searched from the PubMed database.
Results: Our study found that Obesity initiate a number of metabolic derangements in various tissues
including hepatic, muscle, pancreatic and adipose tissues all of which participate in increased IR. Outcomes

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of many investigations provide enough evidences about the immense role of adipose tissue in escalating
obesity associated IR. Studies demonstrate that Adipose tissue secretes important proteins including
adipokines/ (adipocyte specific cytokines or adipocytokines) such as adiponectin, leptin, resistin, IL-6, TNFα
etc. Imbalance in these adipokines not only initiate but further complicate Insulin resistance. Additionally
adipocyte’s endothelium reticulum stress (ER stress) and macrophages in adipose tissue has found
responsible as a key players behind many if not all these events. ER stress in adipocyte results in unfolded
protein response (UPR) which can initiate a viscous circle generating inflammatory metabolites leading to IR.
Furthermore these events in turn cause deranged fatty acid metabolism resulting in increased free fatty acids
level (FFA) ectopic lipid deposition which promote ER stress and inflammation. All these events finally
culminate in one end point which is IR.
Conclusion: Increased adiposity and ER stress appears the central factor initiating and maintaining cascades
of interlinked events all of which directly or indirectly results in increased IR and T2DM. Further elucidation
of these events that connect obesity, inflammation, ER Stress and insulin resistance will open new strategies
for prevention and treatment of obesity-associated metabolic, cerebrovascular and cardiovascular diseases.

Poster 8(ID242)
Approaching to Calculate the Contribution Rate of CDC’s Work on Life Expectancy with
Delphi and AHP Methods
BaojieJiang, XiaodongTan, Juan Di
School of public health, Wuhan University, Wuhan, China

Objective: To establish an index system of life expectancy and to provide a method to calculate the
contribution rate of center for disease control and prevention to the residents.
Methods: 18 experts were selected for two-round consultation to ensure the index system by using Delphi
method. The weights of each indicator in three grades and contribution rate were calculated based on analytic
hierarchy process (AHP).
Results: The appraisal system of life expectancy is ultimately established which contained 3 first-level
indicators,8 second-level indicators and 27 third-level indicators. Based on the appraisal system, we
calculated the contribution rate is 19.3%.
Conclusion: The appraisal system and the contribution rate which establish and calculate by using Delphi
method and AHP are scientific and reliable as the beneficial attempt for the scope which to calculate the
contribute rate of staffs of CDC. We also provided a feasible quantitative assessing tool for calculating the
contribution rate.

Poster 9(ID243)
KAP of the Workers OnSchistosomiasis Control in Jingjiang Section of Changjiang Waterway
Bureau
Yu Denga, XiaodongTana, YanjieLiub
aSchool of Public Health, Wuhan University, China
bGeneral Hospital of the Yangtze River Shipping, China

Background/objective: To investigate knowledge, attitude and practice (KAP) on schistosomiasis control of

workers in Jingjiang section of Changjiang Waterway Bureau, and to provide basis on intervention strategies

79
of preventing epidemic spread of schistosomiasis.
Methods: A questionnaire survey was carried out for workers’ KAP on schistosomiasis control in the
Jingjiang section of Changjiang Waterway Bureau. A total of 129 workers were surveyed.
Results: The workers’ understanding rates of schistosomiasis control reached 62.79%; the acceptance rate of
relevant schistosomiasis examinations reached 90.70% overall, and 97% of workers never took the initiative
to survey and report snails.
Conclusion: The schisosomiasis control awareness of workers in Jingjiang section of the Changjiang
Waterway Burea was qualified; however the compliance of snails surveying and reporting was relatively low.
Relevant health education intervention must be taken to maintain the existing high awareness, to raise the
compliance of snails searching and reporting and to prevent the epidemic spread of schistosomiasis.

Poster 10(ID255)
The Research of the Damage of Methyl Mercuric Chloride on rats’ Hippocampus
Zhiyan Lua, Jinwei Wub, Yongyi Bic ,Guangyuan Chena, Jianying Tiand,Raajthilaga , Firoz.K.Pa
a Zhongnan hospital, Wuhan university, China

b Hainan provincial Nongken Hospital, China

c Corresponding author, School of Public Health, Wuhan University, China

d Ningxia Medical University, China

Objective: To investigate the impacts of Methyl Mercury Chloride (MMC) on the cognitive functions,
hippocampus, and ultrastructure in Sprague Dawley (SD) rats.
Method: 30 healthy 20-day-old male SD rats weighing 30-40 grams were randomly divided into 3 groups of
10 to receive daily injections at the same time. Two dose levels were used: 4mg/kg as high dose (H-MMC),
2mg/kg as low dose (L-MMC), in addition to the control group which received 4mg/kg sodium chloride
solution (N-NaCl). After daily subcutaneous injection for 50 days, 6-day Morris water maze tests were used
to assess the learning and memory functions of test subjects. Following a 5-day training while testing, spatial
probe tests were conducted of time and paths crossing to the target quadrant on the 6 th day. After the rats
were euthanized, their hippocampus slices were stained with hematoxylin and eosin, and analyzed with light
microscope and electron microscope.
Results: The time H-MMC group rats spent in finding platform was significantly longer than N-NaCl group
on 2 to 5 days and also significantly longer than L-MMC group on 4 to 5 days. The number of crossing times
of H-MMC group rats to the target quadrant was 0.63±0.74 which is much lower than C-NaCl group
(3.13±1.56), with P-value < 0.05. No statistically significant difference was between crossing times of
L-MMC and C-NaCl. For H-MMC group, swelling and dissolution of golgi complex were examined under
electron microscope, along with endoplasmic reticulum expansion and cytoplasmic edema. L-MMC group
was examined mild cytoplasmic edema.
Conclusions: MMC can cause cognitive impairment in terms of learning and memory on SD rats, change
shape and quantify of neurons in the hippocampus, and damage cell ultrastructure.

Poster 11(ID257)
Assessing the Scientific Research Capability on Schistosomiasis in Five Schistososomiasis
Control Institutions Along the Middle and Lower Reaches of the Yangtze River in China:
Results from a bibliometricanalysis of Chinese literatures

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 Ying Wang, Xiao-dong Tan
School of Public Health, Wuhan University, Wuhan, China

Objective: The purpose of this study was to evaluate and compare the scientific research capability on
schistosomiais in five provincial-level schistosomiasis control institutions along the middle and lower
reaches of the Yangtze River in China, based on a abibliometric analysis of Chinese literatures.
Methods: A joint search of Chinese literaturespertaining to schistosomiasis published by Hunan, Hubei,
Jiangxi, Anhui, and Jiangsu provincial schistosomiasis control institutions was performed in three major
Chinese databases, including CNKI, Wanfang and VIPduring the period from 2002 to 2011. Core authors,
publication journals, publication date, and affiliations were captured.
Results: Totally 1127 Chinese literatures were captured by the 5 institutions from 2002 to 2011,with a
comprehensive influence index of 984.547. Most of the papers were published in Chinese Journal of
Schistosomiasis Control accounting for 50.5%, and the core authors based on Zhou, Liang, and Hong were
formed. Jiangsu Institute of Parasitic Diseases ranked first in all the statistical indexes. However, there was
an unbalanced phenomenon among the 5 institutions in the total status, author’s information and the
comprehensive influence index.
Conclusions:The scientific research capability on schistosomiasis along the Yangtze River valley appears a
steadily increasing tendency; however, unbalanced development is found in various regions. Cross-province
and cross-country communication and cooperation is required to improve the scientific research capability.
Poster (ID271)
Association of Iternet Use with Mental Health Among Chinese College Students
Anna Zhu, Qiqiang He
School of Public Health, Wuhan University, Wuhan, China

Objective: To detect the association of Internet use with mental health among Chinese college students.
Methods: This study was conducted from October to November 2011 among college students in Wuhan
University, China. Information for basic characteristics and Internet use was collected by self-administered
questionnaires. Self-rating Depression Scale (SDS) and the Self-rating Anxiety Scale (SAS) were used to
measure the status of depression and anxiety.
Results: A total of 1109 randomly selected freshmen (18.87±0.94 yrs) were included in the present study.
The Internet use time was 7.39±0.89 hrs. There was no significant difference in Internet use time between
males and females (males: 7.59±0.87 hrs, females: 7.18±0.91hrs, p = 0.26). The prevalence of depression
and anxiety was 10.6% and 7.7% in the study subjects, respectively. The difference of anxiety between males
and females was significant (6.8% vs 8.9% for males and females，P = 0.01), but not in depression (10.2% vs
11.0% for males and females，P = 0.39). The students who had more Internet use were more likely to be
depressed (OR = 1.64，95% confidence interval (CI) = 1.06-2.53, P = 0.02) than that of less Internet use.
Conclusions: Long Internet use may have a negative effect on mental health among Chinese college
students .Intervention strategies to reduce Internet use may improve mental health in college students, but
more researches and studies are needed.

Poster 12 (ID305)
Water and the Apothecary of Life. Chinese Online Participation in Environmental Health
81
 Communication
Cornelia Bogen
Research Center for Public Health, Medical School, Tsinghua University, Beijing/China

Background: Due to the growing number of mobile phone users doing mobile web surfing, China has
meanwhile become the nation with the largest number of internet users worldwide. Online discussions and
active participation within Chinese social networking websites and forums are quite vibrant. As people
increasingly become aware of the environmental effects of the country’s economic growth, more and more
people get concerned about pollution and its impact on health. The contamination of water, leading to
various kinds of infectious and chronic diseases, premature death or cancer, is among the most prominent
topics of discussion in present-day Chinese online health communication.
Method: By making a content analysis of current Chinese websites, forums, and microblogs that deal with
the topic of water safety, citizen and community participation in environmental health care via new media
technology are investigated. The empirical research is guided by theories of modernization based on the
difference between the economic development of society and its ecological condition.
Results: There are various websites (Chinese and foreign online newspaper articles, scientific studies) that
frankly report about the degree of water pollution in China and its relation to an increased cancer rate. Those
texts are copied, translated, and uploaded by the users in blogs and forums. Online discussions range from
the economic and socio-political causes to measures how to protect the country’s water resources. However,
the users’ access to posts that comment on cases of water pollution in hometowns or villages, including a
critical evaluation of how the local government dealt with it, is denied.
Conclusion: In order to promote the people’s trust into decision-making processes within health care politics,
online users should be given the unrestricted opportunity to report on environmental pollution. This will
probably cultivate a growing consciousness of and commitment for the need to protect natural resources
nationwide.

Poster 13(ID309)
Effect of Lycium Barbarum Polysaccharides on Rats’ Cavemous Nerve Clamping Injury
Repair
Zhizhuo Zhang, Haiyan Shao, Nanmao Dang
School of Public Health of Wuhan University, China

Objective: To investigate the effects of LBP (Lycium barbarum polysaccharide) on rats’ Cavemous Nerve
(CN) clamping injury repair and its relationship with oxidative stress.
Method: 112 SPF male SD rats were randomly divided into four groups, after clamping injury, LBP gavage
for 14d respectively 1d, 7d, 14d after modeling, saline gavage for comparison. Detected the serum
glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and malondialdehyde (MDA) content 7d,
14d, 30d, 90d respectively after modeling and the morphological regeneration status of CN were observed
90d after modeling.
Results: Compared with the control group, LBP intervention could accelerate CN repairing effect after injury,
increase GSH-Px and SOD activity and reduce MDA content. The effect was significant starting intervene 1d
after modeling.
Conclusions: LBP promote repairing effect of rats’ CN after clamp injury, and earlier intervention shows
more obvious effects.
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Poster(ID311)
The Associations Between Dietary Intake and Mental Health in Chinese College Students
Danyi Zou, Qiqiang He
Wuhan University, Wuhan, China

Background/objective: There are increasing numbers of studies revealing the mental health problem in the
college students; however the data on the association between dietary intake and mental health are
limited.The aim is to evaluate the mental health of college students and investigate the associations between
dietary intake and mental health in Chinese college students.
Methods: The study was conducted with a sample of 2382 college students (58.8% male) in Wuhan, China.
The sociological features and frequency of food intake were estimated by a 161-item questionnaire.
Symptom Checklist-90 (SCL-90) was used to assess mental health.
Results: 941 (39.5%) college students had mental health problems, with 276 (29.3%) reporting depression
and 316 (33.6%) reporting anxiety, respectively. There was a statistically significant difference between the
groups with/without mental health problem：Single-child (2=34.98, P＜0.001), Household Registration
(2=13.73, P＜0.001), Poverty student (2=17.03,P＜0.001), Living expenses per month (2=9.34, P=0.002),
Family education background (ather 2=15.06,P=0.002; mother 2=16.12,P ＜ 0.001). Students eating
barbecue and fried foods (OR=1.10, 95%CI=1.01, 1.20), sugar drinks (OR=1.17, 95%CI=1.06, 1.28) and
wine (OR=1.23, 95%CI=1.07, 1.42) with frequency >1/week were at higher risk of depression, when
compared with those who ate ≤ 1/week. And students with higher frequency food intake (>3/week) of
barbecue and fried foods (OR=1.12, 95%CI=1.03, 1.22) and sugary drinks (OR=1.21, 95%CI=1.10, 1.32)
were easier to get anxiety than those with lower frequency (≤3/week).
Conclusion: These findings implicate an inversely significant association between dietary intake of barbecue
and fried foods, sugar drinks, wine and mental health among Chinese college students.

Poster 14(ID317)
Study on the Relationship Between the Quality of Community Health Services and the
Residents’ Satisfaction in Shiyan, Hubei Province of China
Chi Yuana, Luo Yib, Yang Bingc, Meng Run-tangd , Liu Bingd
a Liaoning Medical University, Jinzhou, China

b Ningbo College of Health Sciences, Ningbo, China

c Wuhan university, school of public health, Wuhan, China

d Institute of Medicine and Nursing of Hubei University of Medicine, Shiyan, China

Objective: To understand the development of implementation of the community health services in Shiyan,
Hubei province in China, and then research the relationship of service quality and the residents’ satisfaction.
Methods: Sampling survey was conducted to access statements of relevant materials, health records,
telephone or household survey of the development of community health service, data adopted descriptive
statistics analysis, analysis of variance (one-way ANOVA), correlation analysis and stepwise regression
analysis.
Results: Residents were totality satisfied with the community health services, the residents’ satisfaction was

83
highly correlated with service quality.
Conclusion: Community health services quality have the problems of regional imbalance and township
clinics’ position not well revealed. We should further deepen the reform; give full play to the community
health services in the maintenance of the positive role of the public health.

Poster 15(ID333)
Nutrition Knowledge Awareness, Eating Behavior and Nutritional Attitude of Taxi Drivers in
Beijing, China
Linhong Yuan, Meng Sun, JinMeng Liu, Weiwei Ma, Rong Xiao
School of Public Health, Capital Medical University, Beijing, P.R. China

Background and Aim: The current number of taxis in Beijing had reached 66,000, and more than 100,000
people were employed as taxi drivers in Beijing. However, the health and nutritional status of this special
group are usually ignored. Some evidence exists regarding occupational health and safety of taxi drivers in
China, however, little is known about their nutrition knowledge awareness, eating behaviors and nutrition
attitudes.
Methods: 195 taxi drivers completed a questionnaire to collect socio-demographic, lifestyle and
occupational information, as well as their nutrition knowledge, eating behavior, and their nutrition attitude.
And SPSS statistics software was applied for statistical analysis of data.
Results: The drinking and smoking rates of taxi drivers are 63.5% and 74.6%, respectively. 75.3% drivers
work more than 10 hours, and 86.4% drivers sleep less than 8 hours per day. 60.8% of the investigated taxi
drivers are lacking of physical activity. Most of the taxi drivers are lack of general nutrition knowledge, such
as the recommendation of salt, cooking oil and calcium for Chinese adults. 43.8% and 38.1% of taxi drivers
take "cheap price" as their principal food choice criteria. A few taxi drivers consume milk or diary products,
legumes, fruits, whole grains daily, which accounting for 7.5%, 14.4%, 10.4%, and 6.5% respectively. The
proportion of subjects who can not guarantee three meals a day and regular meal intake were 17.6% and
21.4% respectively; and 22.6% subjects self-report they have no habit of eating breakfast. 470.9% of the taxi
drivers show willingness to change their unhealthy lifestyle and dietary habits; and 25.9% do not think it is
necessary to do it.
Conclusion: Deficit of nutrition knowledge, unhealthy eating behavior, and poor working condition is
common in taxi drivers. More attention should be paid on the health and nutritional education for improving
taxi drivers’ health and nutrition status.

Poster 16(ID370)
Correlation Analysis of Short-Term Air pollution and Hospital Admissions of respiratory
diseases in Wuhan, China
Chao Huang, Hao Xiang
Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China

Background: In air pollution time-series studies, research on the delayed lag pattern of the association of air
pollutants and health effects have been hot, however, still not be well investigated, largely because of limits
of worldwide data source.
Objective: To examine the association between daily air pollution levels (PM10, NO2 and SO2) and daily

84
hospital admissions of respiratory diseases in Wuhan, China.
Method: To collect daily concentrations of major outdoor pollutants (PM10, NO2 and SO2) and
hospitalizationof respiratory diseases from fourprincipal medicine centers in Wuhan since 2006 to 2008, and
conduct the association analysis by one-way retrospective case-crossover design.
Results: The overall mean concentrations of pollutants in Wuhan were 11953g/m3 for PM10, 5321g/m3 for
NO2, and 5631g/m3 for SO2. The increased risks for all-respiratory diseases admissions due to every 10g/m3
increase in PM10, NO2 and SO2 were 0.7% (95%C.I: 0.1%-1.4%), 3.1% (95%C.I: 2.0%-4.2%) and 1.2%
(95%C.I: 0.4%-1.9%) on average of three days. When stratified by sex, for all-respiratory diseases, when
stratified by sex, limited significant associations were found. We found all the three air pollutants were
significantly associated with females. In contrast, as for male, all-respiratory diseases admissions and only
PM10 and NO2 levels were significantly associated.No association between hospital admissions and levels
of PM10, NO2, SO2 for COPD were found.
Conclusion: There is a significant positive association between transient high exposure to air pollution and
hospital admissions for all-respiratory disease in Wuhan, China.Also, we showed that NO2 can remain a
serious public health problem even when its concentration is under the respective air quality standard.

Poster 17(ID416)
Effect of Laminaria Japonica Polysaccharides on Genital System Recuperation of Local
Radiation Damaged Male Rats
QihanZhao, QiongLuo, Jingjing Li
Department of Nutrirent and Food Hygene, School of Public Health, WuhanUniversity, Wuhan, China

Objective: To investigate the effect of LJP on genital system recuperationoflocal radiation damaged male
rats.
Methods: The Wistar rats were randomly divided into 2 groups, the model group and LJ P treatment group
(50 mg·kg- 1·d - 1). LJ P was applied to the treatment group for 10 d before local irradiation withγray (6. 0
Gy) ,execute rats in first day ,7th day and 14th day. The levels of serum T, LSH, FSH, E 2. organ index of
testis. superoxide dismutase (SOD) activity and malonic aldehyde (MDA) contents.
Results: LJP could make the damaged testis recover to near normal, elevate the organ index of testis and
epididymides, promote the level of sexual hormone, increase the activity of SOD and decrease the contents
of MDA in testis tissue.
Conclusion: LJP can obviously promote the genital system recuperation of local radiation damaged male
rats.

Poster 18(ID439)
Gender Differences in Healthy Homes Environments Related to Childhood Obesity in
Nanchang, China
Xiaoxu Xiea, Hongjiao Wua, Thomas Leeb, Christina M.B. Wangb, Xiaojun Zhoua, Yuanan Lua, b, Zhaokang
Yuana, Jay Maddocka, b
a School of Public Health, Nanchang University, China

b Office of Public Health studies, University of Hawaii at Manoa, Honolulu, USA

Background: Childhood obesity is rapidly increasing in China with a rates doubling between 2000 and 2010.

85
Boys (8.9%) are consistently more likely to be obese than girls (5.3%). With the country’s rapid
modernization, traditional family roles and home life changes could be contributing to this increase. The
purpose of this study was to investigate gender differences in the home environment and parental
permissiveness related to childhood obesity.
Methods: A cross-sectional survey of 522 primary caregivers of children ages 2 to 14 was conducted in four
locations in Nanchang, China in the spring of 2013 using face to face, anonymous questionnaires. Data
included socio-demographics, physical activity, media use and food environment. Differences between boys
and girls were tested using a Pearson's chi-square test, Mann-Whitney U test and Student's t test.
Results: The response rate was 86.1%. Most of the parents 287(55.0%) had boys. Boys were significantly
(p<0.05) more likely than girls to: have access to balls; have food insecurity; not have adequate space to
exercise while watching TV/Videos; watch more TV per week; be allowed take snacks/sweets or soft drinks
without permission; and to have sugary drinks at snacks and meals available. Girls were significantly more
likely than boys to: have active video games, have their parents watch them dance or play sports, to
participate in organized sports/ group activities, and have fresh fruits accessible. Parents also believed that
boys would eat too many junk foods or favorite foods if not controlled.
Conclusions: Results indicate that parents tend to be more permissive with boys than girls allowing them
access to unhealthy foods and more television time. Girls were more likely to join organized sports, have
their parents watch them be active and have fruits available in the house. These differences may be
contributing to the higher prevalence of obesity in boys in China.

Poster 19(ID502)
Correlation of ERG Over-expression with Adverse Clinicopathologic Features of Prostate
Cancer in a Chinese Patient Cohort
Yanan Zhanga, Zixuan Yangb, Pengcheng Zhub, Xuan Denga
aSchool of Public Health, Wuhan University, Wuhan, China

bTongji Medical College of Huazhong University of Science and Technology, Wuhan, China

Background: ERG over-expression has been detected in 20-70% prostate cancer patient bio-speciman. This
overexpresssion was caused by the chromosomal rearrangement that results in the fusion of ERG and other
genes, most predominantly, TMPRESS2. Although controversial prognosis indication of ERG have been
reported, present biology experiments show that ERG correlates with the aggressiveness of the tumor,
therefore it is interesting to further explore the relevance of ERG in specific clinical settings.
Method: 185 prostate cancer cases and 16 benign prostate hyperplasia cases that had prostatectomy or
biopsy between 2005 and 2012 were included in the study. ERG N-terminal mouse monoclonal antibody was
used in immunohistochemistry staining to show ERG overexpression. ERG positive status was illustrated by
causes for patients to see doctors, bio-specimen sources, patient age, preoperational PSA, Gleason scores,
invasion status and bone metastasis.
Results: Among 185 cases, 16 of them have been found positive in ERG immunohistochemistry staining.
The positive rate was only 8.5%, while the information on the neoadjuvant therapy was not available. Among
49 Prostatectomy cases, 7 (14.29%) of them were ERG positive. ERG expression was associated with
Gleason score (p=0.004) and invasion (p=0.045) of the tumor. In this study cohort, ERG positive patients
were of highest proportion (87.5%) with Gleason score 7 group.
Conclusion: Though only 8.5% ERG expression could be detected in our study cohort, this expression was
associated with Gleason score and invasion. Since the malignance functions of ERG have been characterized
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in cancer biological studies, ERG expression could serve as an indicator for needs of aggressive therapy. The
analysis of causes for patients to see doctors also suggested the importance of introduction of PCa screening
in high risk population.
Poster (ID509)
Explore the Influences on Rate of Breastfeeding at Six Months in Zhejiang Province, China
Yuanying Maa, Liqian Qiua, Meiyun Chenb, Lei Jinb, Huaying Hub, Wuping Zhangb
a Women’s Hospital, School of Medicine Zhejiang University, Hangzhou, China

b The Women’s Federation of Zhejiang Province, Hangzhou, China

Background: Breastfeeding rate is still lower than the aims of 50% for exclusive breastfeeding rate at six
months set up by China National Program of Action for Child Development. This study aims to explore the
influences on breastfeeding from birth to six months in Zhejiang Province, China.
Method: This study was conducted in nursery schools randomly chosen from 11 Administrative Region in
Zhejiang Province. Mothers who have child at around 3 years old without any diseases at birth were
recruited to complete a questionnaire delivered by trained teachers. A questionnaire was developed including
mothers’ demographic factors, their plans for breastfeeding, prenatal education of breastfeeding,
breastfeeding process during 0-6 months, breastfeeding problems and breastfeeding support. Influences
factors about breastfeeding were analyzed between two groups (Exclusive breastfeeding and not exclusive
breastfeeding) using T-test statistic and Chi-square by SPSS 16.0.
Results: There were 1277 efficient questionnaires collected. It was found the exclusive breastfeeding rate,
any breastfeeding rate and formula feeding at six month was 39.9%, 42.3% and 17.9% respectively. There
was significant difference in the variable of mean age between two groups (t=-2.78, P<0.05). Variables of
prenatal education of breastfeeding (χ2=9.300, P<0.05), cognition on importance of breastfeeding (χ2=44.258,
P<0.05) and if plan for breastfeeding (χ2=96.061, P<0.05) affected the exclusive breastfeeding rate at six
months respectively. In addition, there was significant difference if mother had breastfeeding problems
between two groups (χ2=26.820, P<0.05.)
Conclusion: The exclusive breastfeeding rate at six month was still lower than recommendation. Age,
Prenatal education of breastfeeding, cognition on importance of breastfeeding, if plan for breastfeeding and
breastfeeding problems were the influences on exclusive breastfeeding at six month in Zhejiang province,
China.

Poster 20(ID510)
Survey and Research on Health Literacy for Higher Vocational College Students in Nanyang
City
Wang weinaa, b, Tao junlianga, b, Hou yanlib, Zhang dongxianb, Hu nana, b, Man yonghonga, b, Bi yongyia
a Wuhan University School of public health, China

b Nanyang Medical College, China

Backgroud/ Objective: To preliminarily master the students health literacy in Nanyang higher vocational
colleges, and discuss the factors affecting their health literacy level.
Method: Amended the 2008 Chinese Citizens Health Literacy Questionnaire by making some additions and
deletions and work out the questionnaire fitting the higher vocational college students, and extract the
respondents meet the conditions to make field survey according to the design scheme.
Results: 1.4% college students had satisfied health literacy. Students with qualified health literacy of basic
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knowledge and concept, healthy life styles and behavior, basic skills were 3.7%, 13.0% and 35.0%,
respectively. The health literacy levels of college students differ in major, grade, gender, origin of students
and parents’ education level and differences have statistical significance.
Conclusion: Higher vocational college students are different from the ordinary undergraduate students and
they have low health literacy. We'll build information channels suitable for higher vocational college students,
and actively carry out health education work, and overall improve the health literacy level of higher
vocational students.

Poster 21(ID521)
Evaluation of the Cognitive and Behavioral Effects of a Peer Education Model-Based
Intervention to Sun safe in Children
Ping Hua, Lingli Hana, Huan Zenga, Yong Zhanga, Manoj Sharmab, Yong Zhaoa
a Public Health & Management College, Chongqing Medical University, Chongqing, China
b Health Promotion and Education, University of Cincinnati, Cincinnati, USA

Background and objective: There have been many studies that evidence the health hazards of sun safe, but
little study on Sun safe intervention model, especially in China. The objective of the study is to evaluate the
cognitive and behavioral effects of a peer education model-based intervention to sun safe.
Methods: Two primary schools were chosen out randomly in one district in Chongqing, China. Two grades
(grade four and grade five) were selected from each school, and three classes were selected from each grade
through stratified clustered sampling approach. A total of 305 students were selected out as control group and
304 students were in the intervention group. In intervention group, 36 students were selected through a rigid
evaluation process as peer educators from each class in intervention school and were trained for one month
on sun safe and skills of being peer-educator. All educational activities such as discussions, lectures,
pamphlet and competition of sun safe knowledge, were organized by peer educators for one month.
Self-designed questionnaires as the cognitive and behavioral effects of intervention to sun safe practices were
used for four times including before intervention, after intervention immediately, one month and three
months of the intervention to two groups’ students.
Results: After the intervention, sun safe knowledge scores which gained by the students from intervention
group have been remarkably improved, compared to baseline survey (p=0.0082), while the control group
students’ scores have made no difference (p=0.410). The score of better sun safe practices of intervention
was higher than that of control group at immediate, one month and three months after intervention
(P=0.000~0.022).
Conclusions: Peer model-based intervention to sun safe can improve the students’ knowledge, but has limited
effect on behavior of better sun safe.

Poster 22(ID533)
Dietary Vegetable Oil Consumption in A Rural Chinese Population and Its Relation to
Hypertension: A Cross-sectional Population-based Survey
Qiang Lia, Hong Yana, Shaonong Danga, Yaling Zhaoa, Ruihai Yangb
a Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University College of
Medicine, Xi’an, China
b Department of Cardiovascular, Hanzhong People's Hospital, Hanzhong, China

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Background/objective: High blood pressure is one of the major public health problems in China and its
prevalence is rapidly increasing recently. Lifestyle changes such as replacement of animal oil with vegetable
oil are widely recommended in the prevention and management of hypertension. But vegetable oil
consumption status and its relation to hypertension is less reported. Therefore we conducted the present study
to examine the consumption status of vegetable oil and its association with the prevalence of hypertension.
Method: In this population based cross-sectional study, stratified randomized cluster sampling method was
used and 3021 adults aged 18 to 80 years from 9 rural townships of a low socioeconomic status county in
Hanzhong prefecture, Shaanxi province, China were included. Demographic, lifestyle, and dietary habits
(including cooking oil consumption) were collected through face to face survey by trained interviewers from
October to November 2010. Blood pressure and anthropometrical measurement were performed by medical
workers.
Results: The average vegetable oil consumption per person per day was 57.54 ± 32.16(g), which were
significantly higher than the average level of 30(g) in rural Chinese population in 2002 (P<0.01). The
multi-variable adjusted ORs (95% CIs) of hypertension for the 2nd to 5th quintile of vegetable oil
consumption category versus the lowest consumption category (1st quintile) were 1.17 (0.89-1.54), 1.07
(0.83-1.38), 1.16 (0.87-1.56), and 1.38 (1.05-1.81), P for trend was 0.03. The associations were stronger in
those with family history of hypertension.
Conclusions: Dietary vegetable oil consumption was high in this rural population and it was positively
associated with the prevalence of hypertension. Recommendations for the reduction of vegetable oil
consumption should be intensified in the study area.

Poster 23(ID542)
AStudy on Equity of Health Status and Health Care Utilization of Migrant Children in Pinghu
City of Zhejiang Province
Yang Li, ShiyunHu, Hong Jiang, HuiTan, XuQian
School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University,Shanghai,
China

Background: In China, the number of migrant children continuously increases. The health of migrant
children is concerned with not only the quality of migrant population, but also the economic development
and social stability of the in-flow places. However, poorer health status and less utilization of health care
among migrant children are very common. Therefore, the analysis on health equity among migrant childrenis
important to promote equitable success to better health status and health care.
Methods: By using two-stage randomized sampling, 1168 migrant children under 3 year-old in Pinghu City
of Zhejiang Province were recruited. The questionnaires were used to collect data on health status and health
care utilization. Then equity of related health indicators were analyzed by using some statistical methods
such as Lorenz Curve, GiniCoefficient, Concentration Curve and ConcentrationIndex (CI), etc.
Result: The incoming gap of migrant family are relatively fair (Gini Coefficient is 0.34). But there is
inequity of heath among migrant children in different economic levels. 0-3year-old migrant children
fromlower incomefamilies havemore serious health problems and receiveless healthcare services: the CI of
diahrrea during previous two weeks and aneamiaare-0.018 and -0.045, which indicate the migrant children in
lower economic levels are more vulnerable tosuffer from diahrreaand aneamia; the CI of health check-up
within one-year-old and systematic management are0.011 and 0.062, showing the migrant children in higher
economic levels receivemore health care services; in addition,with the -0.018 as CI of breastfeeding to 6
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months, lower economic households conversely prefer breastfeeding than other economic level families.
Conclusion: More attention should be paid to the inequity of health status and health care utilization among
migrant children under 3 year-old. Relevant policy and interventions should be promoted to decrease the
degree of inequity.

Poster 24(ID546)
Persistent Organic Pollutants – Dioxins
Xiaohui Liang, Beibei Deng, Zhenzhu Yin, Yixin Liu, Yongyi Bi
School of Public Health, Wuhan University, Wuhan, China

Background/Objective: Environmental problem is becoming an important component of global health. The

rapid process of industrialization and urbanization leads to a variety of serious pollution problems.
Environmental persistent organic pollutants-dioxins and dioxin-like compounds, a kind of huge security risk
to human health, are concerned by the international community and public society. Due to their chemical
stability and fat tissue absorption, they can be stored in the body for a long time and can damage organs and
systems. Therefore, to fully understand related information about Dioxins is very necessary and urgent. The
objective of the paper is to shed light on reducing the releasing persistent organic pollutants and eliminating
dioxin exposure in order to better protect the ecological safety and human health.
Method: Based on publication in Chinese and English, natural characters, hazards, environmental pollution
status, mechanisms and prevention for Dioxins and dioxin-like compounds will be specified in this review.
Results: At present, it is indicated that Dioxins exist in the environment mainly from combustion processes,
especially waste incineration and traffic emissions. The main accumulating places for such compounds are in
soil and food, especially dairy products, meat, fish and shellfish. Dioxin toxicity mainly lies in the
reproductive system, immune system, skin toxicity and high carcinogenicity. The mechanism of action of
dioxin is not very clear currently, and the toxic mechanism of aromatic hydrocarbons receptor (AHR) is
widely accepted. The best way to prevent or reduce human exposure to Dioxins is aimed at the source, and
effective monitoring system should be established.
Conclusion: Current evidence suggests that Dioxins can bring long-term dangers to the environment and
human, and their harm could not be ignored. Therefore, governments need strengthen environmental
supervision and management in order to control Dioxin harms.

Poster 25(ID559)
The Status and Trend of Injury Among School Children and Adolescents in China: A
Meta-analysis
Lu Wanga, Xiao M. Yua, Hai P. Xub
a Institute of Child and Adolescent Health of Peking University, Beijing, China
b Peking University First Hospital, Beijing, China

Background: Injury is a leading cause of death among school children and adolescents, and the incidence is
increasing in China. Reducing the disability and mortality of children and adolescents caused by injury has
become a priority in public health according to MDGs. However, injury among children and adolescents
hasn't been highlighted in National Injury Surveillance System in China. This article presents a meta-analysis
to investigate changes in injury incidence among school children and adolescents in China over the past
decade, focusing on trends and risk factors.
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Method: A meta-analysis was undertaken to comprehensively review the injury of Chinese school children
and adolescents (aged from 6 to 19 years) over the past decade. Relevant data published from 2000 to 2012
in Chinese electronic databases were identified and retrieved. A combination of medical subject headings and
text words (injury, children，adolescent，student,etc.) were used. The data summarized include study design,
causes of injuries and outcomes. Analysis was performed based on set criteria.
Results: Fifty-three studies were identified. The overall estimated incidence of unintentional injury among
subjects was 26.2% (95%CI: 23.2%-30.8%), injuries caused by sharp or blunt objects (12.5%), falls (12%),
cut (7.6%), collisions (4.9%), burns and scalds (3.3%) are at the top-five. In the past decade reviewed, the
incidence of school children and adolescents engaging in injuries increased from 25% in 2000–2001 to 39%
in 2010–2011. The potentially influencing factors were associated with different regions, gender, and age.
Conclusions：The incidence of injuries among school children and adolescents is increasing over the past
decade in China, higher than the international estimate level. Efficacious monitoring and intervention
strategies need to be developed and implemented.

Poster 26(ID575)
Exploring the Training Goals and Competencies of Global Health Undergraduate Program in
China
Feifei Li, Zongfu Mao, Qiqiang He, Quan Wang, Lu Ma, Yuliang Zou, Xiang Hao
School of Public Health, Wuhan University, China

Background: With the increasing economic integration and prevalence of cross-border health issues, there
will be great potential needs for professionals in global health in China. However, there are no
comprehensive and suitable global health training programs for undergraduates in China.
Methods: We searched the published articles on Pubmed and CNKI, explored global health undergraduate
program on websites of European and American universities, and then summarized training objectives,
competencies and curriculum systematic, conducted a preliminary undergraduate program. Employing
brainstorming and focus group interviews, we invited experts at home and aboard to accomplish several
rounds of discussion and at last form a global health undergraduate program according to China’s demand.
Results: We summarized a set of Global Health undergraduate training goals and required knowledge and
competencies.
1. Training objectives: Fostering inter-disciplinary talents with global health multi-disciplinary background,
who is familiar with the main challenges of the global health problems and should be able to identify, assess
and put forward solutions of the important health issues domestic and overseas, they should work under
different culture with teamwork, good communication and coordination skills.
2. Core knowledge and competencies: (1) Understanding the major global disease burden and health
determinants; (2) Identifying and evaluating health problems so as to analyze and solve health problems with
multi-disciplinary knowledge from various perspectives; (3) Understanding the differences between different
health care systems, able to work under different political, economic and cultural backgrounds; (4)
Management and leadership skills.
Conclusion: School of Public Health, Wuhan University pioneered to standardize the training objectives and
competencies of undergraduate students of global health which might benefit in promoting the development
of global health professional training course in China by providing reference for other peer colleges.

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Poster 27(ID579)
A Study on the Mode of Medical Insurance Payment in the Context of New Medical
Reform----Based on the Empirical Research of the New Rural Cooperative Medical System in
Gansu Province
Han Xue-mei, Li Juan, Yan Qian ,Hu Qi,Shao Yu-wei,Wang Li-xian,
School of Public Health, Lanzhou University, Gansu Lanzhou

Background: The payment of social medical insurance is not only an important link of social medical
insurance system, and the payment also affect the medical behavior,and have obvious orientation or
restricting effects to the cure rate and fair in the process of cost controlling, resource allocating, medical
quality and health service. Therefore, mode of Payment reform has been the new focus problems in the
reform of medical insurance system. In order to seek a fair, reasonable and good efficiency mode of payment,
all countries want to explore the various fee payment methods in the world. In this study, through an
Empirical Study of the new rural cooperative medical care payment methods in Gansu Province, aims to
propose an insurance payment method which fits the new rural cooperative medical.
Method: Based on descriptive research and empirical method of Suzhou district in Jiuquan city and Huining
country for the implementation of the new rural cooperative analysis.
Results: It illustrates that after implemented the grouped by disease and bed day paid payment in Huining
County, the medical quality has improved and the medical institution’s Actual Co-payment Rate
increased.The farmers benefited more in Huining and Jiuquan.
Conclusions: In the process of the new rural cooperative medical care payment reform in Gansu Province,
the total amount of prepayment, by service unit costs and a range of single-DRGs are a more realistic option.

Poster28(ID586)
Study on the effect of social capital with the survival quality of HIV/AIDS
Lingling Yuan, ZhaokangYuan, Qunying Xu, Hongying Jiang, Huilie Zheng, Li Wang, Guilian Lan
Department of epidemiology and health statistics, school of Public Health, Nanchang University, Nanchang, Jiangxi,
China

Background: To explore the relationship between quality of life and social capital among people living with
HIV/AIDS (PLWHAS), analyze the effect of social capital for PLWHAS survival quality and provide the
scientific basis for PLWHAS survival quality.
Method: A face to face cross section survey was carried out. Quality of life in AIDS patients was evaluated
by Medical Outcomes Study-HIV (MOS-HIV), the status of social capital of PLWHAS was measured by
Social Capital Questionnaire (SCQ) and their demographic features which might be related with PLWHAS’s
quality of life. One-way analysis and multiple linear regression analysis were used for the results.
Results：371 PLWHAS were surveyed. Two summary scores of MOS-HIV, i.e. Mental Health Summary
Scores (MHS), Physical Health Summary Scores (PHS) of PLWHAS were 46.60±10.45 and 51.14±9.28. The
scores of social capital, trust, the ability of access to resources and social participation were 5.04±2.76,
2.18±1.30, 1.54±0.86 and 1.31±1.39 respectively. The social capital (β=0.514, P=0.010), trust (β=1.207,
P=0.004) and ability of access to resources (β=1.512, P=0.016) were protective factors associated with MHS.
Social participation (β=0.257, P=0.364) was not associated with MHS.
Conclusion: Social capital had a positive impact to PLWHAS’s mental survival quality. Construct good

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social capital is important to improve the PLWHAS’s survival quality.

Poster 29 (ID600)
Impact of Micronutrient Supplementation in Pregnancy on Prevalence of Anemia,
Birthweight, Duration of Gestation and Perinatal Mortality in Rural Tibet
Yijun Kanga, Shaonong Danga, Hong Yana, Lingxia Zenga, Duolao Wangb, Qiang Lia, Jianpeng Wangc, Ouzhu
Luobud
a School of Public Health, Xi’an Jiaotong University Health Science center, China

b Department of Medical Statistics, Faculty of Epidemiology and population Health, London School of Hygiene and

Tropical Medicine, London, UK

c The Primary Health and Maternal and Child Health Division of Health Bureau of Tibet Autonomous Region, China

d School of Medicine, Tibet University, China

Background/objective: Poor nutrition during pregnancy has adverse consequences for the mother and child
in both the short and longer term, and anemia is regarded as a major risk factor for unfavorable pregnancy
outcomes.We assessed the impact of antenatal supplementation with multiple micronutrients (MMNs)
compared with folic acid alone on hemoglobin (Hb) concentration, birth weight, duration of gestation and
perinatal mortality in rural Tibet.
Methods: A non-randomized field trial conducted in two rural counties in Tibet, rendezvous for national
minorities. All pregnant women in the counties allocated from enrolment until delivery to daily
supplementation with folic acid alone (control) or MMNs with a recommended allowance of 23 vitamins and
minerals.
Results: In rural populations in Tibet antenatal supplementation with MMNs, and continuing until delivery,
increased Hb concentration by 7.03g/l (95% CI 4.60 to 9.46 g/l) compared to control, result in a significantly
reduced prevalence of anemia in these women (RR 0.71, 95%CI 0.52 to 0.96). Duration of gestation was
0.20 weeks (95% CI -0.03 to 0.43) longer in the MMNs compared with the control. There was modestly
decreased in the incidence of spontaneous abortion in the MMNs compared to control (RR 0.53, 95%CI 0.25
to 1.13). MMNs were associated with a significantly reduced risk of preterm delivery (RR 0.41, 95%CI 0.21
to 0.77). MMNs had no effect on birth weight compared with control by 5 g (95%CI, -52.9 to 62.89 g).
MMNs was associated with decreased perinatal mortality compared with control from 38.7‰ to 22.6‰ (RR
0.50, 95%CI 0.23 to 1.07).
Conclusions: In rural populations in Tibet antenatal supplementation with MMNs were associated with
reduction of anemia in the third trimester and preterm delivery compared with folic acid. In addition, MMNs
modestly decreased the incidence rate of spontaneous abortion and perinatal mortality compared with folic
acid.

Poster 30(ID646)
Challenges in Providing Basic Public Health Services: A Case Study in Western Rural China
Yin Zhang, Minxing Chen, Jun Lu
Research Institute of Health Development Strategies, Fudan University, Shanghai, China

Objective: This study was undertaken to uncover the challenges of basic public health services (BPHS)
provided by village doctors in rural western regions, since the Chinese central government launched the New
Healthcare Reform in 2009. Data from the present study would be useful in the development of strategies to
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address these challenges and ultimately improve BPHS services.
Methodology: Six leaders of township health centers, 6 managers for BPHS in township health centers, and
82 village doctors in Y County, Guizhou province, were chosen using a purposive sampling strategy. A
mixed method design was employed to assess the challenges in BPHS delivery experienced by village
doctors.
Results: The main challenges in delivering BPHS include heavy workload, poor working conditions, low
income and lack of social security, and insufficient cooperation from the rural residents. These challenges
contribute heavily to the dissatisfaction of village doctors, and consequently worsen the quality and equity of
BPHS provision.
Conclusion: The design of the BPHS package does not account for the challenges faced by village doctor.
Government officials and policy makers should consider the barriers, and focus on improving the quality and
equity of BPHS by developing relevant strategies.

Poster 31(ID712)
How Much Do GPs Know About Family Doctor System and Are They Satisfied? – Data from
Shanghai
Zhiqun Shua, Limei Jinga,b, Xin Cuia, Zhaohui Duc, Xianguo Xuc, Xiaowen Yina
a Pudong Institute for Health Development, Shanghai, China

b Fudan School of Public Health, Shanghai, China

c Pudong Management Centre of Medical Institution , Shanghai, China

Background: As one of the important content of current medicine health system reform in China,
community health service attracts attention by the whole country. Shanghai has taken the lead role in
establishing a construction of community health service network. Realizing general practitioners’ role play as
“gatekeepers” through the implementation of family doctor system is the current primary task. The aim of
this study is to understand GPs’ cognition and satisfaction about family doctor system at the beginning of the
reform process.
Methods: A questionnaire survey on GPs’ knowledge and satisfaction about family doctor system was
conducted among 161 GPs in 8 community health service centers in Shanghai. The investigation content
includes GPs’ basic information and working condition, cognitive degree, incentive and restrictive
mechanism, occupational self-identity and satisfaction.
Results: 81.37% of GPs knew about family doctor system well. In GPs’ view, residents valued family
doctors’ quality of service (31.14%), communication skills (28.41%) and service attitude (24.55%). 26.71%
of GPs were satisfied with their current work and 13.04% were unsatisfied. 41.61% GPs thought that
performance appraisal can increasing their working enthusiasm, however 28.57% didn’t think so. Residents'
recognition (33.66%), high income (24.08%), high professional reputation and social status (22.36%) could
bring GPs a sense of achievement.
Conclusion: Most GPs knew about family doctor system well. Overall GP satisfaction with current work is
general. In the process of family doctor system implementation, the most important aspects need to be
improved are: bettering the doctor's treatment, enhancing the promotion of performance appraisal,
strengthening policy and guidance, strengthening the training of general practitioners and improve relevant
health care policies.

Poster 32(ID718)
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Effectiveness Evaluation of Capitation Reform in the New Rural Cooperative Medical Scheme
(NRCMS) Payment System Reform Based on Demanders’ Perspective
Ru Chena, Limei Jinga,b, Xin Cuia, Jiquan Loua, Ming Lic, ZhenglongNia
a Pudong Institute For Health Development, Shanghai, China

b School of Public Health, Fudan University, Shanghai, China

c Pudong District Health Bureau of Shanghai, Shanghai, China

Background: As stakeholders inNRCMS, participating farmersare playingan important roleincapitation, but

also the target population to implement measures. This study aims to evaluate effectiveness of capitation
reform in NRCMS in Pudong New Area from demanders’ perspective, and strive to meet their
maximumbenefit demand.
Methods: Pudong New Area launched the capitationreform on August 1, 2012. By collecting indicators’
related data of the benefit coverage, health service utilization, reimbursement degree, expense burden and
resistance capabilities of participant in pilot areas, and doing statistical analysis; a questionnaire was
designed to investigate the satisfaction of 660 patients in 33 community health service centersand the survey
was conducted twice in the same month in 2011 and 2012 for comparison.
Results: 1) The mean annual times of hospital visit for participating farmers from August to December in
2012 increased by 6.11% compared to the same period in 2011；hospitalization reimbursement rates
increased by 19.12% in 2012; 2) in 2012, the figures of the total outpatients expenditure and the outpatient
reimbursement rate showed a decrease of 2.37% and 3.44% respectively; The total hospitalization
expenditures and the outpatient reimbursement rate showed an increase of 1.83% and 0.18% respectively;
3)out-of-pocket medical expenditure per capita increased by 16.30% in 2012; the proportion of out-of-pocket
medical expenditure per capita in annual net income per capita decreased from 2.55% to 2.41%; 4)the
synthesized satisfaction of participating patients scored 91.33 points in 2012, and it was basically equal to
that in 2011.
Conclusion: After the implementation of the capitation, the benefit ratio and hospitalization benefit levels
were improved, and the outpatient service utilization was guaranteed. The resistance capabilities were
enhanced. Meanwhile measures to promote thecapitation reform did not affect the satisfaction of participant.
These suggest that the capitation is sustainable.

Poster 33(ID721)
Analysis of the Path to Promote Medical Students’ Humanistic Literacy
Xiaoping Dua,b, Nan Hua,b
aSchool of Public Health, Wuhan University, Wuhan, China
bNanyang Medical College, Nanyang, China

Background: Humanistic literacy is an essential part of the medical students' comprehensive qualities,
deeply affects the effect of medical practice. Building education path to the medical students' humanistic
literacy is a long-lasting but new topic, a series of problems of system engineering including the innovation
of education concept, education teaching contents, methods, means, discipline and curriculum system reform,
the construction of campus culture and so on. To entirety promote medical students' humanities literacy has
very important practical significance and long-term significance.
Methods: Amended the College Students Humanistic Literacy Questionnaire by making some additions and
deletions and work out the questionnaire fitting the medical college students, and extract the respondents
95
meet the conditions to make field survey according to the design scheme.
Results: Based on the sampling survey of medical students’ humanistic literacy, at present, the different
degrees of deficiency in humanities literacy of medical students exist. It embodied in not enough rich of the
cultural deposits of medical students, relatively lack of humanities knowledge, relatively narrow scope of
knowledge, lack of enough understanding about present social situation; some medical graduates can't
accurately write medical documents; some don’t know how to face the patients and can't effectively
communicate with the patients; some of the medical students lack in unity cooperation spirit; Some lack in
sense of achievement with less joy, etc.
Conclusion: From the aspects of teaching content, method and means, teaching staff, the campus culture,
social practice and the humanistic literacy evaluation system, we explore effective education path to improve
medical students' humanistic literacy education in the paper. There are six points, first, enriching Teaching
Content Diversity; Second, strengthening the targeted teaching methods; Three, optimizing the teaching staff
structure; four, manifesting inclusiveness of campus culture; Five, widening the space of social practice; Six,
constructing pluralistic evaluation system.

Poster 34(ID740)
What Factors Affect Residents’ Decision to Sign the Contract with family doctors? –A
Behavior Survey in Pudong New Area, Shanghai
Limei Jinga,b, Xiaoming Sunc,a, Zhiqun Shub, Jing Xuc, Junwei Wangb, Mingjun Mab
a Fudan School of Public Health

b Pudong Institute for Health Development

c Pudong New Area Health Bureau

Background: China's new round of medical health system reform is to establish primary health care system
for the community residents, the implementation of gatekeeping in primary health care is the inevitable trend.
In order to make the GPs have a gatekeeping role in the health care system, a resident contract is the first
critical step.The aim of this studyis to investigate residents and to analyze the influencing factors on the
contract rate.
Methods: A questionnaire survey on situation of residentcontract and influencing factors was conducted
among 1200 patients in 6 community health service centers in Pudong New Area, Shanghai. Logistic
regression analysis was used to identify the risk factors for residentcontract.
Results: The influencing factors for residents’ contract behavior were age (OR 1.03, 95%CI 1.02-1.04,
p<0.001), Education level (OR 0.83, 95%CI 0.75-0.93, p=0.001), communal participation of social capital
(OR 1.34, 95%CI 1.15-1.56, p<0.001), acceptance of the gatekeeping (OR 3.25, 95%CI 2.07-5.12, p<0.001),
the year of investigation(OR 2.58, 95%CI 1.92-3.47, p<0.001) and publicity (OR 1.60, 95%CI 1.39-1.85,
p<0.001).
Conclusion: The elderly and the residents with lowereducation level could be focus group of this work in
that they are more inclined to sign the contract with GPs. Residents’ communal participation of social capital
and publicity efforts for gatekeeping were important factors. Therefore advancingthis work need to
strengthen publicity on gatekeeping and enable people to mobilizesocial capital.

Poster 35(ID742)
Evaluation Study on the Effect of Participating Farmers’ Medical Expense After the

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 Implementation of Capitation Reform
XinCuia, Limei Jinga,b, Jiquan Loua, Jianjun Guc, Xiaohu Yuc, Wei Chend
a Pudong Institute for Health Development, Shanghai, China

b Fudan School of Public Health, Shanghai, China

c Pudong New Area Health Bureau

d Pudong New Area New Rural Cooperative Medical Management Office

Background: Methods of payment have always been a key part of health reform in various countries of the
world. In Pudong New Area of Shanghai, Capitation payment reform for NRCMS was implemented from
August 2012. The aim of this study is to evaluate the effect of controlling the medical expenses for
participating farmers after the implementation of this reform.
Methods: This study collected the NRCMS operational data before and after the implementation of
capitation reform. The data included 11.6 million outpatient and 51,000 inpatient records about treatment
cost, hospital visit, the amount of compensation and other data from 2011 to 2012.
Results: During August to December 2012, after the implementation of capitation reform, (1) The growth
rate of participating farmers’ total medical expense fell 9.15%comparing with the same period in 2011; (2)
the total cost of outpatient decreased 16.62% comparing with the same period in 2011; (3) The
hospitalization expenses increased 1.94% comparing with growth rate of pre-reform from January to June
2012 (23.92%), it is down significantly; (4) The medical expenditure services for an outpatient in community
health service centers per capita in 2012 is 95.67 Yuan, comparing with 108.75 Yuan in 2011, it is decreased
by 12.02%.
Conclusion: After the Capitation reform, the excessive growth of medical costs obtained a certain degree
control, and the NRCMS fund was more secure. However, this reform only made an initial mechanism of
self-restraint for community health service centers. There is still research space about how to motivate the
staff in hospitals of grade 2 and 3 to control medical expense actively.

Poster 36(ID751)
Analysis for Patients, Satisfaction with Community Health Institutions in Pudong New Area
Liu Yuanfenga, Jing Limeia,b, Ding Yea
aPudongInstitute for Health Development
bPublic School of Fudan University

Background: Evaluation has begun to carry out for all community health institutions in Pudong New Area
ever since 2007. Of which the indices for patients, satisfaction contain five elements: convenience, comfort,
economic, safety, efficiency.
Method: Based on 900 questionnaires for patients, satisfaction collected in 2012 evaluation, we have done a
fuzzy comprehensive analysis (FCA) and analysis of variance (ANOVA).
Results: It shows that 1) patients living in urban and rural areas are more satisfied than those living in
outskirts; and 2) people are still concerned about medical expenses.
Conclusions: The results indicate that community health institutions must make great efforts to attract
excellence talents, in order to supply patients with more safe and more effective medical services. At the
same time, effective measures should be taken to reduce the economic burden accompanied.

Poster 37(ID756)
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 Prevalence of Health Related Risk Behaviors Among Chinese College Students
Chen Li, Qiqiang HE
Wuhan University, Wuhan, China

Objective: The aim of this study was to investigate the prevalence of health risk behaviors and its associated
factors in a sample of Chinese college students.
Methods: This study was conducted in one university of Wuhan, China from May to June, 2012. Health risk
behaviors were obtained by self-administered standardized questionnaires, including Pittsburgh sleep quality
index, Internet Addiction Test, Self-rating depression scale and self-rating anxiety scale.
Results: A total of 1280 students were included in the data analysis. 819 (64.0%) students were males and
461 (36.0%) students were females. They ranged from 18 to 26 years old. The average age was 19.96±1.17.
466(36.4%) students reported ever smoking. The first reason for them to smoke was curiosity (40.7%). And
the second reason was bad mood (21.0%). 354 (27.7%) students smoked in dormitory. 505(39.5%) students
sported 1-2 times a week, while 138(18.6%) males and 105 (22.8%) females almost never sported (p<0.05).
728 (56.9%) students reported a good quality of sleeping, while 313 (24.5%) students reported a bad quality
of sleeping.
Conclusions: College students had a high percentage of health risk behavior practices.Several high health
risk practices were identified in the study subjects, including physical inactivity and tobacco use.

Poster (ID760)
The Association of Parental BMI and Cardiovascular Disease Risk Factors in Offspring
Yayun Xu, Qiqiang He
WuhanUniversity, Wuhan, China

Background/objective: To estimate the relationship between parental BMI and children cardiovascular
disease (CVD) risk factors.
Method: This cross-sectional studycomprised 583 pupils (242 girls) in Wuhan, Hubei Province. Parental
weight and height were self-reported and BMI was calculated. CVD risk factors [BMI, waist circumference,
hip circumference, total body fat (sum of three skinfolds), blood pressure, cardiorespiratory fitness, total
cholesterol, triglycerides, HDL cholesterol, LDL cholesterol and fasting glucose] were measured.The
relationship between parental BMI and children’s CVD risk factors was analyzed using multiple linear
regression.
Results: Maternal and paternal BMI were positively associated with children BMI (β＝0.123, P＝0.001; β＝
0.172, P<0.001), waist circumference (β＝0.252, P＝0.028; β＝0.413, P<0.001), hip circumference (β＝
0.316, P＝0.003; β＝0.425, P<0.001) respectively after controlling for total body fat. The association also
remained between maternal BMI and children waist circumference (β=0.164, P=0.021), maternal and
paternal BMI and hip circumference (β=0.205, P=0.011; β=0.194, P=0.012) after excluding obese children.
Maternal and paternal BMI were negatively related to children cardiorespiratory fitness (β＝－0.156, P＝
0.002; β＝－0.155, P＝0.001), but this relationship only persisted between mother and children after
controlling for total body fat (β＝－0.139, P＝0.001). There is no significant association between parental
BMI and other cardiorespiratory risk factor.
Conclusions: Highmaternal and paternal BMI may increase the risk of CVD in their children through higher
BMI, waist circumference, hip circumference. And children with high maternal BIM had worse
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cardiorespiratory fitness.

Poster 38(ID788)
Concerns About Air Quality and Environmental Protection Among Residents of Nanchang,
China
LianJ Zhanga, Peng Zhanga, JiaoJ Zoua, ZhiQ Jianga, Thomas Leeb, Jason Maddockb, Yuanan Lub, ZhaoK
Yuana
aSchool of Public Health, Nanchang University, Nanchang, China

bDepartment of Public Health Sciences, University of Hawaii at Manoa, Honolulu, USA

Background: Rapid economic development in China has been accompanied by serious environmental
pollution, most notably air pollution. This study is designed to understand the knowledge and perceptions of
Nanchang residents about air pollution and prevention, with the intention to promote a more active role of
government and individuals in environmental protection.
Method: A cross-sectional survey of residents was conducted in four locations in Nanchang, China between
May to June 2013, using face-to-face, anonymous questionnaires. Descriptive analysis and chi-square test
were performed to estimate the association between concerns about air quality and individual and
governmental roles in environmental protection. Five independent variables: respondent’s gender, age,
residency, education, and income, were statistically analyzed using the chi-square test.
Results: The survey was completed by 721 residents (response rate = 89.5%). Approximately 70% of the
interviewees perceived the air quality was fair or good, even though only 12.2% checked the air pollution
index regularly. More than 70% of participants believed that Nanchang government has not spent enough
resources on air pollution prevention. Almost all of the participants (>98%) showed strong support for more
government spending for improving Nanchang air quality and agreed that this is also the responsibility of
every citizen. Most respondents (78.5%) even expressed their willingness to contribute money to improve
the air quality in Nanchang, particularly from those with higher annual household income (>¥60,000). In
addition, results revealed that the majority of respondents (over 91%) worry about the effects of the air
quality on their children’s health in the future.
Conclusions: Although air pollution is getting worse in Nanchang, most respondents considered the current
air quality to be fair or good. A large percentage of citizens, especially those with higher education and
income, are strongly supportive of additional efforts to improve air quality.

Poster 39(ID829)
The Longitudinal Study of the Influence of NRCMS on the Utilization of in-hospital Service in
Rural Areas of Mainland China
JiaoJ Zou, ZhaoK Yuan, HuiL Zheng, LianJ Zhang, Xi Wang
School of Public Health, Nanchang University, Nanchang, China

Background: To study the longitudinal change of the influence of new-type rural cooperative medical
system (NRCMS) on the utilization of in-hospital service in rural areas of China, evaluate the implementing
effects of NRCMS from the angle of in-hospital service.
Method: Adopt multistage stratified random sampling method to collect research objects, selected 3 counties

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9 townships 27 administrative villages from Jiangxi province. Each sample administrative village collected
70 households as objects to carry out household survey 5 times. Adopt the rate of hospitalization, the rate of
early discharge and the rate of not in-hospital as the descriptive indexes. Single factor analyze and
multifactor logistic regression analyze were used. Dynamic analyze was used to explore the reason of early
discharge and not in-hospital.
Results: The rate of hospitalization was raised from 4.00% in base-line to 7.93% in 2012, the rate of early
discharge was decreased from 11.73% in 2006 to 5.30% in 2012, the rate of not in-hospital was decreased
from 32.90% in base-line to 3.56% in 2012 (all P value <0.05). The liner trend test of 3 indexes showed
statistically differences (P<0.05). The result of the logistic regression analysis showed that exclude other
factors, the investigation year was significantly affect the change of the rate of hospitalization and the rate of
not in-hospital (P<0.01). The rate of hospitalization was positively correlated with financing level, the rate of
not in-hospital was negatively correlated with financing level (P<0.05). The proportion of financial difficulty
for early discharge and not in-hospital were dropped significantly (P<0.05).
Conclusions: NRCMS has improved the utilization of in-hospital service significantly, but there is still room
for growth. Financial difficulty was still the mainly restrictive factor, but its restriction ability had been
weakened down greatly. We should further strengthen its financing level and focus on the health service
demand of key crowds.

Poster 40(ID865)
Survey and Research on Language Environment and Higher Vocational College Students’
Health Behavior
Nan Hua,b, Zhijiang Zhanga, Xiaoping Dua,b
aSchool of Public Health, Wuhan University, Wuhan, China
bNanyang Medical College, Nanyang, China

Background: Through the survey we want to understand and study the relationship between language
environment and students’ health behavior of Nanyang City higher vocational colleges, and discuss the
significance of promoting college language environment and guiding health education.
Methods: Adopting the method of stratified random cluster sampling from 3 higher vocational colleges in
Nanyang, choosing 650 freshmen to junior students as respondents, from March 16 to May 20, 2013, we
carried out the self-administrated on-site questionnaire survey. Combined with the practical situation of
Nanyang higher vocational college students, amended the Symptom Self-evaluation Scale - SCL90 and
Patron and Hahn's Health Assessment Scale by making some additions and deletions, the questionnaire
fitting this survey was compiled. Questionnaire content mainly includes the general information of
respondents and the specific situation of the language environment, levels of health behavior knowledge,
faith, and action.
Results: Recycling effective questionnaire 621, effective recovery rate was 95.5%. Using SPSS20.0
statistical software to analyze data, and results show that the health behaviors of college students differ in
different origin of students, commonly used dialect, parents commonly used language, age, sex, major,
family harmony degree, the Internet usage frequency, the Internet language understanding degree, campus
language environment, and the differences have statistical significance.
Conclusion: The health behavior of college students on the one hand was influenced by its growing

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language environment, on the other hand the influence from the Internet and campus language environment
on students’ present and future cannot be ignored, presenting the growing trend with age. Therefore, to
improve college campus language environment is extremely urgent, lead and develop healthy, positive,
scientific, harmonious language environment, can effectively promote the further development of college
health education and improve education quality of colleges and universities with important significance.

Poster 41(ID871)
QCC Application in the Surgical Instrument Traceability for Security Management
Shuyan Xia a, Chuanhua Yu a, Tiyu Zhao b, Hong Chen b
aWuhan University, School of Public Health, Wuhan, China
b Operating Room of Tongji Hospital, Wuhan, China

Objective: To explore the QCC (quality control circle) application in surgical instrument traceability
forsecurity management.
Methods: The QCC team was founded to take 10 implementation Strategies which are problems exploration,
activity plan, situation grasp, goal setting, factor analysis, measures formulation, measures implementation,
effect confirmation, standards development, the daily management of the setting goals. Retrospective data
collection was taken in surgical instruments defects for traceability management from August to December in
2012(control group), comparing the data from January to May in 2013 (observation group). Before QCC
team measures taken, instrument traceability defects totaling was 1,189 cases out of 14,645 cases of surgical
instruments used in 5 months in 2012. Over the same duration in 2013, instrument traceability defects were
693 cases out of 20,071 cases of surgical instruments used. Statistical analysis showed there were three main
issues should be solved first which were “damages to instrument performance”, “instruments placing in the
wrong location”, “instrument integrity damage” in total 9 instrument defects. Set its target value and
implement strategy according to the target.
Results: 1.The tangible outcomes: surgical instruments defects rate dropped from 8.12% to 3.45% (p<0.05),
there are significant differences. After a QCC, occurrence rate of damages to instrument performance
reduced from 269 to 159, instrument placing in the wrong location reduced from 165 to 115, instrument
integrity damage occurs from 151 to 80 times. 2. The intangible outcomes: scores for QCC members in 5
dimensions of QC practices, communication and coordination, brainstorming, teamwork, problem
exploration are growing.
Conclusions: QCC team adopt scientific management methods, not only can reduce the defect rate of
surgical instruments, but also can ensure the safety of surgical patients and mobilize team members
enthusiasm for work, increase the members’ ability of solving problems independently.

Poster 42(ID874)
Comprehensive Hospital Health Education on the Impact of Chronic Disease Control
Zhao yana, b
a The School of Public Health, Wuhan University, China
b Nanyang Medical College, Nanyang city, China

Background: to explore the comprehensive hospital health education on the impact of chronic disease
control.

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Methods: 120 cases of chronic disease patients met the inclusion criteria were randomly divided into control
group and observation group, control group received conventional drug therapy, observation group received
conventional drug therapy and health education training.The effects and bad life changing situation were
observed after six months of treatment.
Results: Observation group which have lower incidence of bad living habits such as moking, excessive
drinking, halophilic, high-fat diet and lack of physical exercise was statistically significant difference
compared with the control group(p < 0.05). The observation group 60 cases, 23 cases were excellent, 35
cases were effective, 3 cases had no effect, total effective rate is 95%; Control group 60 cases, 16 cases were
excellent, 28 cases were effective, 16 cases were ineffective, total effective rate is 73.3%, two groups of
cases before and after the treatment the clinical comprehensive efficacy comparison, the clinical therapeutic
effect of observation group was better than control group (p < 0.05).
Conclusion: the comprehensive hospital health education improving clinical symptoms in patients with
chronic disease is remarkable.

Poster 43(ID891)
Treatment with Wogonin to Mouse with Streptozotocin-Induced Type 1diabetes: Effects on
Adiponectin, Osteopontin and Insulin Signal Pathway in The Adipose Tissue
Tan Yang, Yongyi Bi
The school of Public Health, Wuhan University, China

Background: Type 1 diabetes mellitus (T1DM) is a serious chronic non-communicable diseases that has
been demonstrated to be associated with a kind of adipocytokines. Our previous studies showed that
wogonin has an influence on glucose regulation, The aim of this study is to investigate the effects of
wogonin on type 1 diabetic mice induced by streptozotocin (STZ) and explore the potential mechanism.
Methods: Forty male mice were randomized into five groups: control group, STZ group, wogonin 5mg
group, wogonin10mg group and wogonin 25mg group. T1DM was induced in mice by intraperitoneal
injection of STZ (100 mg/kg body weight, once daily for 5 d) ，thereafter, the body weight (BW), blood lipid,
blood glucose were measured. Serum insulin and adiponectin (ACRP30) and Osteopontin (OPN) were
assayed by enzyme-linked immunosorbent assay (ELISA). Levels of total ACRP30, total OPN, total ERK1/2,
total PKCδ and Phospho- PKCδ, total AKT and Phospho-AKT in the adipose tissue were analyzed by
Western blot. Reactive oxygen species (ROS) production in the adipose tissue was measured by
Chemiluminescence analysis.
Results: Wogonin significantly increased body weight and serum insulin, decreased blood lipid and fasting
blood glucose. Wagonin increased the ACRP30 expression in adipose tissue compared to STZ group; it also
decreased Serum OPN and adipose OPN levels; it also increased total ERK1/2 and phosphorylation of AKT
in adipose tissue but decreased PKC δ and Phospho PKC δ. Wogonin inhibited the increasing of ROS
production in the adipose tissue in STZ-induced type 1 diabetic mice.
Conclusion: Wogonin could reduce hyperglycemia and dyslipidemia in STZ-induced type 1 diabetes mice，
which is associated with the regulation of adipocytokines, ROS and insulin signal pathway in adipose tissue.

Poster (ID1166)
Investigation and Analysis of the Related Knowledge, Attitude and Behavior on AIDS of The
Fsws in Jiangsu Province, China
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 Wenzhe Maa, Yang Wena, Minghui Zhangb, Xiping Huanc, Haitao Yangc, Zhihang Penga, Rongbin Yua, Lu
Wangd, Ning Wangd, Hongbing Shena , Feng Chena
a Department of Epidemiology & Biostatistics, School of Public Health, Nanjing, China

b Zhenjiang City Center for Diasease Control and Prevention, Zhenjiang, China

c Jiangsu Province Center for Diasease Control and Prevention, Nanjing, China

d National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention,

Beijing, China

Background/objective: To understand the status of related knowledge, attitude, the practical situation of
behavior on AIDS of the female sex workers(FSWs) who work at entertainment venues in Jiangsu province
and to provide a more effective scientific evidence to prevent and control the prevalence of AIDS.
Method: 867 FSWs in three cities of Jiangsu province were interviewed by trained interviewers using
anonymous questionnaire designed by our group.
Results: Overall proportion of knowing the three HIV transmission routes was 56.5%, the rate of condom
use during the latest sexual intercourse with regular sexual partners and customers was 57% and 77.7%,
respectively, there was significant difference between these two kinds of people (χ2=73.125, P =0.000),
while different age groups were not significantly different among each other (χ2=2.753, P=0.431). Results of
a logistic regression analysis indicated that age, household location, having regular sexual partners or not and
the awareness of AIDS prevention measures were associated with condom use during the latest sexual
intercourse. Knowledge with regard to sexually transmitted diseases(STD)/AIDS of FSWs mostly come from
television (69.9%), followed by friends (45.5%). When being suspicious of developing STD/AIDS, 85.9% of
interviewees would choose to seek medical treatment from public hospitals.
Conclusions: Entertainment FSWs have a certain understanding of AIDS-related knowledge, which is not
comprehensive, however. The customers didn’t realize that using condoms can prevent STD/AIDS, therefore
raising their knowledge of preventive measures is an important factor to increase the use of condom. FSWs’
not using condoms with regular partners will lead to further spread and accelerate the prevalence of AIDS.
Further efforts should be made according to the characteristics of this group to strengthen their health
education and behavioral intervention. In practice, more flexible and comprehensive strategies should be
taken to intervene in FSWs’ behavior to control the spread and prevalence of AIDS.

Poster 44(ID899)
Challenges for Elimination of Schistosomiasis Japonica in China: Praziquantel Resistance in
Schistosoma Japonicum
Wei Wang, You-Sheng Liang
Jiangsu Institute of Parasitic Diseases; Key Laboratory on Technology for Parasitic Disease Prevention and Control,
Ministry of Health, Wuxi 214064, People’s Republic of China.

Background: Currently, praziquantel is virtually the only drug of choice for treatment of human
Schistosoma japonicum infections in China. Following long-term, repeated, and extensive use of the drug,
there is a worry about the emergence of praziquantel resistance in S. japoincum. The purpose of this study
was to investigate the likelihood of development of praziquantel resistance in S. japoincum subjected to
subcurative doses of the drug.
Methods: S. japoincum-infected mice were treated with subcurative multiple doses of praziquantel. Drug
treatments commenced 35 days post-infection, and the eggs subsequently produced by worms that had
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survived the drug treatments were used to infect snails. Eight drug-treated passages of S. japoincum in mice
were completed, with the amount of drug administered to the infected mice generally being increased with
each passage (starting from 100 mg/kg at the first passage).
Results: 67.4% and 31.9% of the Jiangsu isolate of S. japonicum at the eighth passage selected for
praziquantel resistance survived 300 and 600 mg/kg of praziquantel given 35 days post-infection, while only
28.5% and 2.6% of the worms derived from S. japonicum infections that had not been subjected to drug
pressure survived the 300 and 600 mg/kg of praziquantel treatments. In addition, 54.3% and 38.1% of the
Hunan isolate of S. japonicum selected for praziquantel resistance for 8 passages survived 300 and 600
mg/kg of praziquantel given at the same time post-infection, while 29.2% and 2.5% of those without
exposure to drug pressure were resistant to 300 and 600 mg/kg of praziquantel treatments.
Conclusions: S. japonicum subjected to drug pressure may develop resistance to praziquantel over the
course of relatively few passages, and the sustainability of the gains achieved in schistosomiasis control in
China may be seriously threatened by praziquantel resistance. Schistosomiasis elimination would be difficult
to achieve with the current control measures.

Poster 45(ID911)
An Outbreak of 2009A (H1N1) Influenza in A School — Chongqing, China, 2013
Hao Zhanga,b,c,d, Yong Xua,b, Hong Yand, Gang Lie, Quoqing Shic, Qin Lif
a Yichang municipal Center for Disease Control and Prevention, Yichang, China
b Public health research center of Three Gorges university, Yichang, China

c Chinese Field Epidemiology Training Program, Beijing, China

d Wuhan University, School of Public Health, Wuhan, China

e DianJiang county Center for Disease Control and Prevention, Dianjiang, China

f Chongqing municipal Center for Disease Control and Prevention, Chongqing, China

Background: On Mar 7, 2013, over 20 students of a school reported sick with fever and cough. We
conducted this investigation to identify the agent, mode of transmission and to recommend control measures.
Methods: We defined a suspected case as onset of fever (≥38℃) and one of the following: sore throat and
cough in any person in the school from Feb 25 to Mar 25, 2013. A confirmed case was a suspected case plus
2009A (H1N1) influenza virus isolation (+) from nasopharyngeal secretions. We searched for cases by
reviewing records of morning and afternoon inspection, records of the local hospital and interviewing
students in the school. Non-removal epidemiological model was used to predict the possible cases without
control measures and compare them with the actual incidence. We can also assess the effect of the control
measures after Mar 7 by this epidemiological model.
Results: We identified 26 suspected cases and 3 confirmed cases with the attack rate (AR) of 5.9% (29/494)
in the school during Feb 28 to Mar 11, 2013. The main signs included 100% fever, 68% cough, 52% sore
throat, 21% headache, 17% running nose, 17% fatigue, 14% sore muscle and 6.8% vomit. No death cases.
All cases were teenagers with median age of 15 (range: 12-16 ages) distributed among 7 classes with AR
ranged from 2.4% to 32%. Calculated by Non-removal epidemiological model, the incidence decreased 3.6
times, and the actual cases were 18% of the expected number after taking quarantine measures.
Conclusions: This outbreak of acute fever and cough caused by 2009A (H1N1) influenza virus. Right after
school starts is the high incidence period of 2009A (H1N1) influenza and other respiratory diseases. 2009A
(H1N1) influenza outbreak can be controlled effectively by taking morning and afternoon inspection,
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isolating patients timely, and maintaining good hand hygiene.

Poster 46(ID914)
Trend analysis of Total Health Expenditure in Western Less Developed Region, China --
Gansu Province as An Example
Xiaobin Hua,b, Yancheng Wangc, Huaiqi Wangd, Zongfu Maoa
a School of Public Health, Wuhan University, Wuhan, China

b School of Public Health, Lanzhou University, Lanzhou, China

c Department of Health of Gansu Province, Lanzhou, China

d Institute Health Education in Gansu Province, Lanzhou, China

Background: Health financing reflects the health fund inputs from all financial sources in region during
some period. Total health expenditure (THE) by source includes government health appropriation, social
health expenditure (social insurance and others), out-of-pocket health expenditure. The result of health
accounts can reflect and evaluate the amount and the change trends of THE, the composition of health
financing, the adaptability of health development to economy development in the region, and the equity on
health financing. This paper focuses on the estimation and forecast of Gansu provincial THE in order for
policy making to establish suitable health financing strategies and mechanisms.
Methods: Data were collected from Gansu Statistical Yearbook, Gansu Health Statistics Annals Reports,
and Gansu Health Financial Annual Reports from 1995 to 2011. Different analytical methods were applied to
estimate and compare the THE from different sources.
Results: The THE increased from 2.5 billion RMB in 1995 to 39.4 billion RMB in 2011. The THE Per
capita increased from 106.5 RMB to 1535.0 RMB for the same time period. The THE as a percentage of
GDP increased from 4.5% to 7.8%. According to statistical standards of Chinese national health accounts,
the proportion of government expenditure in THE increased from 22.6% in 1995 to 41.1% in 2011. The
proportion of social expenditure decreased from 33.6% to 25.2%.The proportion of out-of-pocket
expenditure increased from 43.8% in 1995 to 58.4% in 2002, then declined year by year, 33.7% in 2011.
Conclusions: "Rely on the government" financing mode in Gansu province as an example of China's
western less developed region. Although the health financing is changing to a more reasonable
composition, it still shows an inappropriate composition, insufficient public financing, and relative high
out-of-pocket expenditure. It is the most important improving public financing in western less developed
region in China.

Poster 47(ID925)
Functional Evaluation of Community Healthcare Service Centers in Nanchang Using TOPSIS
Analysis
Dehua Duana, Zongfu Maoa, Xiaojun Zhoub, Ping Huc
a Wuhan University, School of Public Health, Wuhan, China
b Nanchang University, School of Public Health, Nanchang, China

c Children's Hospital of Jiangxi Province, Nanchang, China

Objective: To investigate the service quality of community healthcare service centers in Nanchang City, and
in turn make recommendations to improve healthcare services in Nanchang city and Jiangxi Province.
Methods: Service quality of 48 community healthcare service centers in Nanchang city was evaluated using
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a survey with 16 indicators. Data were analyzed using the method of TOPSIS.
Results: (1) The C values varied from 0.115 to 0.469, with 12 centers having C values less than 0.2. (2) The
best two-way referral rate was 640.947 per 10,000, while 17 centers’ rates were 0. (3) Only 1 indicator, the
door-emergency service, received a failing score, with an average rate of 0.005.
Conclusions: (1) The overall service quality of community healthcare service centers in Nanchang city is at
an acceptable level, although some aspects need improvement. (2) The two-way referral is highly inefficient.
While the number of patients transferred from Center to hospital is very low, the transfer rate from hospital
to center is even worse. (3)The database of resident’s health status, which was developed at high cost and
contains valuable information, was poorly utilized. Increased usage of this database in the future could
enhance service quality.

Poster 48(ID949) Commented [何宁1]: ID949 从 oral 变为 poster

Relationship between Concentration Changes of Particulate Matter and Aerosol Scattering
Coefficient
Shao Haiyana, Ma Lua, Zou Yan-qinga, LI Junb, MAO Fei-yueb, SHIMA Masayukic, TAMURA Kenjid
a School of Public Health, Wuhan University, Wuhan, 430071, China

b State Key Laboratory of Information Engineering in Surveying, Mapping and Remote Sensing, Wuhan University,

Wuhan, 430072, China

c Department of Public Health Hyogo college of Medicine, Japan

d National Institute for Environmental Studies, Japan

Background: To study the relationship between concentration changes of particulate matter and aerosol
scattering coefficient.
Methods: During three study periods, Dec. 23, 2009 - Jan. 05, 2010 (winter), Mar. 23 - Apr. 05, 2010
(spring), and Jul. 23 - Aug. 05, 2010 (summer), data of aerosol scattering coefficients were captured by
Integrating Nephelometer Model 3563; in every same period, the concentrations of PM10, PM2.5 and
organic carbon (OC) and element carbon (EC) were determined in the campus of Wuhan University. The
characteristics of the seasonal changes of pollutants were described, and the relationship between
concentration changes of particulate matter and aerosol scattering coefficient was analyzed.
Results: Seasonal characteristics displayed that among of three seasons, concentrations of PM10 and PM2.5
as well as concentrations of OC and EC in winter were higher than those in spring, in summer they were
lowest. A moderate positive correlation was found between aerosol scattering coefficients and concentration
changes of PM2.5 in each season. Moreover, all of the correlation coefficients were greater than 0.6.
Multiple linear regression results showed that explanatory power to PM2.5 of regression model can reach to
75%, even to 96% in winter and summer, under controlling the temperature, relative humidity and wind
velocity.
Conclusion: The relationship between concentration changes of PM2.5 and aerosol scattering coefficient
will be affected by various environmental factors depending on the different seasons, so, under the full
consideration of environmental factors adjustment, aerosol scattering coefficient may improve the prediction
accuracy of PM2.5 concentration changes.

Poster 49(ID951)

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Knowledge, Perceptions and Acceptability of Human Papillomavirus Vaccine Among Medical
Students in Chongqing of China: A University-wide Survey
Chun-Jing Fua, Xiong-Fei Panb,c, Feng Chenb, Zhi-Mei Zhaob, Ying Wenb, Man-Dong Feib, Chun-Xia Yangb,
Xiao-Ni Zhonga
a Department of Health Statistics and Information Management, School of Public Health and Management, Chongqing

Medical University, Chongqing, China

b Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, China

c Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

Background: Medical students are future health care providers and their perspectives and attitudes are
essential for success of future HPV vaccination initiatives.
Methods: We surveyed 605 medical students from Chongqing Medical University (Chongqing, China) using
a designed and pretested questionnaire on HPV related knowledge and perceptions of human papillomavirus
(HPV) vaccination in May, 2013.
Results: 68.9% medical students were females, and 95.3% were ethnic Han Chinese. The mean age was 21.6
(standard deviation: 1.0) years old. Only 18.5% correctly answered over 14 of 22 questions on HPV related
knowledge. 71.0% were willing to receive or recommend HPV vaccination. 77.6% thought that the best time
for vaccination was before sex debut, and 34.1% considered that age 13-18 years was preferable for HPV
vaccination. Age 19-25 years was preferred by 36.8%. Consistently, 44.3% and 43.3% stated that junior or
senior middle school (or equivalent) was an optimal education stage for HPV vaccination. The most and least
selected venues for vaccination were center for disease prevention and control (29.6%) and school (8.9%).
The most frequently cited reasons against vaccination were inadequate information of HPV vaccine (58.3%)
and concerns about vaccination related complications (23.6%). 81.0% favored national HPV vaccination
program, but 54.0% of them requested government subsidy. 51.1% regarded school course as primary source
of HPV related information, and 94.0% asked for HPV related education by experts. Female students (OR:
2.52; 95% CI: 1.42-4.47) and students hoping for more HPV education (OR: 3.90; 95% CI: 1.53-9.94) were
more likely to accept HPV vaccination. An increasing trend was observed in HPV vaccination acceptability
in relation to HPV related knowledge (Ptrend=0.0002).
Conclusions: Our study shows high acceptability of HPV vaccination among medical students. However,
HPV related knowledge is lacking and should be incorporated into medical education to facilitate future
implementation of HPV vaccination in China.

Poster 50(ID962)
Quality of Life for Patients with Esophageal or Cardiac Lesion: A One-year Follow-up
Ying Wena, Xiong-Fei Pana,b, Zhi-Mei Zhaoa, Wen-Zhi Huanga,c, Feng Chena, Hui Lana, He Huanga, Man-Dong
Feia, Chun-Xia Yanga
a Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, China

b Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

c Department of Infection Control, West China Hospital, Sichuan University, Chengdu ,China

Background: The burden of esophageal and cardiac cancer remains heavy in China. The current study
examined the quality of life (QOL) for patients with esophageal or cardiac cancer at different stages and
along the timeline of treatment in China.
Methods: Patients with esophageal or cardiac lesion completed QOL-core 30 and supplemental QOL-OES
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18 before primary treatment, and at 1, 6 and 12 months after treatment. QOL was compared between groups
after adjusting for age and sex based on scores for two questionnaires.
Results: Fifty-nine patients with precancerous lesion, 57 with early stage cancer, and 43 with advanced
cancer responded to our survey. Patients with advanced cancer reported poorer QOL in most aspects of two
questionnaires than those with early stage cancer or precancerous lesion before treatment (P<0.01). Global
QOL scores before treatment and at 1 month after treatment were 70.6 ± 8.9 versus 68.8 ± 9.1 (P<0.05), 70.1
± 8.0 versus 61.1 ± 10.6 (P<0.001), 67.4 ± 11.5 versus 62.0 ± 9.1 (P<0.001) for three stages of lesions.
Thereafter, most aspects recovered gradually in precancerous lesion and early cancer patients. At 12 months,
scores for all aspects recovered to levels before treatment for patients with precancerous lesions (P>0.05),
while social, pain and insomnia scores for early stage and advanced cancer were lower than corresponding
baseline levels (difference between means>5, P<0.01). At this time point, compared with patients with early
cancer, those with advanced cancer showed poorer QOL in all function and most symptom aspects (P<0.01).
Conclusions: Patients with precancerous lesion or early stage esophageal or cardiac cancer show better QOL
than those with advanced cancer. It indicates that early detection and treatment may improve QOL for
esophageal or cardiac cancer. Target intervention and counseling may be given by health care providers
during treatment and follow-up to facilitate the QOL improvement.

Poster 51(ID1035)
The Temporal Characteristics and Trend of Hepatitis B Incidence Cases in China Based on
National Data from 2006 to 2012
Shuping Sang, Chuanhua Yu
Wuhan University, Wuhan, China

Background: There is still a large number of Hepatitis B patients in China. It is very important to
understand the epidemic characteristics of Hepatitis B and to forecast the incidence cases of Hepatitis B in
China．
Methods: Surveillance data of Hepatitis B incidence cases in China from 2006 to 2012 is used. We describe
the temporal epidemic characteristics and trend of the Hepatitis B in China, using SAS 9.2 to build ARIMA
models for the Hepatitis B and finally find out the best model, then use the model to forecast the incidence
cases of Hepatitis B in China in the future.
Results: The total incidence cases of Hepatitis B in China in 2006 is 1261735, this number becomes
1257320 in 2012. The model SARIMA( 1,0,1) ( 0,1,1)12 is established based the data and the best SARIMA
model is (1-B)(1-B12)Zt=(1- 0.73418B) (1-0.99891B)αt. It then predicts that the number of incidence cases of
Hepatitis B in China in 2013 will be less than 2012.
Conclusion: The model of ARIMA can be used to forecast incidence of Hepatitis B in China. The Hepatitis
B in China from 2006 to 2012 show the seasonal behavior and has a fluctuant tendency to reduce. The cases
of Hepatitis B in China are reported more in March and August.

Poster 52(ID1079)
How Can Educational Interventions Improve Primary Pharmacists' Competencies for Taking
Responsibility on Primary Medication Requirements: Cross-sectional Study and Interviews
Hongmin Li, Guowu Ding
School of public health, Lanzhou University, China

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Background/Objective: Unreasonable prescriptions are serious in primary China while there are
improvement medication requirements as well. It’s important and necessary to educated the primary
pharmacists for rational use of drugs in China. This study aims to recognize the education mode in existence
and explore the appropriate mode to pharmacists primary.
Methods: This study combined evidences from literatures, surveys and interviews. 1265 primary
pharmacists were investigated on what and how the training modes they already had and wanted, and 28
training experts and researchers were interviewed on what kind of education and training mode they
preferred and the obstacles to change.
Results: Main problems in primary pharmacists training mode in were identified: uneven training levels, the
lack of content’s pertinence and skills training, ignorance on the process management and insufficiency of
quality assessment and feedback.
Conclusion: One complete primary pharmacists training mode in primary was proposed on combining
scientific evidence with Chinese primary situation in the whole management process view. The complete
primary physicians training mode need these characters—a clear plan of training programs, an unified
organization to integrate the educational resources effectively, the innovation of training methods and content;
control and feedback throughout the whole management process. More attention to primary pharmacists’
requirement needed to pay and E-health methods could be used as an effective way to train the use of new
medicine and prescription analysis.

Poster 53(ID1094)
Web-Based Respondent-Driven Sampling: A Methodology Study
Jing Jing Li a, Shiyue Lia, Xinguang Chenb, Yayun Xua, Hong Yana
a School of Public Health, Wuhan University, China

bPediatric Prevention Research Center, Wayne State University, USA

Objective: Hard-to-reach or hidden population has always been a common difficulty for researchers.
Respondent-Driven Sampling (RDS) was designed to solve this problem and the web-based version of RDS
method (WebRDS) was believed an innovative better version to access the hidden group, yet few researchers
had ever tested the effectiveness and efficiency of WebRDS. In this study, we used webRDS to recruit a
sample of college student and examined whether the sample can match with true institutional proportion.
Method: We recruited 6 initial participants (seeds) and use email to send out the electronic questionnaires
using web-based RDS sampling method, and examine the final sample’s equilibrium, homophily and
compare the estimated population with true population.
Results: We found that among the nine variables investigated, five of them, which are all basic demographic
indexes, sex, birth year, race, political status, and high school location satisfying the equilibrium requirement.
And the true value of sex, race and high school location was captured by the RDS estimate of the confidence
interval (CI).
Conclusions: The results from this trial successfully proved the strong ability of estimating population
parameters of webRDS, and hence justified the effectiveness and feasibility of this quantitative method as a
reliable surveying tool. What can also be implied from these researches is that RDS method could also be
suitable for general population surveying.

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Poster (ID1096)
Association Between Eating Frequency and Blood Pressure and Lipids in Chinese Adults
Longbiao Cai, Qiqiang He
Wuhan University, Wuhan, China

Objective: To investigate the association of eating frequency and blood pressure and lipids in Chinese
adults.
Methods: Using the data from The China Health and Retirement Longitudinal Study (CHARLS), we
excluded subjects who reported hypertension and heperlipemia, The study subjects were divided into three
groups according to their eating frequency (more than three meals a day, three meals a day, less than three
meals a day). BMI (kg/m2) was calculated based on self-reported weight and height, the mean arterial
pressure (MAP) was calculated based on their systolic blood pressure (SBP) and diastolic blood pressure
(DBP).
Results: A total of 1955 subjects (982 males, aged 57.91±10.51 years) were included in the final analysis.
After adjusting for age, gender, educational level and other potential confounding factors, no significant
differences were found for SBP, DBP, and MAP in the three groups. However, subjects who ate three meals a
day had significantly higher total cholesterol (210.414±1.87 mg/dl VS. 195.80±4.34 mg/dl, p=0.002) and
high-density lipoprotein (51.36±0.56 mg/dl VS. 44.08±1.30 mg/dl, p<0.001) than those ate less than three
meals a day.
Conclusions: Eating frequency is significantly associated with blood lipids but not blood pressure in
Chinese adults.

Poster 54(ID1127)
The BLM-3AB Challenge Assay: A Micronuclei-based Method for Measuring DNA Repair
Capacity
Xiao-wen Xua, Jie Jiaoa, Yuan Suna, Guang-hui Zhanga, Jing Gaoa, Guo-qiao Zhenga, William Aub,
Michael Fenechc, Zhao-lin Xiaa
a School of Public Health, Fudan University, China

b MPH Education Center, Shantou University Medical College, China

c CSIRO Preventative Health Flagship, Adelaide, Australia

Background/objective: The health of populations occupationally exposed to genotoxicant has been the
focus of global public. Efficient DNA repair activity, which can serve as both biomarker of effect and
susceptibility, is critically important for maintaining genomic integrity and reducing risk for cancer.
Therefore, having sensitive DNA repair functional assays can be useful for identifying such abnormality
which can be applied to risk prediction and disease prevention. We have developed a version of challenge
assay to measure DNA repair capacity (DRC).
Method: Cell samples were exposed in vitro to bleomycin (BLM). Subsequently, the cell culture was
divided into two tubes with one added with 3-AB to suppress the DNA repair responses and the other
allowed to perform normal repair function. Then the DNA damage was measured using the CB-MN assay
and the DRC was calculated by the following equation: 3AB index= (MN-BLM+3AB-MN-BLM)/ MN-BLM+3AB. We
have used the assay to measure the DRC of five vinyl chloride-exposed workers, five office staffs in the
same factory and five teachers to support the feasibility of the assay.
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Result: For each individual, the MN frequency of the baseline, being treated with BLM only and
(BLM+3-AB) together increased gradually, suggesting the feasibility of the assay. The DRC varied in
populations with different environmental conditions. The mean BLM-3AB index for the three groups: VC
exposures, office staffs and teachers were 0.12±0.07, 0.40±0.01 and 0.51±0.05, respectively. Additionally,
the MN frequencies of the three groups were (8.20±4.82)‰, (3.40±1.14) ‰ and (1.20±0.84) ‰, respectively,
which was in accordance with our assumption that the higher the DRC, the lower the DNA damage level.
Conclusion: The BLM-3AB challenge assay provides a new tool to identify DRC in genotoxicant-exposed
populations. Therefore, the use of this assay contributes to the prediction of health hazards.

Poster 55(ID1129)
Myeloperoxidase Polymorphism and the Risk of Lung Cancer: Systematic Review and
Meta-Analysis
Ting Zhang, Lei Pan, Cuili Yang, Ruilin Xue, Chengcao Sun, Dejia Li
School of public health, Wuhan University, China

Background: Genetic studies have shown that multiple genetic loci may contribute to sporadic lung
cancers. Myeloperoxidase (MPO) polymorphism has been found to be associated with lung cancer. Many
epidemiologic studies have investigated the association between MPO polymorphism and the risk of lung
cancer, but the results were controversial. We therefore pooled data currently available to examine the
association between MPO polymorphism and lung cancer risk.
Methods: PubMed/Medline, EMBASE and China National Knowledge Infrastructure (CNKI) databases for
case–control studies were searched that reported on associations of MPO polymorphism and lung cancer risk.
We first performed a general analysis concerning all included studies and then the sub-analyses were
conducted upon Asian population and Caucasian population.
Results: The analysis included 23 studies. The OR of comparison between the allele of A and G allele is 0.89
(95% CI, 0.81-0.97) in the general population. The OR of comparison between AA+AG and GG is 0.91
(95% CI, 0.88–0.97). In the Asian population, the ORs of comparison between AA vs. GG, AA vs. AG+GG
and AA+AG vs. GG were 0.56 (95% CI, 0.34-0.97), 0.59 (95% CI, 0.36-0.98) and 0.86 (95% CI,
0.73-0.99). However, no associations were found in the Caucasian population.
Conclusions: The association between MPO polymorphism and lung cancer risk was further strengthened in
Asian population. We suggest researchers could re-investigate the association between MPO polymorphism
and lung cancer risk with more specific participants in Caucasian population. In the future studies, we
could focus on interactions between combined genes and environmental risk factors.

Poster 56(ID1130)
A Quantitative Survey on Perceptions of Hot Temperature Health Risks Among Residents in
Hainan Province
Xudong Li
Chinese Disease Prevention and Control Center

Objective: To investigate the residents’ perceptions of high temperatures risks to health, and explore the
related factors.
Methods: Questionnaires were used to investigate adult residents in Haikou city, Sanya city, Ding'an County
and Changjiang County, 1316valid questionnaires were collected.
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Results: The mean score of the risk perception in related to high temperatures among the resident was
2.95±0.95, the percentage of the participants who thought high temperatures was not dangerous at all,
somewhat dangerous, dangerous, more dangerous, and very dangerous to the health of oneself was 7.15%,
22.41%, 42.86%, 23.63%, 3.95%, respectively. Higher risk perception in the residents living in high
temperatures-prone areas, the Knowledgeable about high temperatures (OR=1.95, 95%CI:1.33~2.86), poor
health (OR=1.91, 95%CI:1.23~2.95), who aggravated of pre-existing illness in hot weather (OR=1.84,
95%CI:1.00~3.37).
Conclusion: There is a lack of risk perception to high temperature risks to health among the residents in
Hainan province . We should establish an effective heat health warning system in the future, and improve the
perception of the public health risk of high temperatures through effective risk communication methods.

Poster 57(ID1135)
A Study of the Microbiological Quality of Kitchen Dishcloths in Domestic Homes in China
Shen jin a, b, Zhao binxiu b, Li tao b, Ban haiqun b, Qiu xia b, Tian liang c, Ge yilin c, Chen taiyao c, Li shiyue d,
Zhang liubo b
a doctor, Wuhan university, Hubei, China

b Institute of Environment Health and Related Product Safety, Center for Disease Control and Prevention of China,

Beijing, China
c Center for Disease Control and Prevention of Shanghai, Shanghai, China

d Wuhan university, Hubei, China

To data, there have been no published information and empirical data available on the microbiological
quality of kitchen dishcloths in domestic homes in china. In this study, 1010 “in-use” kitchen dishcloths were
collected from domestic premises in Beijing and Shanghai to analyze the microbiological quality. The
aerobic plate counts for dishcloths were between 10cfu/cm2–109cfu/cm2, ranging in number from
150cfu/cm2-1.776×109cfu/cm2 (Beijing) and 62.5cfu/cm2-8.75×108cfu/cm2 (Shanghai). 19 species of bacteria
were detected from the dishcloths, most of which were conditioned pathogenic bacteria. This study found
there to be significant difference in the aerobic plate counts of dishcloths for the type, the number of the days
used, activities used for and some family factors. The results of this study highlight the potential for
contamination and risk of kitchen dishcloths in our domestic homes.

Poster 58 (ID1137)
The Analysis of the Bargaining Power between Hospitals and Health Insurers in China
Zhou Shang-cheng
Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, Hubei, China

Objective: looked for a implementation pathway with the national social health insurance negotiation.
Method: Descriptive analysis with market concentration was carried out to understand the current situation
of negotiations and bargaining with both sides.
Results: There are two aspects on the negotiations power performance between hospitals and health insurers.
On one hand, it is described for the basic situation of the negotiating parties. Comparing with international
level, China health insurers had relatively weak bargaining power, controlling costs means more backward.
On the other hand, Combined with international research, the thesis focused on the market concentration
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impact on the health care negotiations, and put Hubei empirical research as an object to confirm. The
medical services industry in Hubei Province reached 67.82 percent of market concentration, indicating a high
degree of market concentration.
Conclusion: The author suggested that public hospitals should be separated regulating and running of health
care organizations and the government should set up third-party monitoring mechanism to improve the
efficiency of health care negotiations.

Poster 59 (ID1140)
Profile of Anthropometric, Biochemical, and Body Composition Assessment of Obese
Adolescent Among Student of Hasanuddin University, Makassar, Indonesia
Nurpudji Astutia,c, Ria Qadariahb, Iriyani Harunb, Kurnia Yusufb, Nahla Eva Syariatib, Rahmawati
Syarifuddinb, Wilma Dian Todingb, Ansar Mursahac
a Nutrition Department of Medical Faculty of Hasanuddin University, Indonesia

b Nutrition Department of Public Health Faculty of Hasanuddin University, Indonesia.

c Center for Food, Nutrition and Health Research of Hasanuddin University, Indonesia.

Background/Objective: Obesity prevalence in adolescent is increasing in developed and developing country,

and this would increase the risk for early cardiovascular disease. This study was aimed to describe the
measurement profile of anthropometry, biochemical, and body composition of obesity adolescent among new
student in Hasanuddin University, Indonesia.
Method: This study was a cross-sectional study. Screening of Obese (IMT) was done to all new student.
Obese student was randomized with systematic random sampling to obtain the main sample. The chosen
samples (62 samples) was taken their vena blood to biochemical assessment and body composition using
BIA. Data were analyzed using SPSS program version 16.
Results: The study result showed that obesity prevalence among adolescent (new student) was 7.9%.
Obesity more prevalent among female (8.1%) than male (7.6%). BIA assessment showed mean of body fat
percentage and visceral fat level was 37.26±7.9% dan 11.36±2.5 respectively. Biochemical assessment
showed mean of lipid profile for total cholesterol, LDL, HDL, and Triglyceride was 181.7±33.9,
120.36±31.8, 43.7±7.7 dan 96.3±43.6, mean of HsCRP, apoB, HbA1c and GDP was 2.95±2.9, 94.12±21.3,
5.47±0.29 dan 87.4±9.5.
Conclusion: Obesity prevalence among new student adolescent is quite high. Mean of biochemical
assessment show the point in border line of normal which indicate the increasing of cardiovascular disease.

Poster 60(ID1147)
The Accumulation and Efflux of Lead Depend on ATP-dependent Efflux Pump - Multidrug
Resistance Protein 1 and Glutathione in Testis Sertoli Cells
Shaoxin Huanga, Jingping Yea, Jun Yua, Li Chena, Hong Wanga, and Chunhong Wanga, b
aDepartment of Toxicology, School of Public Health, Wuhan University, Wuhan, PR China

bHubei Biomass-Resource Chemistry and Environmental Biotechnology Key Laboratory, Wuhan, PR China

Background: Lead poisoning has been recognized as a major public health risk, one of the reasons for lead
toxicity is accumulation in cells, lead excretion is crucial for organisms to survive the toxicity. In this study,
mouse testis sertoli cell line (TM4 cell) was used to explore the lead accumulation characteristic, and the
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relationship between lead excretion and ATP-dependent efflux pump - multidrug resistance protein 1
(MPR1).
Methods: Treaded with diverse doses of lead acetate, CCK8 was used to evaluate the cell activity. With
either MK571 or lead acetate, calcein AM (a fluorescent MRP substrate) was used to assess whether TM4
cells possess MRP-like transport activity through a microplate reader. After incubated in 20μM lead acetate
medium 24h, cells were further incubated with lead acetate-free medium and with or without MK571, BSO,
EA and NaN3 for 0, 1, 3, 6, 9 and 12h, and contents of cellular lead were quantified by atomic absorption
spectrometry respectively. The relationship between lead transportation and MRP1 was further confirmed by
Real time PCR.
Results: The accumulation of lead in TM4 cells was dose-dependent by adding lead acetate, but lead level
was higher in the 12h point than in the 24h point at the same dose groups. TM4 cells possess MRP-like
transport activity and lead could induce MRP-like transport. After changed to incubate with lead acetate-free
medium, energy inhibitor NaN3 could block lead efflux from TM4 cells; lead contents both in MRP specific
inhibitor MK571 and in GSH biosynthesis inhibitor BSO group were also all significantly higher than those
in control cells at 3, 6, 9 and 12h points. The expression of MRP1 mRNA was significantly up-regulate in
cells treated with lead until for 24h.
Conclusions: These mean that the accumulation and efflux of lead were dependent on MRP1 and GSH in
TM4 cells.

Poster 61(ID1151)
Research and Evaluation on the Psychologyof HIV/AIDS Patients
Wang Zhenkuna,b, Yu Chuanhuaa,b, He Qingc, Wang Jiajid
a School of Public Health, Wuhan University, China

b Global Health Institute, Wuhan University, China

c Faculty of Education, Hubei University, China

d School of Public Health, Guangzhou Medical University, China

Objective: To investigate the psychological health status of HIV/AIDS patients, and to provide scientific
evidence for interventions, social support and improvement inlife qualityfor HIV/AIDS patients.
Method: 250 HIV/AIDS patients who have been treated in hospitals of three pilot areas of HIV/AIDS Care
and Treatment Project of Hubei Province since 2004, were investigated by questionnaires mainly based on
Symptom Checklist 90(SCL-90).Participants were investigated twice (12/2009 and 12/2010)in the unified
way.
Results: 1.The SCL-90 results of HIV / AIDS patients: The scores of total and other nine factors of
HIV/AIDS patients are significantly higher than them of national adult norms. Compared with the former
one,the latter result revealed other scores are increased significantly except that there is no significant
difference in depression.The scores of total and other nine factors of SCL-90 in two surveys are highly
correlated.2.The comparison of SCL-90 rating scale results of HIV /AIDS patients with different
characteristic:Scores of total and obsessive-compulsive symptoms, interpersonal sensitivity, depression,
anxiety, and hostility factor in different age groupsare significantly different. Terrorist factors of different age
groups areonly significantly different in the previous investigation; Except somatization,other factors of the
SCL-90 scales in different gendergroups have no significant differences;and on somatization factor,female
patients only score higher than male patients in the latter survey; All factors in SCl-90 scale in different
marital statusgroups also have no significant differences; Interpersonal sensitivity, psychoticism, phobic
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scores in different cultural levelgroupsare significantly different, and total score and obsessive-compulsive
symptoms, anxiety, paranoia performance of them areonly significantly different in the first survey; Each
factor between HIV-infected and AIDS patients have no significant difference except anxiety. AIDS patients
only score higher than HIV patients in the latter survey on the anxiety factor.
Conclusions: HIV/AIDS patients have various psychological problems and these problems are highly
correlated. The positive rate of mental problems is up to 70%. They need psychological counseling, but they
are passive about it. Both survey results display the scores of total and other nine factors are significantly
higher than national adult norms.And compared with the former one,the latter result revealed other
psychological symptoms are getting worse except depression status.In addition to the influence of HIV
infection,the psychological reactions and psychiatric disorders of HIV/AIDS patients have correlation with
age and cultural degree, but have no correlation with gender, marital status, the stage of the disease.

Poster 62(ID1153)
Dietary Flavonols and The Risk of Pancreatic Cancer: A Meta-analysis of Prospective Cohort
Studies
Lei Pan, Ting Zhang, Cheng-cao Sun, Cui-li Yang, Rui-lin Xue, De-jia Li
School of Public Health, Wuhan University, Wuhan, China

Background: Flavonols are a class of flavonoids, polyphenols, which are ubiquitous in plant foods and may
exert cancer preventive effects, but clinical and epidemiological studies suggest inconsistent association
between intake of flavonols and pancreatic cancer. So a systematic literature research and meta-analysis were
conducted to assess the association of intake of flavonols and pancreatic cancer.
Method: We searched Pubmed databases for English-langue studies up to August 2013, and included cohort
studies on the association between intake of flavonols and pancreatic cancer, and with some manual search to
improve the retrieval. Heterogeneity analysis and sensitivity analysis were conducted to verify the stability of
the results. Finally the publication bias was inspected.
Results: We finally included four studies which involves 751090 participants and 3540 pancreatic cancer
cases. The summary relative risk (RR) of pancreatic cancer for the highest intake of flavonols compared with
the lowest is 0.97 (95% confidence interval (CI): 0.87, 1.09). Furthermore, in subgroup analyses, Follow-up
period: > 11 years and 2 article dietary flavonols and the risk of pancreatic cancer RR is 0.82, 95% CI (0.62,
0.62); 11 years or less, 2 article RR is 1.02, 95% CI (0.91, 0.91). According to the location, 3 study groups in
the United States, dietary flavonols and pancreatic cancer risk RR is 1.04, 95% CI (0.92, 1.17). There is no
relationship between dietary flavonols intake and risk of pancreatic cancer.
Conclusion: The present meta-analysis indicates that intake of dietary flavonols is not associated with the
reduced risk of pancreatic cancer.

Poster 63(ID1154)
Can We Improve Actively Life Quality for Maternal? An Attempt to Reasonable Indexing for
Intrahepatic Cholestasis of Pregnancy
Dan Deng, Min Ding
College of Public Health and Management, Chongqing Medical University

115
Objective: Aimed at improving maternal quality of life by exploring the superior classification model of
intrahepatic cholestasis of pregnancy (ICP).
Methods: Between the normal maternal and ICP maternal, fifteen kinds of serum bile acid were analyzed by
combining modern classification technology and receiver operating characteristic curve method in SAS
software.
Result: The optimal biomarker of ICP, which is the combination of glycocholic acid (GCA), taurocholic
acid (TCA), glycochenodeoxycholic acid (GCDCA) and CG, had also been advanced. The normal maternal
and patients with mild and severe ICP had been distinguished ideally.
Conclusions: A simple, sensitive, and specific classification model of ICP has been developed. It shall
scientific guide the amendment of intrahepatic cholestasis treatment guidelines (version 1). Also say, it shall
be very important for reasonable choice of delivery mode for maternal, accurate judgment the timing of the
pregnancy termination and effective improvement the prognosis of perinatal children.

Poster 64(ID1155)
Research and Evaluation on the Psychologyof HIV/AIDS Patients
Wang Zhenkuna,b, Yu Chuanhuaa,b , He Qingc, Wang Jiajid
a School of Public Health, Wuhan University, China

b Global Health Institute, Wuhan University, China

c Faculty of Education, Hubei University, China

d School of Public Health, Guangzhou Medical University, China

Objective: To investigate the psychological health status of HIV/AIDS patients, and to provide scientific
evidence for interventions, social support and improvement inlife qualityfor HIV/AIDS patients.
Method: 250 HIV/AIDS patients who have been treated in hospitals of three pilot areas of HIV/AIDS Care
and Treatment Project of Hubei Province since 2004, were investigated by questionnaires mainly based on
Symptom Checklist 90(SCL-90).Participants were investigatedtwice(12/2009 and 12/2010)in the unified
way.
Results: 1.The SCL-90 results of HIV / AIDS patients: The scores of total and other nine factors of
HIV/AIDS patients are significantly higher than them of national adult norms. Compared with the former
one,the latter result revealed other scores are increased significantly except that there is no significant
difference in depression.The scores of total and other nine factors of SCL-90 in two surveys are highly
correlated.2.The comparison of SCL-90 rating scale results of HIV /AIDS patients with different
characteristic:Scores of total and obsessive-compulsive symptoms, interpersonal sensitivity, depression,
anxiety, and hostility factor in different age groupsare significantly different. Terrorist factors of different age
groups areonly significantly different in the previous investigation; Except somatization,other factors of the
SCL-90 scales in different gendergroups have no significant differences;and on somatization factor,female
patients only score higher than male patients in the latter survey; All factors in SCl-90 scale in different
marital statusgroups also have no significant differences;Interpersonal sensitivity, psychoticism, phobic
scores in different cultural levelgroupsare significantly different,and total score and obsessive-compulsive
symptoms, anxiety, paranoia performance of them areonly significantly different in the first survey; Each
factor between HIV-infected and AIDS patients have no significant difference except anxiety. AIDS patients
only score higher than HIV patients in the latter survey on the anxiety factor.
Conclusions: HIV/AIDS patients have various psychological problems and these problems are highly
correlated. The positive rate of mental problems is up to 70%. They need psychological counseling, but they
116
are passive about it. Both survey results display the scores of total and other nine factors are significantly
higher than national adult norms.And compared with the former one,the latter result revealed other
psychological symptoms are getting worse except depression status.In addition to the influence of HIV
infection,the psychological reactions and psychiatric disorders of HIV/AIDS patients have correlation with
age and cultural degree, but have no correlation with gender, marital status, the stage of the disease.

Poster65(ID1156)
The Networks of Sheep Movements in Three Counties of China and the Implications of
Network Properties for Brucellosis Spread
Yangli Wua, Peng Lia, Youming Wangb, Ling Haoa, Yin Lib, Jinhua Lib, Baoxu Huangb, Chuanhua Yua,
Xiangdong Sunb
a Public Health Collage of Wuhan University /Global Health Research Center of Wuhan University, Wuhan, China

b China Animal Health and Epidemiology Center, Qingdao, China

Long-distance dissemination of brucellosis is attributed to livestock movements, especially of sheep. Besides,

the risk of brucellosis outbreak in different regions is not the same because the diversity of livestock
movement patterns. In this survey study, we constructed directed sheep movements networks of different
regions in Inner Mongolia to understand epidemiological properties of these networks, and to find out key
points of brucellosis prevention in different networks. The agricultural region network we constructed was
reticular while the pastoral region network presented many "snow-like" structure. And the farming-pastoral
region network had both the characteristics of agricultural and pastoral region networks. The "small world"
properties of agricultural and farming-pastoral region networks indicated the higher risk of brucellosis
outbreak. The majority of influential nodes in agricultural region were farm while sheep traders were
influential nodes in pastoral region and farming-pastoral region. Targeted removal of nodes based on the
betweenness centrality improved the properties of all the three networks, the risk of brucellosis outbreak
declined.

Poster 66(ID1158)
Analysis of Needlestick and Sharps Injuries Among Nurses in A Chinese Teaching Hospital
Xujun Zhang
Southeast University Injury Prevention Research Institute, School of Public Health, Southeast University, Nanjing,
China

Background: Needlestick and sharps injuries are major occupational injury to health care workers
worldwide. Contaminated needles and sharps are the most common cause of transmitting blood or body
fluids borne infections between patients and health care workers. Despite this fact, the epidemiology of NSIs
among registered nurses and nursing students has not been clearly elucidated in China.
Methods: Needlestick and sharps injuries questionnaire was conducted among nurses. We surveyed a large
cross-sectional of nurses from a teaching hospital in Nanjing, China. Descriptive statistics, prevalence, χ2
analyses and logistic regression were used to analyze the data.
Results: From 463 nurses, 402 valid questionnaires were obtained (overall response rate 86.8%). A total of
261 (64.9%) nurses reported a needlestick or sharps injuries. Needlestick and sharps injuries were more
common among females, young nurses, nursing students, surgical nurses and junior nurses. Logistic
regression analysis suggesting that age and work department to increase the risk of needlestick and sharps
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injuries was independent. By causative devices, syringe needle accounted for the highest proportion of all
needlestick and sharps injuries (59%), followed by glass items (22%), and trocar core/catheter wire (4%).
Compared with registered nurses, a significantly higher proportion of nursing students reported needlestick
and sharps injuries from giving injections and discontinuing intravenous lines.
Conclusions: Needlestick and sharps injuries remain an important occupational hazard issue for Chinese
nurses. Programs need to be developed to prevent injuries caused by needlestick and sharps.

Poster 67(ID1163)
Study on Happiness Level and Its Influencing Factors of College -graduated Migrant Workers
Bing Cao, zhengce Wan, Jing Tang, Jiahui Ma, Songli Wu, Xingtian Liang, Xiaoni Zhong
School of Public Health and Management of Chongqing Medical University, Chongqing, China

Objectives: To investigate the happiness level of College –graduated migrant workers, detect explore the
influence factors and discuss the measures to improve their degree of happiness under the current policy and
economic conditions.
Methods: Using self-designed questionnaires and the Campbell Well-being Index Scale to investigate 361
College –graduated migrant workers in Chongqing, Shandong, Hubei, Hebei and Shanxi provinces. Data
analysis involved the use of SAS 9.1 software.
Results: The average happiness level index of College –graduated migrant workers was 7.94±2.23, Single
factor analysis indicated that happiness level statistical differences of different life working condition,
psychological condition, social support and social integration of College –graduated migrant workers (P <
0.05), and the multi-factors unconditioned logistic analysis suggested that the College –graduated migrant
workers happiness level is lower (P < 0.05) for those suffering from chronic diseases, with
lower-than-expected monthly income, deteriorating mental condition, high anxiety or high irritability,
disharmony with family and the lack of support and approval from family regarding their current
employment.
Conclusion: College –graduated migrant workers are the new emerging forces for economic development in
China. Their happiness level are influenced by the type and nature of their work, lifestyle, psychological
status, social support, social integration and so on. In addition to the workers striving diligently to improve
their own conditions, the government and society should pay more attention to their current livelihood and
working condition, strengthen their material guarantee , and at the same time ,provide professional skills
training, raise their income level, pay attention to their psychological needs, provide equitable treatment to
College –graduated migrant workers, to improve their level of social integration, so as to elevate their level
of happiness.

Poster 68(ID1168)
Direct Costs and Related Factors in Patient with Hepatitis B of Jiangsu Province, China
Hua Zhanga, Jianqian Chaoa, Liguo Zhub, Long Songa, Pei Liuc
aDepartment of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China
b Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China.

c Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China

Background/objective: The objective of this study was to measure the direct costs and factors influencing
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the costs in patients with chronic hepatitis B, and provide evidence for the development of health policy.
Method: We conducted a survey of outpatients and inpatients with HBV-related diseases in county hospitals
of three model regions for infectious disease prevention and control in Jiangsu Province, China between
August 1, 2012 and December 31, 2012. Spss19.0 (SPSS Inc., Chicago, IL, USA) was used for the statistical
analysis, sample data of 436 outpatients and 196 inpatients were analyzed.
Results: The average direct costs for HBV-associated admissions were calculated to be US $107.11 for
outpatients, of which drug fees accounted for 74%, and US $3323.82 for inpatients, of which direct medical
costs accounted for 96%.Drug fee, examination fee and antiviral therapy were the main parameters of
outpatients direct costs in a linear regression analysis, while hospitalization days, drug ratio and age were the
main parameters for inpatients direct costs.
Conclusions: The study found that direct costs of patients with hepatitis B-related diseases of Jiangsu
Province were heavy. Further adjustments to outpatient compensation policy, reasonably shorter inpatient
hospital stay, controlling drug costs, slowing disease progression would help to reduce the economic burden
of disease.

Poster69(ID1171)
A Systematic Review on Food Lead Concentration and Dietary Exposure in China
Yingliang Jina,b,c, Pei Liua,b,c, Jie Mina,b,c, Cannan Wangb,c,d, Jinfang Suna,b,c , Yafei Zhanga,b,c
a Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, China
b Institute of Food Safety and Risk Assessment, Southeast University, China

c Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Southeast University, China

d Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, China

Background/objective: This paper is to review the available surveillance data from studies reporting the
contamination surveillance of food lead in China.
Method: Relevant studies were identified by systematically searching CBM and CNKI electronic databases
using the key term of ‘lead’ for surveillance data published in Chinese between 2006 and 2012. To avoid
potential selection bias, all articles were evaluated by two independent reviewers and disagreements were
resolved by discussion or the third author was asked to arbitrate. Of 269 identified publications on
surveillance data of lead in food, 43 articles met the defined inclusion criteria. The food samples were
divided into 11 food groups (cereal grains and pulses, fish, eggs, vegetables, meat, edible fungi, milk and
dairy products, fruits, offal, tea and preserved egg). Surveillance data of publications were reviewed to
calculate the weighted mean and rate exceeding maximum levels (MLs).
Results: This systematic review indicated that the highest lead concentration was 1.937 mg/kg in tea, and the
lowest lead concentration was 0.025 mg/kg in fruits and the total percentage of samples exceeding the MLs
was 5.57%. Dietary exposure to lead was assessed by combining the weighted mean concentration of
surveillance data with national consumption data in 2002. In this review, dietary intake of lead was
1.232μg/kg b.w./day by using a default body weight of 60 kg for the general population.
Conclusions: By synthesizing results from primary studies, systematic review can provide empirical answers
to concerned problems. Control measures should be taken to reduce exposure to lead, from both dietary and
non-dietary sources.

Poster 70(ID1172)

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 Research on Actualities of Patient Safety Culture in Five Hospitals in Sichuan Province
Xiao Huang, Ailing Li, Xue Sun, Qiong Wang, Hong Jia
Luzhou Medical College, Luzhou, China

Background: Patient safety culture was increasingly recognized as an important strategy—perhaps a

necessary precursor—to improve the widespread deficits in patient safety. This study was to know the
actualities of patient safety culture in five hospitals in Sichuan province，analyze the existing problems, for
providing policy recommendations to improve patient safety.
Methods: A cross-sectional survey was conducted in five hospitals in Sichuan province. Data were collected
by using safety attitudes questionnaire (Cronbach’s a coefficient was 0.909, Split-half reliability coefficient
was 0.952) which was design by ourselves. The questionnaire evaluated six patient safety culture dimensions
Results: Valid response rate was92.6% (474/512). The overall score of patient safety culture in the five
hospitals was 3.89 points. The overall score in Grade-Ⅲ hospitals was higher than Grade-Ⅲ hospitals (F =
8.135, p= 0.004). Respondents who contact with patients directly were good at understanding hospital
policies (F=6.308, p=0.012) and (F=8.624, p=0.003) communication. Respondents who contact with patients
indirectly were good at dealing with negative event F = 8.727, p= 0.003)
Conclusions: Good patient safety culture had created in the five hospitals. Patient safety culture scores were
affected by hospitals levels and whether to contact with patients directly or no.

Poster 71(ID1173)
Reliability and Validity of the Physical Activity Enjoyment Scale (PACES) Among Older
Adults with Hypertension in Wuhan, China
Yajuan Xionga,c, Sijian Lib, Gang Zhanga, Chaoyang Zhua, Fang Li a, Niannian Yang a, Jie Gonga
a Wuhan Centres for Disease Prevention and Control, China

b School of Nursing, the Hong Kong Polytechnic University, China

c School of Public Health, Wuhan University, China

Background: Enjoyment is an important construct for people to adhere to a regular physical activity. The
Physical Activity Enjoyment Scale (PACES, Kendzierski & DeCarlo, 1991) is an instrument to assess the
enjoyment of doing physical activity. Although PACES has been validated among different populations in
numerous studies, little is known about its reliability and validity among older adults with hypertension in
China. The aim of this study is to validate a Chinese version of PACES in the population of Chinese older
adults with hypertension.
Method: This study was part of The Self-management of Regular Physical Activity Program for older adults
with hypertension living in the community. Totally 586 patients were selected randomly from 12
communities in an urban area of Wuhan. Finally 559 older adults agreed to participate in this study. The
mean age was 61.2 (SD: 8.4) years old. Approximately 40.8% were males (59.2% females). Pearson
test-retest reliability, inter item correlation and Cronbach alpha coefficient were used for reliability analysis,
and exploratory factor analysis was for testing construct validity.
Results: There were 18 items in the scale with the mean score 4.87±1.09. The scale included two factors:
positive and negative emotions. The exploratory factor analysis showed the scale consisting of two factors
with explained 62.94% variance. The Pearson test-test reliability of two factors were 0.651 and 0.522, and
the inter item correlations of two factors were 0.660 and 0.421 respectively. The total Cronbach alpha

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coefficient was 0.879, while the Cronbach alpha coefficient of these two factors were 0.952，0.831
respectively.
Conclusions: The findings suggested that the Chinese version of PACES has been achieved by its acceptable
reliability and validity. It indicated that it could be applied to measure physical activity enjoyment when
designing a physical activity intervention program in the local Chinese community.

Poster 72 (ID1174)
Health-Related Quality of Life Measured with EQ-5D in Residents of Jiangsu Province, China
Jianqian Chaoa, Long Songa, Hua Zhanga, Liguo Zhub, Hui Jina, Lin Tiana, and Pei Liua
a School of Public Health, Southeast University, Nanjing, Jiangsu, China

b Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China

Backgroun/objective: With the transformation of medical model, the definition of health has re-defined.
Health-related quality of life was paid more attention. The study analyzed the health-related quality of life
(HRQOL) and its determinants of residents.
Method: Face-to-face interviews in cross-sectional analysis were performed with a multistage, stratified
random sample of 1529 residents over 20 years old in major model regions for infectious disease prevention
and control of Jiangsu Province, China using EQ-5D in 2010. EQ-5D essentially consists of two parts—the
EQ-5D descriptive system and the EQ visual analog scale (EQ VAS). The EQ-5D descriptive system
comprises the following five dimensions: mobility, self-care, usual activities, pain/ discomfort, and
anxiety/depression. Each dimension has three levels: no problems, some problems, and severe problems, and
each level has relevant standard coefficient. According to the choice of study objects, the EQ-5D health
index is worked out by the formula.
Results: The percent of respondents who have some problem in all five dimensions are 22.66%, 1.51%,
2.52%, 24.73% and 24.66% respectively. The pain/uncomfortable and anxiety/depression are the main
problems existing in quality of life. The mean of health index is 0.91. According to the point conversation of
the respondents’ VAS, the mean of VAS is health score 0.87. Age, gender, marriage, the medical insurance
form, family income state and inhabitation are the main determinants of HRQOL. Resident with older age,
divorced, without medical insurance, low family income level and living in rural are more prone to have
health problems.
Conclusions: The pain/uncomfortable and anxiety/depression are the main problems existing in quality of
life in Residents of Jiangsu Province, China. We should take some measures to improve the HRQOL. The
elderly health status and the vulnerable groups should be brought into public focus.

Poster 73(ID1175)
Study on the Impact of System of Guiding Rural Residents to Form Reasonable Health
Seeking Behavior
Qingmei Chen, Dongping Ma, Aitian Yin, Shixuan Wei, Zhiqiang Liang
Center for Health Management and Policy, Shandong University, Jinan, China

Objective: To analyze the role and impact of the system to guide the rural residents to form reasonable
health seeking behavior and make policy recommendations.
Methods: Field investigation and expert consultation.

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Results: More than three years after new health reform, the problem of rural health human resource
allocation hasn't been solved substantially; it was also unreasonable that the distribution of diagnosis and
treatment in medical institutions at the grass-roots level; the general practitioners (GP) system and the new
rural cooperative medical system were the most direct and effective to guide residents to form reasonable
health seeking behavior, but there was still a gap between the reality of the systems’ role and ideally.
Conclusion: Suggest taking the implement of GP system as an opportunity to promote the development of
grass-roots health talents, and strengthening the collaborative mechanism of division of responsibility
between different medical institutions and the synergy impact of policies to achieve the goal of rational
medical service seeking.

Poster 74(ID1176)
Analysis on the Development of A Coastal Maternal and Child Health Care Hospital Between
2004 and 2012 in China
Jianduan Zhang, Lilong Huo, Kai Chen, Chuang Sun, Jingdong Ma
Tongji Medical Colledge of Huazhong University of Science &Technology, Wuhan, China

Aim: To investigate disease constitutes of inpatients and discovery the trends of related diseases for giving
advices on rational allocation of health resources.
Methods: Using information of inpatients from 2004 to 2012 of a coastal maternal and child health care
hospital for retrospectively researching and analyzing.
Results: The number of inpatients increased year by year（it grew from 3424 to 10598 between 2004 and
2012）.The top 5 main diseases was normal labor and delivery，pneumonia，neonatal jaundice，abortion and
premature rupture of membrane，which were accounted 14.6%, 7.4%, 5.2%，4.3% and 3.8%, respectively.
The constitute ratio of these diseases had been changed between 2004 and 2012. The incidence of
complications was 62.8% (42.0% of them had 1 complication, 28.5% had 2 complications and 29.5% had 3
or more complications).
Conclusions: The results suggest that some common and frequency-occurring diseases such as pneumonia,
abortion, should be focused in the future. Moreover, more attention should be paid to decrease the number of
complications.

Poster 75(ID1177)
Analysis of related factors in the medical conflicts of stomatology in Guangzhou City of China
Liu Zifenga, Zhao Weib, Yu Dongshengb, Luo Futiana
a Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
b Institute of Stomatological Research & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou , China

Object: The paper aims to analyze the factors in the medical conflict of stomatology, to explore the solution
method to reduce conflicts, and to make suggestions in hospital management and medical care system.
Method: Total number of the patient is 2488358(from stomatology of hospital in Guangzhou city of China
during the year 2008 to 2012), and 523 of which have experienced medical disputes, Chi-square testing and
multiple logistic regression analysis were used to analyze the data.
Results: Of the 523 patients who had a medical dispute(0.21‰). The age groups of 30~40 makes the largest
proportion in the male patients, and 20~30 group is the largest one in the female patients. Female patients
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make the higher dispute rates than the other gender (P=0.016). Since 2009, the dispute rates
exhibited a decreasing annual trend. Binary logistical regression analysis further shows that the disputes
which develop into a conflict have five main related factors: patient sex, specialties, dispute reason, pay type
and days.
Conclusion: The study findings suggest that female patients should be paid more attention, and some
measures in hospital management should be adopt to reduce medical conflict in stomatology. Establishing an
insurance policy of putting more stomatology items into the insurance reimbursement may cut down the
conflict rates.

Poster 76(ID1178)
Effect of Winter Swimming on Blood Biochemical Parameter and Cardio Function
Hao Yang, Dengping Shi
Jing men No.2 People's Hospital

Objective: To explore the effect of swimming in cold water on blood pressure, blood sugar, heart rate and so
on for the normal.
Method: 21 winter swimmers are included who swim in winter for more than 3 years as Experiment Group
in Jingmen city Hubei province. We also choose 21 non-swimmer controls after adjusting the potential
confounding to guarantee the representativeness. 13 health indexes are measured for two groups after
Experiment Group experience six months’ swim training. Hypothesis tests and PSM (propensity score match)
methods are used to analysis the data.
Result: The systolic and diastolic blood pressures for swimmer group are significantly lower than another
group. The swimmer group also has lower triglyceride, lower blood sugar, slower heart rate and lower
high-density lipoprotein (P<0.05).
Conclusion: Winter swimming has positive effect in regulating normal blood biochemical parameter and
improves the cardio function effectively.

Poster 77(ID1179)
The disease burden analysis of inpatient with Coronary Disease during 2002-2012
Jingdong Ma, Chuang Sun, Lilong Huo, Kai Chen, Guanglian Xiong
Tongji Medical Colledge of Huazhong University of Science&Technology, Wuhan, China

To evaluate the hospitalization costs subjected to Coronary Disease, and study the temporal changes of the
cost, we collect data of a representative hospital in China from 2002 to 2012. Taking advantage of the
Hospital Information System WISCO, we also explore the potential influencing factors of the medical
expense.
Descriptive analysis and multiple linear regression analysis were carried out. The result indicates that the
total cost-of-illness has increased during this past period. The western medicine cost and the inspection cost
have also increased. There are several reasons affect the hospitalization expense: the frequency of the
hospitalization, the length staying in hospital, the age of the inpatient.

Poster 78(ID1181)
Evaluation of Training Effects on Diabetes for CDC Staffs

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 Jixiang Ma, Yamin Bai, Xiaorong Chen, Linhong Wang
Chinese Center for Disease Control and Prevention

According to the Global Burden of Disease Study 2010, during last ten years, diabetes has became the main
risk factors to cause DALYs. Our research work was aimed to evaluate the awareness of diabetes of CDC
staffs and through training, to improve their knowledge. People from 5 provinces of China (n=1171) were
trained in diabetes knowledge in May 2013.The awareness of diabetes was estimated by pre-training
knowledge scores. Impact of training was assessed by pre- and post-training scores.
The mean age of the 1171 participants was 34.8 years.66.15% were female. And participants included
bachelors (57.63%), masters and PHD (4.74%), technical college graduates (37.64%). The results of
rank-sum test revealed the training significantly improved knowledge on treatment, prevention and diagnosis
of diabetes (p<0.001), with the mean scores rising from 55.85 to 66.79. Before training, age and provinces
were considered important in scores (both p<0.001).After that, age, provinces and educational background
played important roles (p<0.000, p=0.001, p=0.001, respectively). 50%-60% participants were in despair
need for diabetes knowledge. Well-planned training programme can improve knowledge. Therefore, more
training should be developed to improve public awareness of diabetes.

Poster 79(ID1182)
Analysis of Disease Constitution in Hospital in Central China from 2010 to 2011
Kang Chen, Yongping Xu, Kai Chen, Lilong Huo, Chuang Sun, Guanglian Xiong, Yiming Mu
Department of Geriatric Endocrinology, Chinese PLA General Hospital, Wuhan, China

Objectives: Analysis of disease constitution in different levels of hospital in different provinces at different
times in central China area. Understand to the hospital patient disease constitution and differences. Provide
the scientific basis for the rational use of health resources.
Methods: 30 large hospitals were randomly selected from the central region of China. Use the
unified questionnaire to collect patient’s disease data from 2010 to 2011.
Results: The main compositions were respiratory diseases and gastrointestinal diseases in different
hospitals. There had significant difference of disease constitution between different groups.
Conclusions: There have some differences of disease constitution in different hospitals in central China. The
hospital resource utilization is not reasonable, and it is necessary to take measures to correct.

Poster 80(ID1183)
Analysis of Premixed Insulin Analogues Use in Type 2 Diabetic Patients in China
Xiangling Wang, Guanglian Xiong, Guo Tang, Zhixue Tan, Lilong Huo, Kai Chen, Yiming Mu
PLA General Hospital

Objectives: To understand treatment status and effect of premixed insulin analogues in type 2 diabetic
patients in China, and explore the influential factors of premixed insulin analogues treatment, so that use
premixed insulin analogues more scientific and reasonable.
Methods: Collect the patient data using a unified questionnaire. Use Excel to entry and management data
and use SPSS18.0 to analysis data;
Results: In all of 3002 cases patients, there had 2795 cases of patients who continued to use of premixed
insulin analogues followed up after 3 months. There had 2698 cases of patients who continued to use of
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premixed insulin analogues followed up after 6 months, compared with 3 months of follow-up, the treatment
cases decreased slightly; The average postprandial blood glucose levels were 155mg/dl in patients who
continued to use of premixed insulin analogues followed up after 3 months, decrease compared with baseline.
The kappa analysis of the main reason showed that the consistency of high price and injection pain was
higher; Mostly patients thought that the premixed insulin analogues can help on the health. They were
satisfied with the results of treatment.
Conclusions: The use of premixed insulin analogues may be effective in the treatment of type 2 diabetes.
Most patients are satisfied with the treatment results. It is necessary to take measures to control the main
influence factors of premixed insulin analogues using, in order to further improve compliance of
the premixed insulin analogues treatment, and ultimately improve the curative effect.

Poster 81(ID1185)
The Relationship of County General Hospitals’ Financial Performance and the Number of
Beds in Hubei Province, China
Jingdong Ma, Jing Wang, Jingdong Ma
Tongji Medical Colledge of Huazhong University of Science&Technology, Wuhan, China

Background: Along with the gradually deepened of the reform of our medical system in China, some
hospital managers convinced that bigger hospitals led to lower average cost and improved financial profit
and began to expand, which caused aggravation of the hospital’s financial risks, this phenomenon is
definitely of great concern. The purpose of this article is contributed to find the optimal hospital bed size of
the county level hospitals in China, which can change policy makers’ misconception and provide objective
basis for hospital development planning.
Methods: This is a cross-sectional study using survey data obtained from 75 county (including county-level
cities) general hospitals in Hubei province, China in 2011. 9 representative financial indicators which on the
basis of using literature optimization method and considering the indicators acquired were selected in order
to build the hospitals’ financial performance index system. The factor analysis method was applied to the
comprehensive evaluation of the hospital’s financial status. Regression analysis was used to explore the
relationship between the number of beds of county-level hospitals and the hospital’s financial status.
Results: The relationship of between County general hospital’s financial status and the number of beds
shows a three times curve regression relationship. As the number of beds continuously increasing, hospital
profitability will first gradually increase, but then will gradually decrease, and will then finally gradually
increase again.
Conclusions: When the actual number of beds is around 352, the county general hospital’s financial
condition reaches its highest potential to achieve optimal results and the financial risks to be reduced to a
minimum. Therefore, it is critical for county general hospitals’ managers to properly and appropriately
control the number of beds.

Poster 82(ID1186)
The Disease Burden Analysis of Inpatients with Type 2 Diabetes Mellitus During 2002 – 2012
Xuan Lin, Zhigang Jin, Zhi Zhang, Jing Liu, Yinya Xu, Hanwu He
WISCO General Hospital

Background: Diabetes mellitus (DM) has been declared as a global public health threat to society, and it has
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caused huge economic losses to countries and patients. This study was conducted to estimate the burden of
type 2 DM inpatients.
Methods: Based on Hospital Information System of WISCO general hospital, 7487 hospitalized cases of
type 2 DM were studied. We analyzed the influencing factors and changing characteristics of hospital
charges of type 2 DM patients in 2002 - 2012.
Results: The mean and median values of hospital charges were 5482 RMB and 4810 RMB, The more days
staying in hospital, the older ages and the more hospitalizations lead to higher hospital charges. There were
347 patients with type 2 DM in 2002, but the number had increased to 1217 in 2012; the average length of
hospital stay was 20.89 days in 2002, and the number had decreased to 12.06 in 2012. Hospital costs had
increased from 2002 to 2012, the growth of western medicine expenses, inspection expenses and the other
expenses contributed to the increased costs.
Conclusions: Both of the number of patients with type 2 DM and their hospital charges are growing, health
education should be taken in the general population in order to reduce the morbidity of type 2 DM, as well as
early diagnosis and appropriate treatment should be taken for the patients.

Poster 83(ID1187)
Factors Associated with the Length of Stay of Patients with Respiratory Diseases in China
Jing Huang, Hua Li, Yanhong Fu, Xiao Liu, Zhijiao Jiang, Li Yao, Youfan Jiang
The third people's Hospital of Chongqing

Aim: Length of stay (LOS) is an important outcome as a marker of resource consumption. Determining
which factors were affecting LOS may provide information on reducing costs and improving the delivery of
care. The purpose of this study was to explore the factors associated with the length of stay of patients with
respiratory diseases in a tertiary care hospital in mainland China between 2008 and 2012.
Methods: A retrospective study of factors related to length of stay of 6126 patients with respiratory diseases
from 2008 to 2012 was carried out. All related components were defined and valued at the most detailed
levels. Univariate analysis was carried out using Student’s t-test, Mann-Whitney U test, or chi-square test
and correlation analysis (significance, p <0 .05).
Results: The mean length of stay was 14.00 days (range 6.34~21.66 days).From 2008 to 2012, the mean
length of stays were 14.19 days, 13.52 days, 13.19 days, 14.34 days, 12.28 days , respectively. Factors
associated with length of stay included age (p<0.001), sex (p<0.001), profession (p<0.001), type of disease
(p<0.001), admission condition (p=0.02) and complication (p<0.001).
Conclusion: These data suggest that the length of stay of patients with respiratory diseases is related to age,
sex, profession, type of disease, admission condition, complication, efforts should be made to decrease the
length of stay and to reduce costs.

Poster 84(ID1188)
Symptomatic Vein Thrombosis Associated with Peripherally Inserted Central Catheters in
Breast Cancer Patients
Kang Jun-ren , Chen Wei, Li Hai-long, Sun Wen-yan, Wang Kai, Song Qi, Liu Bing, MA En-ling
Department of Parenteral and Enteral Nutrition, PUMC Hospital, Beijing, China

Objective: To identify clinically incidence, risk factor, diagnosis, and treatment of PICC-associated
symptomatic upper extremity vein thrombosis (UEVT) in breast cancer patients undergoing chemotherapy.
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Methods: A retrospective study of 938 breast cancer patients with PICC from 2011 to 2012 in PUMC
Hospital was performed. The incidence of PICC-associated symptomatic UEVT was determined. Clinical
characteristics were evaluated to identify risk factors of PICC-associated UEVT. The treatment of
PICC-related symptomatic UEVT was also analyzed.
Results: 10 patients (1.1%) developed PICC-associated symptomatic UEVT in 49.4 (4-176)days after
catheter placement, for a total of 1035 catheter-days, with a incidence of 0.11 per 1,000 catheter-days. 9
patients were treated with low molecular weight heparin (LMWH) for 14(3-50) days, 5 of them used catheter
during anticoagulant therapy without PICC removal. The incidence of pulmonary embolus is 0.
Conclusion: Breast cancer patients with a 4 Fr, basilic vein or brachial vein insertion, and good tip position
PICC had a lower incidence of PICC-associated asymptomatic UEVT.

Poster 85(ID1189)
Comprehensive Assessment of Nutritional Status of the Elderly Patients in Five Cities in
China
Wei Chen, Jianqin Sun
Peking University

Aim: To investigate the nutritional status of the Chinese elderly patients and to evaluate the association
between nutritional status of elderly patients and activity of daily living.
Methods: An open, randomized and multi-center investigation was conducted to select the elderly patients in
the elderly patient settlements in the five cities. A short-form mini-nutritional assessment (MNA-SF) was
applied to investigate the nutritional status of the elderly patients. Activity of Daily Living Scale (ADL-S)
was used to evaluate the activity of daily living.
Results: The comparison of the elderly patient nutrition status in the five cities showed that Beijing,
Shanghai and Chengdu were greater than Guangzhou (P<0.05) and the latter was greater than Chongqing
(P<0.05). The results suggested that the nutritional status and daily life ability were positively correlated
(P<0.05).
Conclusions: The elderly patients with having a better nutritional status are more likely to have a better
activity of daily living.

Poster 86(ID1190)
Factors Influencing the Hospital Charges of Inpatients with Type 2 Diabetes Mellitus
Ping Cao, Kaixiu Wang, Hua Zhang, Rongzhi Zhao, Chenglong Li*
Jing men No.2 People's Hospital, Jing men, china

Background: Diabetes mellitus (DM) is known as one of the top four non-communicable diseases that have
leading threat to human health by World Health Organization, it has brought huge economic burden to
countries and patients. Type 2 DM accounts for at least 90% of all cases of DM. The aim of this study was to
analysis the influencing factors of hospital charges for inpatients with type 2 DM.
Methods: The data of this study was obtained from the medical insurance database of a tertiary hospital in
china, and a multivariable linear regression model was adopted to estimate the influencing factors of patients’
hospital costs.
Results: Of the 2,991 cases, 1,696 (56.7%) were male, and the mean age was 55.7 ± 12.2 years. At least one
chronic complication was diagnosed in 2085 individuals (69.7%) of the study cases, and 73 (2.44%)
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individuals had surgeries. The mean hospital charge was CNY (Chinese Yuan) 6,527.77 in 2012, while it was
CNY 4,802.03 in 2005. We found that patients in Urban Employee Basic Medical Insurance had higher costs
than those in New Rural Cooperative Medical Scheme, and we found hospital charges to be higher in female
patients and older patients , patients who stayed more days at hospital and who had surgeries, patients who
had at least one complication.
Conclusions: Medical Insurance should be reformed to protect all people’s health, health education should
be carried out in the general population in order to reduce the morbidity of DM, and early diagnosis and
appropriate disease management should be carried out to prevent and minimize the occurrence of
complications.

Poster 87(ID1191)
Evaluation of Carotid Arterial Circumferential Strain in Health Subjects by Two-dimensional
Speckle Tracking Imaging
Deng Yao, Xie Ming-xing, LÜ Qing, Fang Ling-yun, Xiang Fei-xiang, Jin Bi, Li Zhao-jun
Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and
Technology, China

Backgrand: Carotid arterial circumferential strain can be used as a screening tool for subclinical
atherosclerosis and associated with previous ischemic stroke in the elderly. The aim of our study is to assess
carotid arterial circumferential strain (CACS) in health subjects by two-dimensional speckle tracking
imaging (STI).
Methods: A total of 129 health subjects were enrolled. All the subjects were divided into 3 group: group 1
(20~39 years, n=40), group 2 (40~59 years, n=54) and group 3 (60~81 years , n=35). A ultrasound machine
(MyLab90, Esaote, Italy) equipped with a multifrequency 4-13MHz linear-array transducer (LA523) was
used for all of the ultrasound examinations. The region of interest was placed from the beginning of carotid
bulbs to a 2 cm proximal site in left common carotid atrerial (LCCA). Intiman media thickness (IMT) was
examined by QIMT (Quality intima media thickness). Stiffness parameter β was examined by QAS (Quality
arterial stiffness). LCCA short axial view was recorded (three cardiac cycles). Global peak CACS was
measured by STI. Mean CACS (mCACS) was defined as the mean value of global peak CACS of three
cardiac cycles.
Results: IMT and stiffness parameter β were higher in group 3 (616.66±101.32μm, 11.84±4.88) than group 1
(415.85±58.25μm, 5.60±1.40) and group 2 (528.96±100.46μm, 8.47±2.62), the parameters were higher in
group 2 than group 1; mean CACS was lower in group 3 (2.89±1.24%) than group 1 (5.67±1.55%) and group
2 (3.46±0.98%), the parameter was lower in group 2 than group 1, with statistically significant differences
(P<0.05). Multiple linear regression analysis showed that age (r=-0.613, P<0.001), diastolic blood pressure
(r=-0.231, p<0.001), pulse pressure (r=0.233, P<0.001) and stiffness parameter β (r=-0.267, p<0.0001) are
independent determinants of mean CACS.
Conclusion: CACS is decreased with age in health subjects. Age, diastolic pressure, pulse pressure and
stiffness parameter β are the most important determinants of mean CACS.

Poster 88(ID1192)
Evaluation of Myocardial Function of Left Ventricular in Patients with Severe Aortic Stenosis
by Two Dimensional Speckle Tracking Imaging

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 Han J. Gaoa, Ming X. Xieb, Li Yanga, Lin Heb, Xiao F. Lub, Xiao J. Qinb, Ke Lib
a Department of Ultrasound, 161 Hospital of PLA, Wuhan, China

b Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and

Technology, Wuhan, China

Background/Objective: The presence of left ventricular (LV) myocardium systolic dysfunction is pivotal in
making treatment decisions for patients with aortic stenosis (AS). This study was performed to assess
systolic function of LV myocardium by two-dimensional speckle tracking imaging (2D-STI) in severe AS
patients.
Method: Standard echocardiography and 2D-STI examinations were performed in a total of 54 subjects
including 26 consecutive patients with severe AS with LV ejection fraction (LVEF) ≥50% and 28 controls.
2D-STI including peak systolic longitudinal strain(PLS) assessed from the apical 4-chamber and 2-chamber
views,the circumferential strain(PCS)and radial strain(PRS) measured from the apical short axis view
(averaging 6 segments per view). The above parameters were compared between AS groups and normals.
Results: There was no significant difference between two groups in LVEF, LV end-diastolic dimension
(LVEDD), LV end-systolic dimension (LVESD) and midwall fractional shortening (mwFS) (P > 0.05).
Incomparison with controls，the patients with AS showed a significantly lower PLS (P < 0.001), PCS(P <
0.001), and PRS (P < 0.05). The peak systolic strain rates in the 3 directions in the AS group were lower
compared to the control group (P < 0.05).
Conclusions: In severe AS patients，despite normal left ventricle ejection fraction ，left ventricular
myocardium systolic function is impaired，which manifests in longitudinal，circumferential，and radial peak
strain and strain rates in 3 directions reduction. A larger study is needed to confirm these findings.

Poster 89(ID1193)
Chronic Mitral Regurgitation: A Pilot Study to Predict Postoperative Left Ventricular
Contractile Function Using Speckle-Tracking Echocardiography
LI He, Qin Xiao-Juan, He Lin, Xie Ming-xing
Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China

Objective: The development of postoperative left ventricular (LV) dysfunction is a frequent complication in
patients with chronic severe mitral regurgitation (MR) and implies a poor prognosis. The aim of this study
was to evaluate the predictive value of preoperative regional LV contractile function assessment using
two-dimensional echocardiography–based speckle-tracking analysis in patients with chronic severe MR.
Methods: Forty-one consecutive patients with chronic severe MR scheduled for mitral valve replacement
were prospectively enrolled. Speckle tracking imaging was performed to measure peak systolic radial and
longitudinal strain and strain rates. The average of peak systolic mitral annular velocities (S′) in the apical
4-chamber view at the septal and lateral side of the mitral annulus was obtained by pulsed wave tissue
Doppler echocardiography (TDE). LV dP/dt was obtained from the continuous-wave Doppler signal of the
mitral regurgitant jet. Patients were reevaluated within 1 month after successful mitral valve replacement and
divided in: group A, with a postoperative EF reduction＜10% (27 patients) and group B, with an EF
reduction＞10% (14 patients).Logistic regression screening index was used to establish regression equation
and obtained critical values by receiver operating characteristic (ROC) curves.
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Results: Preoperative speckle tracking–derived radial strain rate at the level of midventricular short-axis
plane strongly predicted a postoperative LVEF decrease of >10%. Its predictive values were greater than
those obtained for preoperative LV volumes and LVEF, LV dP/dt, and Doppler tissue imaging–derived peak
systolic mitral annular velocities. The best discriminant parameter to detect a postoperative LVEF reduction
of >10% with speckle tracking was a radial strain rate at the level of midventricular short-axis plane < 1.652
s_1 (area under the receiver operating characteristic curve, 0.847; sensitivity, 70%; specificity, 88.24%).
Conclusions: Two-dimensional speckle tracking imaging can predict early postoperative LVEF reduction in
patients with severe MR.

Poster 90(ID1195)
Compared with findings of surgery and/or coronary angiography , Evaluate the ultrasonic
diagnosis value for congenital coronary artery fistula
SUN Zhen-xing，LI Ling, XIE Ming-xing
Department of Ultrasonography，Union Hospital of Tongji Medical College，Huazhong University of Science and
Technology, Hubei Province Key Laboratary of Molecular Imaging, Wuhan 430022, China

Background: Coronary artery fistula (CAF) is a rare congenital anomaly. Coronary angiography remains the
gold standard for imaging the coronary arteries, but the relation of coronary artery fistulas to other structures,
their origin and course may not be apparent. In this article, we evaluate the application of transthoracic
echocardiography for the diagnosis of congenital coronary artery fistula.
Methods: The echocardiographic appearances of 63 patients with coronary artery fistulas who had undergone
coronary angiography and/or operation during June 2002 and December 2012 at the Union Hospital of
Tongji Medical College，Huazhong University of Science and Technology, were analyzed retrospectively，
and the results were compared with findings of surgery and coronary artery angiography.
Results: ①Right CAFs were detected in thirty-three patients（52.4%）:eleven of them had drainages to the
right atrium，ten to the right ventricle, two to the left ventricle, nine to the main pulmonary artery, and one to
the coronary sinus. Left CAFs were detected in twenty-nine patients（46.0%）: six of them had drainages to
the right atrium，twelve to the right ventricle, one to the left atrium, two to the left ventricle, seven to the
main pulmonary artery, and one to the coronary sinus. In one case (1.6%), there is origin in both coronary
arteries. Most often the entry point was a single orifice(96.8%)，but，rarely，it was multiple(3.2%).
Fifty-seven patients were diagnosed simplex coronary fistulas (90.5%). Six patients had other congenital
cardiac malformations (9.5%). ②Twelve patients had also undergone conventional coronary angiography
(CAG) . ③The ultrasonic diagnosis of sixty was in line with surgical findings and/or coronary angiography.
The accurate rate for the diagnosis of coronary artery fistula was 95.2%. Preoperative transthoracic
echocardiography had three patients who were neglected CAF. The misdiagnosis rate was 4.8%. We
compared the ultrasonic diagnosis with the results of coronary angiography and/or surgery and found they
had no difference (P>0.05).
Conclusions: Transthoracic echocardiography could be a primary method for diagnosis of congenital artery
fistula．

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Poster 91(ID1196)
The Application of Transthoracic Echocardiography for the Diagnosis of Coarctation of Aorta
Sun Zhen-xing, Li Ling, Xie Ming-xing
Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and
Technology, Hubei Province Key Laboratary of Molecular Imaging, Wuhan, China

Background: Aortography is the recognized “golden standard” because of its direct perceived visual image
and clear diagnosis. However, the method is invasive, expensive and cannot be accepted by some people. It
can not be tolerated for those severe patients. Besides, the retrograde aortic cannulation cannot pass narrow
segment of aorta easily and the accident of aortic cannulation is very dangerous and the mortality of this
complication is quite high when the inner diameter of aorta narrow segment is very narrower. So
aortography is limited by these reasons. Ultrasound diagnosis is non-invasive, inexpensive, and repetitive.
Besides, it not only reveals the direct signs of CoA, but also provides much information of cardiovascular
structures, cardiac function and haemodynamics. In this article, we evaluate the application of
transthoracic echocardiography for the diagnosis of coarctation of the aorta.
Methods: The echocardiographic appearances of 53 patients with coarctation of the aorta who had
undergone surgery during January 2008 and October 2012, were analyzed retrospectively, and the
results were compared with findings of surgery.
Results: Fifty-three cases of CoA includ six cases of solitary type and forty-seven cases complicated with
other cardial anomalies. Fifty-three cases of CoA were confirmed with surgeries. 48 were preoperatively
discovered by echocardiography，while two misdiagnosed as interrupted aortic arch(IAA) and three missed
diagn- osis．The diagnostic accurate rate was 90.6% and the misdiagnosis rate was 9.4%.
Conclusions: Transthoracic echocardiography could be a primary method for diagnosis of coarctation of the
aorta. Preoperative echocardiographic evaluation offers satisfactory Aorta assessment in all heart patients,
thus, it makes preoperative coronary angiography unnecessary. However, angiography is sti11 necessary in
some cases.

Poster 92 (ID1197)
Non-Compacted Ventricular Myocardium with Congenital Cardiac Malformations
Zhang Xiao-xiao, Xie Ming-xing
Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and
Technology; Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan, China

Background: Non-compacted ventricular myocardium (NCVM) is a primary, genetic cardiomyopathy

characterized as distinct morphologic features that are secondary to an arrest of myocardial maturation
during embryogenesis. The clinical features associated with NCVM vary from asymptomatic to symptomatic,
with the potential risk for heart failure, supraventricular, ventricular arrhythmias, thromboembolic events,
and sudden cardiac death. Because the diagnosis of isolated noncompaction cardiomyopathy (i-NCVM) can
be overlooked, its association with congenital cardiac malformations (ni-NCVM) makes the diagnosis of
NCVM even more difficult. With the widespread use and advances in the technology of echocardiography
and other diagnostic modality，there are increasing awareness for identification of NCVM.
Methods: We conducted a retrospective study of 50 consecutive patients with ni-NCVM at our hospital from
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January,2000 to February,2012. All patients underwent clinical examination, electrocardiography, and 2-D
echocardiography (Philips，IE33). The thicknesses of noncompacted myocardium layer (N) and compaction
myocardium layer (C), and the ration of N/C were measured. LV opacification (LVO) was performed for
patients (n=5) with suboptimal echocardiographic image quality or poor endocardial border image to
improve endocardial resolution.
Results: 25 cases had single congenital cardiac structural abnormalities, the other patients had multiple
congenital heart diseases including atrial septal defect (ASD, n=16 [32%]), ventricular septal defects (VSD,
n=15 [30%]), foramen ovale closure (n=14 [28%]), patent ductus arteriosus (n=11 [22%]), endocardial
cushion defect (n=3 [6%]), tetralogy of Fallot (n=2 [4%]), and Ebstein's malormation (n=3 [6%]).The LVO
further detect the abnormal blood flow channels with congenital heart diseases; in addition, it showed
optimal visualization of bilayer (compacted and noncompacted) myocardium and an accurate assessment of
the noncompacted/compacted layer thickness ration.
Conclusion:The most common congenital heart malformations with ni-NCVM are ASD, VSD. This study
shows that the prevalence of ni-NCVM may be higher than that expected before. A larger sample size study
are needed to improve our understanding of this disease.

Poster93(ID1198)
The Enhanced Value of Left Ventricular Opacification in the Diagnosis of Noncompacted
Ventricular Myocardium
Xie Ming-xing, Zhang Xiao-xiao, Qiu Lin-li, Yang Ya-li, Lv Qing, Wang Jing, He Lin, Wang Xin-fang
Department Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and
Technology, Hubei Provincial Key Laboratory of Molecular Imagin, Wuhan, China

Objective: To explore the value of left ventricular opacification (LVO) in evaluation of noncompacted
ventricular myocardium (NCVM).
Methods: 1) LVO and 2D echo were carried out in the NCVM patients who have been diagnosed by MRI, in
order to observe the depth of the trabecular recesses, the extent of trabecular muscles, as well as the
continuity of the endocardium. The diameter of compacted layer and noncompacted layer were measured and
the end-diastole ratio of noncompacted to compacted layer (NCR)was calculated. 2) Calculate detection rates
from different images in double-blind experiment, including 2D, LVO, and the combination with 2D and
LVO for the NCVM patients diagnosed by MRI.
Results: 1) The contrast agent microbubbles of LVO were vividly detected in the trabecular recesses, which
could display the compacted and noncompacted myocardium more clearly than rational echocardiographic
examination. At the same time, LVO could be more accurate than 2D to measure the NCR, and there was
significant difference between these two groups (P <0.0001). NCR>2 predicted the diagnosis of NCVM by
2D with a sensitivity of 94.12%, a specificity of 70.00%, and NCR>2 predicted the diagnosis of NCVM by
LVO with a sensitivity of 98.82%, a specificity of 70.00%. The range of noncompacted myocardium
observed by LVO was larger than by 2D. 2) The detection rate of combination of 2D and LVO is higher than
2D or LVO (P <0.05).
Conclusion: LVO can enhance the clinical diagnosis of NCVM in accuracy and sensitivity, which is a useful
tool for the supplement of rational 2D echocardiography.

Poster 94(刘颖)

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 Literature Review on Chinese Medical Aid Policy (1963-2013)
Ying Liu, Quan Wang, Hong Xu
School of Public Health /Global Health Institute, Wuhan University

Objective: To clarify the evolution of the policy, aid scale and form of Chinese foreign medical aid during
1963-2013. And to summarize the characteristics, achievement and trend of Chinese medical aid, then clarify
the thoughts for the improvement and adjustment of the medical aid policy in the new period.
Method: This paper collected the relative literatures of Chinese foreign policy and medical aid, and used
literature research method, comparative analysis method, scenario analysis method, and referred to the
principle of systematic review and evidence-based thinking.
Result: Divided the Chinese medical aid policy into four parts according to the characteristics of policy
evolution in different phases: ① Creation period of the policy and pattern of Chinese medical aid
(1963-1977). ②Period of the first policy adjustment (1978-1994). ③Period of the second policy adjustment
(1995-2002). ④Period of the global health diplomacy (2003-2013).
Conclusion: During the past 50 years, Chinese medical aid has relieved the recipient countries’ shortness of
medical support, cured a large number of patients, notably improved the health care level of the recipient
countries. The mission of rescuing the needed of Chinese medical aid has been accomplished basically, and
the international influence of China has been enhanced. The way of Chinese medical aid has changed from
only sending foreign aid medical team with medical and financial supplies to bilateral or multilateral
cooperation with diversified medical treatment.

Poster 95(ID1201)
Utilization of Oral Hypoglycemic Agents in Wuhan, China: A 5-year Retrospective Study
Rui Huang, PhDa, Ping Gao, MMb, Donghua Zhou, PhDa, Guozheng Liu, PhDc, Zerong Hou, MMd
a Huazhong University of Science and Technology, Wuhan, Hubei, China, 430030

b Department of Pharmacy, Wuhan Children's Hospital, Wuhan, Hubei, China, 430030

c Suizhou Central Hospital, Suizhou, Hubei, China, 441300

d Public Health Bureau of Tianjin Binhai New Area, Tianjin, China, 300000

Background: Diabetes mellitus is a major public health burden. The World Health Statistics 2012 reported
that 10% of the adults worldwide were suffering from diabetes by which up to one third of the populations in
some Pacific island countries were threatened. China has also been experiencing an epidemic of diabetes in
recent years. To this end, reviewing the utilization of antidiabetic medicines is of great significance to
promoting rational drug use. We herein aimed to retrospectively determine the utilization patterns of oral
hypoglycemic agents in 24 hospitals in Wuhan, China from 2008 to 2012.
Method: Drug consumption was analyzed by the ATC/defined daily dose (DDD) method, and number of
defined daily doses (DDDs) and daily drug cost (DDC) were analyzed as well.
Results: In all the hospitals, antidiabetic drug sales and DDDs increased annually, whereas DDC decreased.
Acarbose, repaglinide, metformin, gliclazide and glimepiride dominantly accounted for 79.73% and 76.53%
of total sales and DDDs in the 5 years respectively. Besides, the sales and DDDs of voglibose, new
commercially available DPP-4 inhibitors and aldose reductase inhibitors were elevated rapidly, while
rosiglitazone and traditional Chinese patent medicines were used less frequently.
Conclusions: the utilization of oral hypoglycemic agents in the hospitals was rationally and stably structured.

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Metformin, α-glucosidase inhibitors and 2nd-generation sulfonylureas, as the most clinically approved
agents, predominate in the treatment of diabetes hitherto and thereafter. Meanwhile, novel eligible oral
hypoglycemic agents are commercially potential and feasible.

Poster (孙静老师)
Correlates of Depression Among HIV/AIDS Patients in Rural Central China
Jing Suna, Robert F. Schillingb, Zuxun Luc, Guanmin Chena, Weihua Hee, Peilin Zhoue, Ting Yuanf
aDepartment of Health Statistics, School of Public Health, Wuhan University; School of Public Health

bDepartment of Social Welfare, School of Public Affairs, University of California, Los Angeles

cTongji Medical College of Huazhong University of Science & Technology

d Suizhou Centers for Disease Prevention and Control

eHubei College of Traditional Chinese Medicine

Objective: The aim of this study was to examine the relationship between depressive symptoms and quality
of life, HIV-related stigma and disease symptoms among HIV-positive farmers in rural central China.
Methodology: 156 HIV positive individuals (84 men and 72 women) were assessed for depression, quality
of life, HIV-related stigma and HIV-related symptoms using the CES-D, WHO-QOL-HIV-BREF, a modified
version of the HIV Stigma Scale, and the symptom scale of ACTG Adherence Follow up Questionnaire.
Descriptive statistics, measures of association and regression analyses were used to identify patterns of risk
for depression.
Results: The mean CES-D score was 26.36 (S.D. = 13.00) and 121 (77.6%) patients had a score of ≥ 16.
Quality of life, perceived health status, common HIV-related symptoms and stigma were associated with
depressive symptoms. The final multivariate model included 3 factors that accounted for 60.2% of the
variance in depressive symptoms. With respect to depressive symptoms, the majority of variance was
accounted for by three variables including: total common symptoms in the past month, total stigma score and
total quality of life score in past two weeks.
Conclusion: Depression is common and severe in HIV infected persons in rural central China. Quality of life
is affected by depressive states, but overall QOL may also be protective against depressive symptoms.
Although this exploratory study cannot establish causality with respect to QOL and depression, HIV patients
in rural central China may benefit from timely symptom management and interventions aimed at improving
quality of life and decreasing stigma and discrimination.

Poster (王超)
A Study About Effectiveness of the New Rural Cooperative Medical Care Payment Reform
Which Was Based on Development Model
Chao Wang,Yun Zhang, Hong Xu,Jing Cai,Ying Liu ,Zongfu Mao
School of Public Health /Global Health Institute, Wuhan University

Objective: Using development-model to evaluate the effectiveness of the new rural cooperative
medical care payment reform in Jiang Xia district.
Methods: The new rural cooperative medical care fund data was collected from the new rural
cooperative medical care management system with the implementation of the‘Fee for service unit
payment’ reform. we used random intercept heteroscedasticity model and random slope model to fit
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the data respectively, and added the reform variable, ’time’ variable to optimize the model.
Results: We found significant heterogeneity among the fitting data groups (1381631, P=0.0005);
Into the reform of the variables and time variable model –2LL lowest values (–2LL=1949.0);
According to the ICD-10 disease classification , the average medical expense of the initial were
significantly different (1004.30,P=0.0181); The average medical expense there was no statistically
significant difference over rate of time change (44.7364, P = 0.6689); Payment reform to a certain
extent offset by the natural growth of evaluating medical expense (258.03, P=258.03).
Conclusion: ‘Fee for service unit payment’ reform can control the reasonable cost growth; the
reform variable into the model fitting effect variable optimal.

Poster (深圳坪山)
The Pingshan Route Maps of Buliding up the Health Management System for Everyone
Chen XiangHui
Director of Pingshan Public Health Bureau

Objective: The Goal of Health Management System for Everyone in Pingshan. Every Pingshanese should
have a personal physician to assure the integration and continuity of all medical services. Every Pingshanese
have the right of health maintaining. We have a accreditation system to provide the quality and safety
medical service.
Overview of Pingshan: GDP 30.022 Billion RMB(2012), increasing rate 20.1%; People 700,000 Insurance:
cover 95% Health care institution 75 Hospitals 4。licensed beds: 500. Health professional and staff: 2000.
Overview of Pingshan Primary Health care system CHC:29 community health center for family medicine.
and primary care,253 health staff and professionals).
Strategy: 1.Build the DEP, 2. Build research center, 3.Start to certificate FPs, 4.Build the simulation lab on
fam. Med.
The Route maps of the health management for everyone: H.M.O. system: 1.Qualified Family Physicians
(3 Yrs training Program for FPs), 2.Accreditation of C.H.C.s (Accreditation for international standard), 3.
Health information technology (Business & Clinical Process Automation), 4.Payment for add value (Support
from goverment)

Poster
Characterization of MBL producing Pseudomonas aeruginosa isolated from patients with
Cystic Fibrosis by phenotypic and genotypic methods.*
Li Yongwei a, b,Wang Chunxib,Chen Jianshe b, Zhang Xiaoqian b, Hu Yue b, Niu Xiaobin b, Pei Dongxu b, He
Zhiqiang b, Bi Yongyi a*.
a Wuhan University School of public health, Wuhan, 430071

b Department of Clinical Laboratory, Henan Hospital of Traditional Chinese Medicine Hospital, Zheng zhou,

450002,China

Introduction: Pseudomonas aeruginosa continues to be a major cause of infections because of its high
intrinsic resistance to antibiotics and often require immediate attention as they cause treatment failures.
Pseudomonas aeruginosa is the leading cause of respiratory infections in persons with cystic fibrosis
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(CF).Carbapenems including antibiotics are used to combat infections with Pseudomonas aeruginosa. In
recent years, resistance to carbapenemase among P. aeruginosa are being reported. Production of metalobeta
lactamase (MBLS) and decreased penetration of drug leads to resistance.
Materials and Methods: In this study, a total of 572 CF patients sputum samples were collected and
demographic details from all the patients were collected in a questionnaire. All the specimens were processed
according to standard protocol. Antimicrobial susceptibility testing was done using Kirby-Bauer disc
diffusion method to determine the drug resistance pattern. All the strains of P. aeruginosa were screened for
production of MBLS using disc impregnated with IPM-EDTA.The blaVIM and blaIMP genes were detected
by duplex PCR.
Results: Of the 217 isolates of P. aeruginosa, 159 (73.3%) were resistant to imipenem and 141 (64.9%) to
meropenem. Cetazidime and tobramycin showed 112 (51.6%) resistance. 96 (44.2%) were resistant to
piperacillin-tazobactam, gatifloxacin and netilmicin.78 (35.9%) were resistant to ciprofloxacin and
gentamicin. 62 (28.6%) were resistant to cefoperazone, cefepime and ceftriaxone. Least resistance was
observed for amikacin 51 (23.5%) followed by ceftizoxime which showed 32 (14.7%). MIC was done for
imipenam resitant isolates, which showed reduction in the MIC values.MBL production was screened by
zone enhancement method, which detected 63 (56.25%) MBL producers by using cetazidime plus EDTA
discs. Out of 63 MBL positive isolates taken, for PCR 53 (84.1%) was positive for the blaVIM genes and 48
(76.1%) showed the presence of blaIMP genes.
Conclusion: Carbapenem resistance is of great clinical concern especially in patients with P.aeruginosa
infection with cystic fibrosis conditions. Hence regular screening is required to monitor the resistance pattern
of Pseudomonas aeruginosa in CF patients.
Keywords: Pseudomonas aeruginosa, drug resistance, MBL, Carbapenem resistance, Cystic fibrosis,
*1. Scientific and technological project of Henan Province（project number132102310244）;2. Henan
University of Traditional Chinese Medicine Graduate Innovation Fund Project（project number201210）
*Corresponding author: Bi Yongyi, Email: 1726621467.qq.com

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China(Hong Kong)

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Guest Lecture 1(from APACPH)
Training Doctors for Promoting Peace and Harmony
Li Chong Chan
Chair Professor, Department of Pathology and Co-director, Medical Ethics and Humanities Unit, the LKS Faculty of
Medicine, The University of Hong Kong, Pokfulam, Hong Kong

The impact on human suffering extends beyond wars as a result of displacement of people from their homes
– currently millions live in refugee camps in poor impoverished conditions prone to outbreaks of famine
and diseases. Continued conflict leads to a drain on medical services which can be better use to build healthy
communities, and importantly is an indictment of our inhumanity, a reflection of our failings as human
beings to understand and treat each other with respect.
Can we do something about the way we train our doctors so that besides providing humanitarian relief, they
can play a pivotal role to help prevent and/or minimize the effects of conflict? Can doctors besides providing
expertise and working in teams to save lives and relieve suffering of the wounded, works as advocates of
peace and harmony in difficult and tense situations which are often fraught with uncertainty and ambiguity?
I believe we can train doctors to promote peace and harmony provided we address shortcomings in the
current emphasis in medical training based much on exploiting the advances in scientific research and cutting
edge technology where cure and prolongation of lives are priorities. For changes in the curriculum that will
enable doctors to promote peace and harmony, I would suggest it includes at least the following aspects:
That doctors must understand the causes of conflict which are multi-factorial and interconnected. Higher
education at the university level must prepare all students to understand the key issues that lead to and
perpetuate war. A liberal arts education based on interdisciplinary teaching and learning is essential.
That the medical curriculum must be fortified with inclusion of the medical humanities – this will open up an
inquiry into the nature of suffering and healing, and to enable students to ask of themselves “What makes us
human”, and understand the one who suffers, the one who causes the suffering, and the one who heals are
one and same human being.
That there must be teaching and learning activities in particular that promotes wellbeing and builds resilience
through mindfulness training. This together with compassion training will help doctors not only to negotiate
the difficult terrain in the journey to building peace and harmony but provide a means to sustain the work on
a longer term basis.

Guest Lecture 2
Fighting Against Chronic Diseases: What Can We Learn from Hypertension?
Jin-Ling TANG
School of Public Health and Primary Care
The Chinese University of Hong Kong, Hong Kong, PR China

Chronic disease has replaced infectious disease as the major threat to the health and life of mankind. Have
we been responding rationally in an emergency like this? Hypertension is one of the most important chronic
diseases worldwide and also among the most substantively studied human diseases. The battle against the
disease is however far beyond a complete success. I will take hypertension as an example to examine the
evidence on the fundamental issues behind common chronic diseases and the rationale behind the strategies
for their control.
For example, on what basis hypertension is considered as a disease entity? How is the cutoff determined for
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defining and diagnosing hypertension? What are the implications for individuals and populations of changing
the diagnosis criteria? Is blood pressure a good indicator in identifying who would benefit from and should
thus be given antihypertensive drugs? If not, what should we base on in prescribing antihypertensive drugs?
How large is the effectiveness of anti-hypertensive drugs in preventing major cardiovascular events instead
of reducing blood pressure? Is it worthwhile? How willing are the patients to pay for such a benefit?
I will lead to a conclusion that for control of chronic diseases including hypertension we should emphasize
more on lifestyle and dietary changes and make drug policies according to available resources of the
community and the needs and values. No populations could use all its resources only for health and resources
for disease control are thus always limited. Different populations with different resources available and
having difference needs and values should make different decisions. Thus no guidelines are universal and fit
for all individuals and societies. The Chinese healthcare would go bankrupt and not satisfy the public if the
recommendations of wealthy western populations are exactly followed in the country as the Chinese local
guidelines suggest.

Oral 1(ID210)
Finding Alternative Financing Mechanism for Long-term Sustainability of Healthcare: What
Role Can Employers Play?
Su Liua, Hiu Ching April Wong, Wilson Wai-san Tam, Qi Yuan, Hei Kan Higgins Yuen
JC School of Public Health and Primary Care, Chinese University of Hong Kong

Background: Population ageing and ever-rising medical costs have created a global challenge for
governments around the world: how can they find additional resource to ensure long-term financial
sustainability of their healthcare system? In Hong Kong’s case, reform discussion to date has focused on the
balance of public funding and individually-purchased insurance, with the latter promoted by the proposed
Health Protection Scheme (HPS). Little attention has been given to the role of private employers. This study
aimed to gauge employers’ view on the current healthcare reform and to develop policy ideas that would
incentivize employers to provide medical benefits to employees thus share the increasing financial burden.
Methods: An employer survey was conducted among a random sample of 439 local private employers.
Quantitative findings were collated with themes identified from three focus group discussions with 19
representatives from companies of varying size and industry. Employers’ knowledge and perception of the
healthcare reform and their preference over different government incentives were investigated.
Results: Though self-rated knowledge about the reform was 4 out of 10 on average, surveyed employers
expressed an overall neutral (41%) or positive (39%) impression of the HPS. The majority agreed that
employers have a shared responsibility for employees’ health and wellness, but many found cost to be the
biggest challenge, particularly smaller employers. Reform proposal allows employers to migrate their current
insurance policy to HPS, but many survey respondents said they wouldn’t do so unless the government
makes HPS more attractive than competing plans. Among different incentives, tax concession was most
welcomed by employers.
Conclusion: Governments need to recognize employer-provided medical benefits as a viable source of
healthcare financing, and consider incorporating it in the existing health system when developing policies or
introducing reform. Both financial and non-financial (e.g., regulation) incentives can be used to further its
role.

Oral 2(ID827)
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 Perceived Benefits and Needs of Pregnant Women Undertaking DNA-Sequencing Based
Non-Invasive Prenatal Test for Down Syndrome in Hong Kong: A Qualitative Study
Janice YC. Lau, Huso Yi, Olivia MY. Ngan
Health Ethics and Medical Humanities, Centre for Global Health The JC School of Public Health and Primary Care,
The Chinese University of Hong Kong, Hong Kong SAR

Background: Cell-free fetal DNA sequencing based non-invasive prenatal testing (NIPT) allows pregnant
women to detect Down syndrome with high sensitivity of 99% at early stage of gestation without risk of
miscarriage. This service is publicly available in China, Hong Kong and the US. Since its introduction,
attention has been given to the clinical benefits of NIPT. Yet, little has been discussed about its perceived
benefits from consumer perspectives. The aim of this qualitative study was to explore how pregnant women
decide to undertake and benefit from NIPT and to identify unmet needs for improvement.
Methods: In-depth interviews with 45 women who had undertaken NIPT in Hong Kong were conducted
from July to December 2012. The participants were systematically selected based on socio-demographic and
clinical characteristics to increase the variability of the study sample. Interpretative phenomenological
analysis was used to examine informed-decision making of the test and thematic analysis identified the
benefits and needs.
Results: Most women were satisfied with the safety, accuracy and early performance of the test. Yet, to meet
the timeline of medical procedures if necessary, they made communication with obstetricians’ referral based
on screening results in haste manner. Possibility of aborting affected fetus obstructed them from openly
discussing NIPT with family members. Women with inadequate knowledge of the disease, including its
cause and complications did not recall clearly the informed consent procedure; which pairs of chromosomes
and why were they being tested; and how fetus's DNA could be tested.
Conclusions: While NIPT would reduce maternal anxiety by absence of procedural risk to fetus, the
patient-centered information of DNA testing should be developed to increase public health literacy of NIPT.
Better informed knowledge of Down syndrome would facilitate future decision making for patients who
bears affected fetus. Timely genetic counseling and follow-up consultation needs to be developed.

Oral 3(ID887)
Factors Associated with Young Adult Binge Drinking Practices in Hong Kong: A
Cross-sectional Study
Alvin H. Wong, Hale H.L. Ho, Jean H. Kim
JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR

Background: Though Hong Kong had traditionally enjoyed low levels of per capital consumption among its
citizens, recent policy changes such asa governmental decision to eliminate taxes across most alcoholic
beverages have brought about concern about their impact to alcohol-related harm.Among all drinkers, local
statistics have shown that those 18-25 years of age are particularly vulnerable to binge drinking practices on
a monthly basis. This study aimed to explore the determinants associated with binge drinking among Hong
Kong local young adults and their implications on health promotion.
Methods: An anonymous, cross-section, population-wide telephone survey among local Hong Kong Chinese
residents and two-way visa holders was conducted in 2011, the sample of which included young adults 18-25
years of age (n = 684). Participants were asked about their drinking patterns as well as their attitudes on a set
of alcohol expectancy statements.
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Results: Binge drinkers among local young adults tend to be of the male gender and not included in student
communities. Among all alcohol expectancies identified to impact varying levels of drinking, only who held
the social benefits related to drinking to a high regard were found to be much more likely to have had at least
one past-month binge drinking episode.
Conclusions: Among the positive drinking-related factors identified, social benefits of drinking were found
to be the sole predictor of past-month binge drinking for local young people. Such findingswarrant further
examination of the underlying context of social drinking in this subgroup, as they lie in direct contrast with
previous research showing that social drinking served as a protective factor against hazardous drinking
occasions among Chinese people overall. Possible health promotion messages tailored for young adults may
consider centring on preventing overzealous perceptions of alcohol’s impact on social facilitation.

Oral 4(ID947)
Can Self-collected HPV DNA Sampling Be A Screening Tool for Cervical Cancer?
Lai Yi, Eliza Wong
Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong

Backgrounds: The causal relation between Human papillomavirus (HPV) and cervical cancer has enabled
HPV DNA self-sampling to be a possible screening method. This study investigated whether self-sampling
could be an alternative for cervical cancer screening, by exploring the attitudes and acceptability of
self-sampling for HPV DNA testing in women visiting community clinics , and comparing the self-collected
samples with Pap smear results in Hong Kong.
Methods: A randomized control trial of 393 women recruited, aged 35 to 65 years old. These women were
assigned to either Arm 1 (having self-sampling before Pap smear) or Arm 2 (having Pap smear before
self-sampling). Before having the two tests, participants were surveyed on the attitudes of both tests; after
having the two tests, they were again asked the attitudes and preferences. Women were also assessed their
intentions to use HPV DNA self-sampling if it were offered to them in the future.
Results: Participants generally accepted self-sampling and clinician-sampling (overall score 7.8 and 7.7).
Women had a significantly more positive feelings about self-sampling (less anxious, less uncomfortable,
more pleasant, less embarrassed, more relaxed, less painful and less invasion of privacy) (p < 0.001).
However women trusted Pap test results more and had more confidence in collection than self-sampling
(p<0.001). The prevalence of HPV was 11.7% (46/392) self-collected vaginal samples and 7.7% (30/392)
clinician-obtained cervical samples. The overall agreement was 93.9% and 52.0% agreement among the
positives, with kappa of 0.65, 95% CI of 052-0.78.
Conclusions: The good concordance with HPV DNA detection and acceptability suggest self-sampling
could be an alternative method to boost up the participation rate for cervical cancer screening. Further
longitudinal studies are needed to evaluate its performance in the context of population based screening
programme.

Oral 5(ID985)
Using Travel Data to Estimate the Epidemic Size during a New Influenza Pandemic: A Joint
Estimation Approach
Ka Chun Chong, Benny Chung Ying Zee

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 Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong

Background: A reliable method to estimate epidemic sizes during early phases of a new influenza pandemic
is critical in addressing infectious disease response. Estimation solely based on the routine surveillance data
may give an underestimate as the data only reveal a small proportion of actual infections due to the
underreporting from asymptomatic or mild cases. Nevertheless, surveillance at the borders such as time of
import from the source country could refine the estimate as the data is relatively more complete and timely
than other available data. A simple method is suggested to estimate the epidemic size and is demonstrated its
reliability and validity in simulations.
Method: A susceptible-exposed-infectious-recovered (SEIR) model is adopted to describe the dynamic
system of the infectious disease. By assuming Poisson sampling process, routine surveillance data is fitted
into a likelihood function from the model given a parameter of reporting ratio to real epidemic size.
Additionally, travel data of the times of infected cases imported from the source country and the daily rate of
travel to particular country are used to formulate another likelihood function. A joint likelihood function is
thus formulated from two different likelihoods. A maximum likelihood method is employed to estimate the
model parameters. To assess the validity and the reliability of the proposed method, we investigated the
required sample size of the travel data for the estimated epidemic size to be included within the 95%
confidence interval through simulations.
Results and Conclusion: Overall, the proposed method is valid for most of the simulation scenarios and its
reliability is moderately sensitive to the disease transmission parameters. Through a demonstration for the
usefulness of travel data in determining the epidemic size, improved coordination or technical innovations to
streamline or even centralize infectious disease surveillance of travelers between countries would be
beneficial to public health.

Oral 6(ID1098)
Tobacco and Alcohol Control: Challenges to Academic Public Health
Tai-Hing Lam
School of Public Health, The University of Hong Kong, Hong Kong, China

Background: The 2011 UN Summit Political Declaration on Prevention and Control of Non-communicable
Diseases highlighted 4 NCDs, 4 risk factors and public health prevention. Tobacco and alcohol need urgent
and stringent control measures.
Methods: Tobacco control is leading the way with WHO Framework Convention on Tobacco Control and
MPOWER strategies. The Stage of The Tobacco Epidemic model has shown many developed countries
benefiting from increasingly stringent tobacco control measures with decreasing mortality following major
decline in smoking (Stage 4). Some countries are moving towards an ‘endgame’. Public health academics
contributed enormously in research, education and advocacy.
Results: Alcohol control is lagging behind miserably: all countries are at Stage 1 (increasing use) or 2
(increasing mortality) of the proposed The Stage of The Alcohol Epidemic model. That alcohol is a
confirmed human carcinogen is ignored; moderate drinking is promoted for heart protection by the industry.
The challenges of alcohol control are more serious. In Hong Kong, with strong input from public health
academics to government policies, smoking prevalence has declined from 23.3% to 11.1% during 1982-2010.
Age standardized lung cancer and cardiovascular disease rates are decreasing. But Hong Kong has the most
anti-public health measure of zero beer and wine tax since 2008. Our research has shown no heart protection
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effect from moderate drinking.
Conclusions: Research on alcohol use and related harms and policies needs to expand urgently. Public
education and health promotion campaigns can highlight alcohol carcinogenicity to raise the alarm.
Campaigns against drinking before driving and alcohol related violence, as external immediate harms to
others, can be very effective. MPOWER for tobacco control can be adopted for alcohol control. Public health
academics should advocate for a Framework Convention on Alcohol Control. Non-drinkers are not antisocial
but are healthy role models. To drink or not to drink, it is now a public health issue.

Poster 1(ID461)
Public Health Implications of DNA-Based Non-Invasive Prenatal Testing Service for Down
Syndrome in Hong Kong
Olivia MY. Ngan, Huso Yi, Janice YC. Lau
Health Ethics and Medical Humanities Unit, Centre for Global Health, JC School of Public Health and Primary Care,
The Chinese University of Hong Kong, HKSAR

Background: Down syndrome (DS) is the most frequent chromosomal abnormalities, with its prevalence of
1/600-800 live births. In response to its public health concern, Hong Kong (HK) provides a universal DS
screening service, which can detect about 90% of DS at 5% false-positive rate (FPR). The positive cases are
offered for an invasive diagnosis, which carries 1% risk of miscarriage. Since late 2011, non-invasive
prenatal tests (NIPT) using cell-free fetal DNA detecting over 99% of DS (0.1% FPR) have been available in
China, HK, and the US. While there is evidence of clinical utility of NIPT, its public health implications are
unknown. The study aims to explore the factors associated with the adoption and promotion of the test in
HK.
Methods: A survey among obstetricians, nurses, midwives, sonographers, and genetic counselors assessed
clinical experiences and various attitudes: NIPT, new evidence-based practice (N-EBP), shared decision
making (SDM), and termination of pregnancy (TOP). Multivariate analyses were performed to examine the
correlates of NIPT implementation. As this is an on-going study, preliminary findings are presented.
Results: Although obstetric professionals were knowledgeable about the clinical differences across the tests
for DS, their attitudes towards NIPT were affected by their clinical expertise and medical and public health
ethical concerns – informed consent, standard of care, cost-benefits, and policy regulation. Attitudes towards
N-EBP and SDM were found to be significantly associated with positive adoption of NIPT.
Conclusion: Prevention of genetic conditions of newborns is dependent upon screening, diagnosis, and TOP
in the interaction of healthcare professionals and pregnant women. Education on NIPT is needed for the both
to engage a better informed-decision making over the course of prenatal testing. In order to scale-up NIPT
widely, equally and cost-effectively, the policy of public health genetics should be developed to better
integrate NIPT into the current screening system.

Poster 2(ID464)
What We Dream for in Health Education – Community Self-Promoting of Physical Activities
Cheung Chin Chung Jonathan
The Hong Kong Polytechnic University

Background: According to the Survey conducted by the Department of Hong Kong in April 2012, 62.7% of

143
the interviewees do less than 2 – 3 times of exercise a week. The numbers are alarming. Yet, probably even
more alarming is that, with the length of time promoting physical activities in Hong Kong, the numbers
remain at an unsatisfactory level.
This perhaps suggests current method of promotion needs modification.
Methods: Underlying principle of the project was to incorporate health promotion into the culture of the
service school, such that the schoolcontinues the practice themselves. This is perhaps the direction of future
health education. Via discussion and corporation with teachers and senior students, the project team
attempted to include promotion activities into the ‘House System’ of the schools.
Activities implemented were in regular bases, once a week for a month. After the pioneer program, the
school was supposed to continue the promotion activities.
This method enables schools to promote health concepts themselves, and the project team can enable another
schools.
Results: The attempt of incorporatinghealth education into the culture of service school was not achieved,
limited by the implementing time. However, evidence shows that the project improves awareness of physical
activities of participants.
Questionnaires were collected from participants and non-participants (n=62). Participants (Group A, n=38)
were (p=NS) doing more exercise (the mean 2.73 vs. 2.49 which 3 represents 3 times a week and 2 twice)
after the program, when compared to non-participants (Group B, n=24).
(Table 1)
Group A (n=38) Mean (SD) Group B (n=24) Mean (SD) p value
How often to do exercise 2.73(1.359) 2.49(1.558) NS
Conclusion:
The project cannot be called a full success, yet its ideology can perhapsbe a reference of future health
education.

Poster 3(ID837)
Developing Drinking Advice to Empower the Hong Kong Adults to Make Educated Choices
on Alcohol Consumption
Hale HL. HO, Catalina NG, Lancelot WH. MUI, Joseph TF. LAU, Jean H. KIM
JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR

Background: The Regional Committee for the West Pacific (WPRO) of the World Health Organization has
identified alcohol as a major public health problem in Asia and threat to public health in Hong Kong.
Alcoholic beverages are readily accessible in Hong Kong and drinking culture has made more common after
an adjusted duty tax policy in 2008. Recent studies have shown an increase in drinking prevalence among
adult population in Hong Kong from 30.9% in 2005 to 34.9% in 2010 for males and from 19.5% in 2005 to
24.6% in 2010 for females. Alcohol causes harm beyond the physical and psychological health. Different
level of alcohol consumption potentially leads to acute and chronic diseases. In 2009, alcohol-related illness
or injuries accounted for a total of 2,433 cases in Hong Kong hospitals, and contributed to 0.14% of locally
registered deaths. With an increasing consumption of alcohol, the Hong Kong government realized the
importance of public awareness and commissioned us to develop an official document on drinking advice. It
is crucial for drinking advice for the general public so that they are empowered to make an informed choice
about alcohol use.

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Methods: Social marketing will be used as the guiding approach for the development of drinking advice.
Undifferentiated social marketing principles will be adopted to help establish clear behavioral goals and
objectives. Social marketing tools are to pinpoint target populations and effectively create health messages to
address the local needs and behaviors. Hong Kong local drinking habits and the perceived harms and benefits
of alcohol consumption will be explored through evidence-based methods and findings from literature
reviews, and with careful consideration of international evidence. Detailed examination of the local situation
on alcohol consumption, and consultation of different stakeholders will be conducted, aiming to develop a
drinking advice that is more fundamental to the local context in Hong Kong, and to deliver the alcohol
related harms and benefits to the public more efficiently and effectively.

Poster 4(ID942)
Patients’ Perceptions of Patient Engagement in Hong Kong
Eliza Ly Wong, Pik-man Lin, Siu-fai Lui, Annie WL Cheung, Carrie HK Yam, Sian Griffiths, Eng-kiong Yeoh
Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong

Background: The study aimed at discerning Hong Kong patients’ perceptions of patient engagement. It is
part of the Patient Engagement Study commissioned by the Hong Kong Hospital Authority (HA) which
investigates views on patient engagement from the perspective of both medical staff and inpatients of HA
hospitals.
Methods: Five focus groups were held, each consisted of members from the same HA geographical cluster
that had participated in the study. The participants were asked to express their perceptions on patient
engagement, including perceived definition, experienced benefits and barriers, and suggested strategies to
improve patient engagement. Thematic analysis was used for data analysis.
Results:33 patients enrolled in the study and each focus group contained 4-8 patients, in which 25
participants suffered from chronic illness, 16 had attained lower secondary education or below, 22 either not
working or were having part-time jobs.
Respondents cited listening to the medical advice of health professionals, obtaining information, mutual
communication, inform of alternative treatment, involved decision-making, trust and engaging family
members as components of engagement, and identified limited time and resources of healthcare staff,
patients’ incapability of asking questions; patients’ poor literacy, socioeconomic background or health
conditions, staff’s indifference towards patient feelings, policy and information access problems as barriers
to engagement.
Improvements suggested were mostly related to information acquirement and platform to communicate with
healthcare staff.
Respondents’ hospitalization experience ranged from highly engaged and well informed to no engagement at
all, whereas communication and decision making process were discussed most extensively.
Conclusions: To the findings on identified components and barriers of patient engagement the patients
perceived, which served as a heuristic study for a Hong Kong-wise questionnaire survey on patient
engagement perceptions of inpatients now in progress. The suggested improvement actions could set a
foundation for further research to find out expectation gap between medical staff and patients, hence to
improve patient engagement and the health system in the future.

Poster 5(ID946)

145
 The Core Components of Inpatient Experiences: Development and Validation Short-Form
Patient Experience Questionnaire in Hong Kong (SF-HKIEQ)
Eliza LY Wong, Siu-fai Lui, Annie WL Cheung, Carrie HK Yam, Pik-man Lin, Sian Griffiths, Eng-kiong Yeoh
Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong

Background: Patient experience reflects the quality of care from the perspective of patient; collection of
patient experiences is therefore an important component for evaluating the quality of health services. The
development of an abbreviated, reliable and valid questionnaire measuring patients’ experience of inpatient
care would increase the ease in which trends in patient satisfaction and experience could be measured on
regular basis and facilitate the quality improvement in addition to cultivating patient engagement. The
study aimed to constitute and test a core set of patient experience questions which are important to patients
and that hospital managers and healthcare professionals might wish to address for monitoring on daily basis.
Methods: Using the framework of the Hong Kong Inpatient Experience Questionnaire (HKIEQ) which was
established in 2010, a validated Short Form Hong Kong Inpatient Experience Questionnaire (SF-HKIEQ)
was developed through consensus-based panel discussion and then the psychometric testing in a validation
survey
Results: 18 items derived from the full version of Hong Kong Inpatient Experience Questionnaire (HKIEQ)
have been found to provide a good representative picture of key inpatient experiences in hospital setting.
These items have a high degree of face validity and show a high degree of construct validity and internal
reliability consistency.
Conclusions: The development of a locally validated SF-HKIEQ could be easily and quickly completed by
patients providing a quick reference of hospitalization experiences for quality improvement. The short form
instrument could also be used as a platform to engage both healthcare staff and patients for monitoring the
quality of hospital care over time and on a daily basis.

146
China (Taiwan)

147
Guest Lecture
Shin-Han Tsai M.D., Ph.D.
Department of Neurosurgery,Taipei Medical University - Shuang Ho Hospital, Taiwan
Dr. Shin received his MS in Division of Anatomy (Neuroanatomy) Institute of Biomorphology, National
Defense Medical Center, Taiwan, Republic of China, Ph.D. in Department of Neurosurgery and Division of
Neurobiology, Department of Cell Biology, Neurobiology and Anatomy, University of Cincinnati College of
Medicine, Cincinnati, Ohio, U.S.A.
Dr. Shin will give a lecture at Injury Prevention: Impact of Prevention Policies in Select Asia-Pacific
countries on October 27, 2013.

Oral 1(from APACPH)

A pilot Study of BQ Chewing Habit Among Aborigines in Taiwan
Chen-Yi Leea, Xue-Xiu Lua, Miao-Ru Yia, Tien-Yu Shiehb, c, Yong-Yuan Changd
a Department of Oral Hygiene, Kaohsiung Medical University

b Global Center of Excellence for Oral Health Research and Development, Kaohsiung Medical University

c Department of Dentistry, Taipei Medical University

d Department of Public Health, Kaohsiung Medical University

Objective: In Taiwan, the ethnic groups of aborigines who have a BQ culture are mainly Paiwan and Amis.
This pilot study is a cross-sectional study and aimed to investigate the Paiwan aborigines who live in
Ping-Tong County.
Methods: The sampling method is multi-stage stratified cluster sampling. From Oct. 2012 to Mar. 2013, we
have completed 1,418 household face-to-face interviews by public health nurses, and the data management is
not complete yet. This report is based on 672 questionnaires that have just been keyed in late July, 2013.
Results: The aboriginal culture or social environment showed an obvious influence on the BQ chewing
behavior. Lifestyle habits (BQ, cigarette and alcohol) were common, and drinking was the most prevalent
habit, followed by chewing and smoking. In this sample, the prevalence of former chewers was 2.4% (n=16)
and which of current chewers was 32.6% (n=219), and the prevalence of BQ dependence was 41.1% (n=88)
among the current chewers. The mean BQDS score was 3.44±4.16. A new ROC curve based on this sample
was conducted and the optimal cut-off score was 3, the optimal sensitivity was 0.989, the specificity was
0.921, and the area under the curve (AUC) was 0.990. Among them 76 (35.7%) reported a total score of 0
point (no dependent symptoms), 41 (19.2%) scored 1-2 points, and 96 (45.1%) scored 3 points or above.
Conclusions: In Ping-Tong, the majority of the aboriginal current chewers reported that chewing BQ is
moderately important in their culture. They thought that people think POSITIVELY of quitting BQ and they
agreed that chewing BQ is unhealthy, but most of them were still undecided about quitting BQ. BQDS
showed that dependent symptoms were common in this sample.

Oral 2(from APACPH)

The Residual Effects of Motorcycle Head and Spinal Injuries
Wan-Lin Chena, b , Yung-Hsiao Chiang c, Hung-Yi Chiou b, Wen-Ta Chiu a, d, Shin-Han Tsai1 a, b, e
aInstitute of Injury Prevention and Control

bCollege of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan

cDepartment of Neurosurgery, Taipei Medical University Shuang Ho Hospital, Taipei, Taiwan

dMinistry of Health and Welfare, Taiwan

148
 eDepartment of Emergency Medicine, College of Medicine, Taipei Medical University Shuang Ho Hospital, Taipei,
Taiwan

Objective: Implementation of a motorcycle helmet law was associated with a 50.2% reduction in motor
vehicle-related deaths in Taiwan over 18 years, despite a 93.3% increase in the number of motorcycles.
Motorcycle Head and Spinal Injuries result in high mortality and morbidity with long term social and
economic impact. The present study is to review the residual effects of motorcycle head and spinal injuries.
Method: We conducted a systematic review of all traumatic brain injury related studies by Taipei Medical
University research team. Data were retrieved from Center of Neurotrauma Research (CNR) of Taipei
Medical University.
Results: Helmet law was associated with a significant reduction in motor vehicle-related deaths. However,
our study found that trauma brain injury (TBI) patients were associated with a 1.99-fold increased risk of
subsequent schizophrenia. Mild TBI patients impaired their ability to increase activation in working memory
(WM) circuitry in both moderate and high WM load conditions. Mild TBI patients showed clear-cut
abnormal functional connectivity map in varying resting-state networks. This result indicates a subtly, but
diffusely interrupted functional connectivity occurring in patients of Mild TBI. Economically, total social
cost associated with TBI and spinal injuries in one single year was NTD 43.4 billion (Not including social
cost associated with mild and moderate TBI).
Conclusion: Patients sustaining mild TBI are more difficult to diagnose. Routine and extended clinical and
laboratory evaluations often fails to show clear morphological brain defects, however these patients
frequently suffer from lasting cognitive, behavioral and emotional difficulties including various degrees of
amnesia, altered executive functions, difficulty in concentration, depression, apathy and anxiety. Traumatic
brain injury and spinal injuries have tremendous residual effect from various perspectives.

Oral (from APACPH)

The Taiwan Experience in Control of Motorcycle Injuries
Dr. Shin Han Tsai MD PhD
Taipei Medical University, Taipei, Taiwan

Oral 3(ID177)
Effects of Osteoporosis and Time Length on Recurrent Falls in Older Men and Women
Mau-Roung Lina, Wen-Yu Yub, Shih-Chieh Wanga
a Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei,
Taiwan
b Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan

Objective: A prospective study was to investigate relationships between osteoporosis and recurrent falls at
two follow-up lengths of 6 and 12 months in older men and women.
Methods: 204 men and 447 women, who visited an emergency department due to a fall, were recruited.
Each participant was contacted by telephone at 1-month intervals over a 1-year period to ascertain the
occurrence of falls.
Results: Men with osteoporosis were not significantly different in the risk of falling from those without

149
osteoporosis at 6 and 12 months. Men with a history of falls were 127% and 110%, respectively, more likely
to have a fall at 6 and 12 months than those without. Compared with men without previous fractures, those
with previous fractures were 258% more likely to have a fall at 12 months. In contrast, women with
osteoporosis were 246% and 125%, respectively, more likely to have a fall at 6 and 12 months than those
without. Women with a history of falls were 129% and 88%, respectively, more likely to have a fall at 6 and
12 months than those without. Women taking sedatives and hypnotics were 75% and 96%, respectively, more
likely to have a fall at 6 and 12 months than the counterpart. Depressed women were 138% more likely to
have a fall at 6 months and those using walking aids were 86% more likely to have a fall at 12 months,
compared to their counterparts.
Conclusions: There may have an effect of osteoporosis on falls for older women but not for older men.
Identification of risk factors for recurrent falls in older men and women may be affected by time length while
their effects are reduced over time. Future research is needed to validate these findings and identify
underlying mechanisms between osteoporosis and the risk of falls.

Oral 4(ID221)
Applying Resistance Training Exercise Program to Enhance Gait Function in Elderly for
Chronically Ill Patients
Ming-Shu Chena.b, Mei-Yu Changa, Jiang, B. C.b.c, Tsung-Ching Lina
a Far Eastern Memorial Hospital, New Taipei city, Taiwan

b Yuan Ze University, Taoyuan county, Taiwan

c National Taiwan University of Science and Technology, Taipei city, Taiwan

Background/objective: In an aging society, an increasing number of elderly adults are suffering from
chronic diseases, such as hypertension, hyperlipidemia, heart disease, diabetes, and/or osteoporosis. Falls are
unpredictable accidents, and the resulting injuries can be serious in the elderly, particularly those with
chronic diseases.
Methods: Regular exercise, such as aerobic training, is recommended to prevent and treat hypertension by
reducing clinical blood pressure; however, there is insufficient evidence to confirm whether regular circuit
hydraulic resistance training can enhance postural stability of those with chronic diseases. We implemented a
12-week circuit hydraulic resistance training program to improve postural stability, gait, and balance and
prevent falls prevention in adults >45 years of age.
Results: We analyzed gait function of 54 elderly (44.0% female; 56.0% male; mean age, 67.56 ± 10.70 years
in 25 exercised experimental group; 27.6% female; 72.4% male; mean age, 65.00 ± 9.67 years in 29 control
group), chronically ill patients with either cardiovascular disease, diabetes mellitus, or osteoporosis (36.0%
CVD; 40.0% DM; 24.0%OP in experimental group; 48.3% CVD; 27.6% DM; 24.1% OP in control group).
After a 12-week training program, postural stability measurements showed enhanced in exercised
experimental group. The mean time of the “single-leg stance with eyes open” increased from 18.10 ± 22.49 s
to 27.01 ± 29.00 s and that of the “timed up-and-go” test decreased from 7.67 ± 2.12 s to 6.76 ± 1.97 s.
During the training period (6-week), the “the area of foot substrate support” increased from 392.00 ± 85.40
(cm2) to 441.73 ± 87.72 (cm2) and end to 433.20 ± 90.35 (cm2) in the 12-week, the paired t-test results
showed statistically significant differences among the pre-training versus training after 6-week (p < 0.05).
Conclusions: Our results showed beneficial effects of resistance training, which can be used to improve
postural stability in elderly for chronically ill patients and male was better than female.

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Oral 5 (ID389)
Feasibility Assessment for Community Pharmacies to Provide Quit-Smoking Services
Pei-Yeng Chen, Jia-Ling Hou , Huei-fen Lin , Shu-Chen Kao , King-Fu Lin , Sheue-Rong Lin
Public Health Department, New Taipei City, R.O.C

Background/objective: In order to provide convenient, accessible and professional quit-smoking methods as

well as services to smokers, the program targeted those above 18 years old who are addicted to smoking. In
addition, the program also implemented 8 weeks of free quit-smoking medication and follow up services
through pharmacists in community pharmacies to enhance motivation and encourage quit smoking.
Method: Local pharmacies willing to participate in the quit-smoking program were recruited to provide
services such as quit-smoking information, patches, service referrals and case management between April
2012 and November 2012.
Results: In 2012, a total of 320 pharmacies in the community participated in the New Taipei City
quit-smoking program. They provided quit-smoking information to 5,002 individuals, referred 373 to
quit-smoking services and managed 2,865 follow-up cases. By the third month, the quit-smoking program
success rate was 11.83%.
Conclusions: The two probable causes of the low success rate are: (1) The free quit-smoking medication
provided was patches that come in only one type of dose; therefore the participating smokers may find the
patch as an unsuitable method and unable to satisfy their needs due to the nature of their occupation or
personal factors, and (2) Some pharmacies in the community are single staffed, hence might not be able to
provide information services or satisfy customer needs. Therefore, for community pharmacies to provide
quit-smoking services, services should be provide for a greater diversity of medications and adequate human
resource to provide professional services.

Oral 6(ID390)
Outcome of Hearing Screening for New Taipei City Newborns
Siou-Jhuang Jyuan, Jia-Ling Hou, Huei-Fen Lin, Shu-Chen Kao, King-Fu Lin, Sheue-Rong Lin
Public Health Department, New Taipei City, R.O.C

Background/objective: Studies showed that 1.3/1,000 of the country’s newborns have congenital bilateral
hearing impairment, and 3.8/1,000 have unilateral hearing impairment (Lin et al, 2002);These hearing
impairment rates are higher than congenital hypothyroidism. Furthermore, hearing impairment in newborns
can only be correctly diagnosed using appropriate test instruments. Moreover, diagnosed infants should begin
wearing hearing aids and receiving auditory rehabilitation before 6 months of age to ensure future normal
language development.
Method: From 2010-2011, newborns less than 1 month old born in city-contracted hospitals and whose
either parent is domiciled in the city can receive subsidy for one hearing impairment screening test per
person each year Qualified medical institutions within the city’s jurisdiction can conduct the screening to
provide newborn hearing screening services and follow-up management for cases with abnormality.
Results: Fifty-three hospitals that perform deliveries and three medical institutions that provide confirmation
of diagnosis participated in the newborn hearing screening services. In 2010, among the 4,645 newborns
screened (83.89% initial screening coverage rate), 165 initial abnormalities were found. Of these, 146 were
re-screened (88.48% rescreening coverage rate), and 12 diagnosis were confirmed (9 bilateral abnormality, 2
unilateral abnormality, 1 other abnormality). In 2011, among the 21,884 newborns screened (86.96% initial
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screening coverage rate), 857 initial abnormalities were found, 678 were rescreened (79.11% rescreening
coverage rate), and 11 diagnosis were confirmed (7 bilateral abnormality, 3 unilateral abnormality, 1 other
abnormality).
Discussion: Treatment, and hearing and speech intervention for binaural hearing loss should be continuously
followed up. In addition, hearing screening for newborns should be more thorough and extensive to ensure
individualized and appropriate care.

Oral 7(ID392)
Analysis of Effectiveness of New Taipei City Active Case Finding Strategies for Detecting
Tuberculosis
Pei-Ru Lin, Hsiao-Yen Chen, Sheue-Rong Lin, Chia-Chi Lee, Lih-Jong, Shen
Public Health Department, New Taipei City, R.O.C

Background/objective: Among Notifiable Diseases, tuberculosis has the highest incidence and is the
leading cause of deaths in Taiwan. Through strengthening education, case managing, and promoting
strategies for finding active cases for tuberculosis, its incidence rate in New Taipei City has dropped from 58
cases per 100,000 people in 2006 to 48 cases in 2012.
Method: Through active case finding strategies in 2012, 100 tuberculosis cases were detected. Results: The
strategies and outcomes were: (1)Among those exposed to tuberculosis, chest X-rays on the first and twelfth
month found 31 cases of tuberculosis, indicating a detection rate of 89 cases per 100,000 people; (2)For
reported exposures aged over 40 between 2008 and 2010, and those aged 12-24 in 2010, free chest X-rays
detected 2 confirmed cases, indicating a detection rate of 1,755 cases per 100,000 people at an average cost
of US$475 per person; (3)Teacher and student health education and symptom scoring (7-point) screening
tests where scores of 5 or more were referred found 54 confirmed cases, representing a detection rate of 11
cases per 100,000 at an average cost of US$188 per person; and (4)Mobile chest X-ray screening vehicles for
high risk population confirmed 13 cases, indicating a detection rate of 50 cases per 100,000 at an average
cost of US$3,779 per person.
Conclusions: Among the active case finding strategies for tuberculosis, the symptom scoring screening was
most cost effective. Although detection rate was low, the simple test could increase the volume of screening,
thereby increasing public awareness of tuberculosis. In addition, those exposed to tuberculosis are at higher
risk of contracting the disease, and consistent with the strategies for screening exposed cases, the detection
rate was 36 times that of the general public. However, detection rate for high risk population is equivalent to
that of the general public, and relevant strategies should be adjusted for detection in high risk groups for
effective prevention.

Oral 8 (ID393)
New Taipei City Blueprint for Medical Resource Planning
Hsiao-Cheng Chen, Yi-Fang Hsieh, Huei-Fen Lin, Yao-Cheng Yang, Sheue-Rong Lin
Public Health Department, New Taipei City, (R.O.C.)

Background/objective: After New Taipei City was upgraded into a municipality, demand for accessible
medical services for its residents grew rapidly. According to the Department of Health’s principles of medical
regionalization delineated in Measures for Hospital Establishment or Expansion Permit on September 16,

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2011, except for New Taipei City’s north and central sub-regions where the ratio of acute care beds has
already exceeded 50 per 10,000 people, general acute care beds in other sub medical regions may be
increased. To cope with its growing population, New Taipei city government evaluated its overall medical
resources according to the philosophy of Localized Medical Care, Localized LOHAS Living. In addition, it
planned excellent localized medical services to provide for its residents the most convenient, timely,
comprehensive healthcare that are consistent with the needs of the public.
Method: To assess the condition of New Taipei City’s medical resources and its need for future expansion,
information such as population density, growth rate, ratio of senior population, geography, transportation,
status of medical resources and medical needs were collected from various administrative regions and
analyzed. The positioning and attributes of newly constructed and expanded hospitals in each sub-region
were then assessed to develop a general blueprint of New Taipei City’s medical resources.
Results and Conclusions: In terms of demand, supply, feasibility and setup model for new hospitals,
conclusions are as follow: after respectively establishing a 500-bed hospital in Luzhou in the northwestern
region of New Taipei City and Tucheng and Shulin in the western regions where medical resources are
inadequate, demands for medical care in western sub-regions will be effectively met; however, medical
resources for northwestern regions will remain inadequate and require further expansion. Furthermore, future
municipal hospitals could outsource their construction and operation to reduce financial burdens and increase
operational efficiency, medical service quality, public health services and social responsibility.

Oral 9 (ID394)
Taiwan’s Aging Population and Community Hospice and Palliative Care
Shin-Yi Lin, Tsui-Mi Huang, Sheue-Rong Lin
Public Health Department, New Taipei City, R.O.C.

In 1993, with the population aged 65 and over reaching 7%, the elderly population is estimated to reach 14%
by 2017. At the end of February 2013, the population of New Taipei City is 3,942,202, of which 356,781 are
aged 65 and above, making the city highest in elderly population in Taiwan.
New Taipei City covers a vast area comprising 29 regions within its jurisdiction. With a large urban-rural gap,
hospice and palliative care resources are unevenly distributed. Moreover, the Chinese philosophy of
establishing roots has resulted in a higher elderly population in remote rural areas, and hence a greater need
for hospice and palliative care. However, unavailability of local resources and high transportation and time
cost prevents hospice and palliative care from becoming prevalent.
To improve the accessibility and immediacy of hospice and palliative care resources and services, New
Taipei City is promoting the Community hospice and Palliative Care Program to link the resources of
hospitals, primary health care groups and nursing agencies to construct a community network of home
hospice and palliative care. Based on its 7 core hospitals, the city’s 29 regions are divided into 7 areas of
responsibility to support and provide consultation for respective regional primary care groups and
community nursing agencies providing front line community hospice and palliative care.
In addition, to enhance professional knowledge, primary care teams in community hospice and palliative
care will complete training courses. Seminars on hospice and palliative care, advanced directives and consent
for hospice and palliative care are also promoted to accomplish community hospice and palliative care.
The New Taipei City’s Community Hospice and Palliative Care will provide holistic and comprehensive
services that involve the whole family, team and community to enable patients to complete their life’s

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journey in dignity and in a familiar environment.

Oral 10(ID396)
Factors Affecting Suicidal Behavior — Case Examples from 2010 to 2012 Suicide Reports
Tsui-Mi Huang , Sheue-Rong Lin
Public Health Department, New Taipei City, R.O.C.

This study mainly examined the relationship among frequency of care interventions, suicidal behaviors and
suicidal deaths in reported cases of suicides and high risks cases in New Taipei City between 2010 and 2012.
Between 2010 and 2012 in New Taipei City, there was a total of 14,837 cases of suicidal intent and attempted
suicides. The average follow-up was 0.9 year; the majority of individuals were females (67.0%); the average
age was 39.9 years old, the majority being 20-39 years old (48.0%), followed by 40-64 years old (39.1%);
34.1% have mental illness; and most cited emotional/relational problems as the reason for suicide (52.8%),
followed by mental health/substance abuse (15.5%), and job/finances (13.7%).
Among the suicide cases, 3,427 individuals re-attempted suicide, indicating a 23.1% re-attempt rate. Of these,
17.3% re-attempted within 6 months; 3.8% between 6 months to a year; 2.0% between 1-2 years; and, 0.1%
after more than 2 years. Re-attempt risk for those with mental illness was 1.78 times more than those without
mental illness; for those who cited mental health/substance abuse as reasons, re-attempt risk was 1.57 times
higher than those who did not cite those reasons; for those 40-64 years old, re-attempt risk was higher (3.26
times higher than those aged 65 and over); and for females, re-attempt risk was 1.09 times that of males.
Frequency of care was an important factor in suicide re-attempt, where the higher the frequency of care, the
lower the rate of suicide re-attempt.
Of the PSIS, SP, BSRS and PHQ scales, the BSRS and PHQ scales were related to suicide re-attempt, with
the BSRS showing the most important impact.

Oral 11 (ID613)
Occupational Injuries and the Guest Worker Program: Comparison of the Occupational
Injury Rates among Migrant and Native Workers in Taiwan
Su-Fen You
I-Shou University, Kaohsiung, Taiwan

Background: An increasing number of international studies have shown that migrant workers have higher
occupational risk than native workers. In Taiwan, though previous studies indicated that migrant laborers
have been more often exposed to occupational hazards than native laborers, there is a lack of understanding
about the differences between these two groups. This study compared the trends in occupational injury
among migrant and native workers and explored the measures that have been taken to protect workers
against occupational injury.
Methods: Statistical data from the Taiwan National Labor Insurance for the period of 1998-2011 was
compiled and analyzed. To get more insight into the attempts during this period by the occupational health
and safety policy strategies to protect workers, online official documents were reviewed, and interviews with
informants in the central government and non-governmental organizations were conducted.
Results: The overall rates of occupational injury among migrant workers were significantly higher than
those of native workers in most of the years analyzed, and the gap between these two groups considerably

154
narrowed in the two most recent years. On average, foreigners had 1.45 times the injury rate of natives. We
argue that the decrease in occupational injury rates for migrant workers can be attributed to several
intertwined factors, among which specific tragedies occurred recently might have provoked labor authorities,
leaders, and employers to take more significant actions to prevent occupational injury.
Conclusions: Under the guest-worker policy, governmental regulations have tended to focus more on social
control than human rights, and the monitoring and management of migrant workers’ safety have been only
loosely enforced. More attention must be paid to ways in which the right of all workers, including migrant
workers, to occupational health can be upheld and promoted in this age of global migration.

Oral 12 (ID912)
Tuberculosis Care in Taiwanese Indigenous Patients: Tribe-engaged and Culturally Inclusive
Education
Wan Man Linb,c, Kuo Yuan Hwaa,b,c
aDepartment of Molecular Science and Engineering, National Taipei University of Technology, Taipei, Taiwan, ROC
bInstitute of Polymeric Science, National Taipei University of Technology, Taipei, Taiwan, ROC

cCenter for Biomedical Industries, National Taipei University of Technology, Taipei, Taiwan, ROC

Background: The purpose of this study is to understand the need for tuberculosis (TB) care and the level of
basic TB knowledge among Taiwanese indigenous patients. Hopefully, through our results, we can increase
the adherence of these patients.
Methods: We selected 44 remote indigenous townships in Taiwan (80 % of total) and recruited 6
practitioners (3 doctors and 3 nurses) for qualitative interview and 269 indigenous TB patients for
questionnaire survey. The data of the qualitative research was analyzed by NVIVO8. The questionnaire data
were examined and analyzed using Frequency Distribution, Pearson's Chi-Squared test and Fisher’s exact
test by SPSS19.
Results: Of the participative patients, over 60% preferred to communicate with TB-DOTS workers using
their native languages, especially male patients (p<0.05), over 50% expected that the health workers are
familiar with their tribal cultures, and over 40% expected the government to intervene in the training. All of
interviewees who are decision makers for hiring TB-DOTS workers have first priority to engage tribal
volunteers who are familiar with patients’ native language. Some patients’ relatives in the tribe could
increase their adherence and the patients over 60% agree that they could be one of TB-DOTS worker
candidates. Furthermore, these patients’ average score from basic TB knowledge was lower and their TB
health education should be given attention.
Conclusions: From the results, we propose the TB-DOTS workers should engage the tribal indigenous
people who are familiar with local indigenous language and culture to take care local indigenous TB patients,
even their relatives could be candidates for this. Meanwhile, these patients could accept culturally inclusive
TB health education, of which we have previously proved the significant learning effect in different
indigenous groups. As a summary, these culturally inclusive measures are expected to shorten the “health
disparity" gap concerning TB among Taiwanese indigenous peoples.

Poster 1 (ID207)
Alcohol Tax Policy in Relation to Inpatient Expenditure from Alcohol Attributed Diseases in
Taiwan

155
 Chih-Ming Lin, Chen-Mao Liao
Ming Chuan University, Taoyuan, Taiwan

Background/objective: The effects of alcohol taxes and prices on drinking and mortality are well
established, but the effects of alcohol taxes on measures of medical expenditure from alcohol-related
morbidity have not been elucidated.
Method: We assess the two opposing effects of alcohol tax policy interventions (tax rate increase in 2002
and decrease in 2009) on hospitalization in monetary terms of alcohol attributed diseases (AADs) in Taiwan.
Admissions data from 1996-2010 were retrieved from the National Health Insurance Research Database
claims file and analyzed in this study. Data on 430,388 males and 34,874 females aged 15 or above who had
an admission due to an AAD were collected. An interrupted time-series analysis examining the effects of the
implementation of alcohol tax policy on quarterly hospital inpatient charges (HIC) for AADs was employed.
Results: AADs inpatients totally cost 640,854 thousand US dollars in the 15-years study period. More than
80% of the HIC were attributed to alcoholic liver diseases. The elderly patients had a higher proportion of
liver diseases compared to the younger ones. Psychoses cost 6%-18% of HIC depending on sex-age groups.
The proportion of HIC for psychoses rose more in women than in men after the first quarter of 2002. The
study showed significant (p<0.001) changes in the adjusted quarterly HIC for AADs in 2002. Quarterly HIC
showed an abrupt 14.8% (i.e. 1,370 thousand US dollars) decline after first tax policy. No change in quarterly
HIC for AAD was found after the alcohol tax increase in 2009.
Conclusions: This study provides evidence that alcohol taxation has resulted in an immediate reduction of
medical expenditure from AADs in Taiwan. The policy of increasing alcohol tax rates may have favorable
influences on health care resource utilization.

Poster 2 (ID277)
A Longitudinal Study of Factors Associated with Objective-measured Physical Activity Among
Older Adults
c
Chin-Ching Wanga, Li-Jung Chena, Po-Wen Kub, Wen-Jung Sun
a National Taiwan University of Physical Education and Sport, Taichung, Taiwan
b National Changhua University of Education, Changhua, Taiwan

c Taipei City Hospital Zhongxing Branch, Taipei, Taiwan

Background: There is few data on objective-measured physical activity (PA) in older people with
longitudinal design. This study examined PA assessed by accelerometer among older adults over three years
and identified associated demographic variables, physical health and psychological factors.
Methods: In 2009, PA was assessed objectively for one week with ActiGraph-GT3X accelerometers in 350
participants aged 65 and older in Taiwan. A total of 307 participants provided valid PA assessments. Among
them, 227 participants completed the second-wave data collection in 2012. Tanita TBF-300 was used to
assess body fat. Subjective well-being was measure by The Chinese Aging Well Profile (physical,
psychological, independent, learning & growth, material, environmental and social well-being). The short
form of Geriatric Depression Scale and Pittsburgh Sleep Quality Index were used to measure depressive
symptom and sleep quality. Baseline variables including age, gender, marital status, body fat, numbers of
chronic diseases (cardiovascular diseases, diabetes, hypertension, stroke, and gouty arthritis), subjective
well-being, depressive symptom, sleep quality and 2009 PA (step-counts) were entered into a multivariate
linear regression model to explore the determinants of 2012 PA (step-counts).
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Results: Average daily step-counts were 6055 in 2009 and 5683 in 2012. Step-counts declined significantly
during this period (p<0.001). No gender difference on step-counts was found in both cross-sectional surveys.
Longitudinal results showed that baseline age, gender, body fat, learning & growth wellbeing, sleep quality
and 2009 PA were significant predictors of 2012 PA (all p<0.05). Those were female, older, with lower
baseline PA, greater body fat, higher score of learning & growth wellbeing, and poor sleep quality showed
lower 2012 PA. A modest total amount of variance (23.9%) was explained in 2012 PA.
Conclusions: Objective-measure PA was associated with demographic variables, physical health and
psychological factors in older adults, which may provide important implications for health promotion in this
group.

Poster 3 (ID343)
The Management Dipute About Taiwan’s Prescription Drug
Hsing-Yen Hsieh, Huei-Chu Cheng
Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan

Background: The purpose of this paper is to explain how Taiwan’s prescription drug management policy
has been adjusted under the pressure of different interest groups and the globalization trend. The pressure
comes from big pharmaceutical companies, Taiwans’ necessity to join the WTO (world trade organization),
financial turmoil of NHI (National Health Insurance), Taiwan’s burgeoning biotechnological industry and
the Ministry of Economic Affairs intending to stimulate this new technology for increasing Taiwan’s
economic growth. Each interest group has its own dispute about the benefit of new drugs, the adequate
duration of patent protection, the importance of providing affordable drugs to citizens facing death threat.
Methods: In this qualitative study second hand data analysis is applied as research method. We evaluate a
variety of data including press reports, government publications and published papers.
Results and Conclusions: These companies in pharmaceutical industry which have the capacity to produce
new drugs are concentrated in only several highly delevoped countries. These companies claim that this
business is risky, that drug research and development is expensive and a long-term patent protection is
needed. These companies also protect their profit by operating TRIPS (trade-related aspects of intellectual
property rights) in WTO. Objections come from those countries needing prescription drugs to save their
citizen facing death threat. They use compulsory licensing to produce drugs with patents. Taiwan gave up
this property rights to get more profit from attending WTO. The NHI has faced severe financial problems
and started drug price reduction several times. This reduction is opposed by drug companies. On the other
hand, local interest groups are forcing Taiwan’s government to protect the right of citizens joining NHI and
to provide the market protection of the emerging bio-technology industry.

Poster 4 (ID344)
The Impact of Health Promotion Activities on Physical Fitness Maintenances of the Elderly in
A Community in Taiwan
Pei-Ching Linab, Huei-Chu Chengb, Wan-Tien Linb, Wen-Hsu Chenab
aCommunity Extension Services Section, E-Da Hospital, Kaohsiung, Taiwan
b Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan

Background: The selected community for this research is located at the outskirts of Kaohsiung city in

157
Taiwan. Since the establishment of the elderly care center in 2005 until now health promotion activities for
the elderly have been performed. The program includes body massage, body and mind stimulating activities,
tai-chi and also health information lectures. The purpose of this study is to assess whether such health
promotion programs improve the physical fitness of these elderly.
Methods: The physical fitness values ranging from March 2011 to March 2013 have been measured
semiannually. The physical fitness information include the BMI (body mass index) value, their body balance,
body elongation, reactivity, heart and lung function plus blood pressure value. The participants being
measured more than 3 times are 33 elderly with an age between 65 and 89. The data will be evaluated and
analyzed by calculating frequency, correlation and time series.
Results and Conclusions: Our preliminary results of research are as follows: Normal blood pressure was
observed in 15 elderly who continued to have normal blood pressure values after participating in health
promotion activities. Of 18 elderly people with hypertension only two continued to have high blood pressure
after these activities, the hypertensions of the other persons got under control. Whether this was due to
medication or to the activities will be examined later on. 29 elders’ BMI values whether with slight
overweight or within normal range remained the same, the BMI value of only one person decreased and even
three increased. The majority of the elderly included in the multiple physical fitness measurements did not
show any improvements, but could maintain their status. The results show that participation in health
promotion program can maintain the elders’ physical fitness state and their body functions. Evaluation and
analysis of the data will be discussed in a further stage of the study.

Poster 5 (ID345)
The Study of Relationship among Experiential Marketing, Customer Satisfaction and
Customer Royalty in Physical Examination Center
Huei Ting Wanga, Chi-Ting Hongb, Yu-Min Chiangc, Ya-Ai Chengc
a National Cheng Kung University Hospital, Tainan, Taiwan

b Kaohsiung Armed Forced General Hospital, Kaohsiung, Taiwan

c I-Shou University, Kaohsiung Taiwan

Background/objective: The environment of the health care industry resulting in a considerable change in
recent years by the NHI system uncertainty, rising health care costs, intra-industry competition, the rise of
consumer awareness, as well as the patient's requirements to improve the quality of medical care and other
factors impact. Many domestic and foreign literature shows that use of customer relationship management
effectively can improve service quality. Therefore, how to use customer relationship management to enhance
service quality of health check, to explore new customers and strengthen the competitiveness is an important
issue facing the hospitals in Taiwan.
Methods: This research took the example of an armed forces regional hospital. A total of 350 copies of
questionnaires were sent to the hospital and 315 copies were returned. These 315 copies were effective and
the valid response rate is 90%. To explore the relationship of four dimensions, there are sense (environmental
facilities), feel (personnel services), act (physical examination process) and relate (health management) in
physical examination service satisfaction scale with satisfaction, loyalty between state of play and after
experiential marketing.
Results: The findings of this study demonstrated that the satisfaction of physician attitudes, environmental
facilities, and health management influence physical examination service satisfaction at present. However,
the satisfaction of health management, personnel services, and environmental facilities influence physical
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examination service satisfaction after experiential marketing. The greatest impact to customer loyalty is
environmental facilities and personnel services.
Conclusions: The study finding indicate that if the hospital proprietor strengthen marketing strategy
(improve the quality of environmental facilities), the personnel’s passion of service, and more service of
health management (follow-up outpatient of medical matters, establish health databases), can enhance
customer satisfaction and loyalty.
Subsequent measures of academic interest, school grades, and achievement test scores beyond the effects of
earlier measures of each of these constructs. In contrast, prior academic interest had small effects on
subsequent academic self-concept and little or no effects on either school grades or test scores.
Conclusions: More strongly than previous structural equation modeling research, the results of the present
investigation demonstrate the positive effects of academic self-concept on a variety of different academic
outcomes.

Poster 6 (ID376)
Correlates of Smoking Behavior Among School Aged Adolescents in Four Countries in South
East Asia
Hans Lie, Liou Jenn-Chang
Asia University, Taiwan

Objective: This study aimed to examine the prevalence and correlates of adolescents smoking behavior and
their lifestyle behavior in Indonesia, Philippines, Myanmar and Thailand.
Method: The Global School-based Student Health Survey data-sets by World Health Organization were
used in conducting this study. Adolescents’ lifestyle behavior was divided into four categories which are
substance use; personal hygiene; mental health; and compromised behaviors. Binary logistic regression
models were applied to predict the smoking behavior.
Results: The Philippines has the highest prevalence of adolescents with smoking behavior with 16.7%
followed by Indonesia, Thailand and Myanmar with 13.5%, 11.6% and 6%, respectively. This study revealed
that adolescent smoking behavior was significantly associated with negative lifestyle behaviors. Adolescent
alcohol use was found to have an effect modifier towards adolescent smoking behavior; there were statistical
interactions between alcohol use and factors such as gender and compromised behaviors.
Conclusions: Issues such as substance use, compromising behavior and mental health are essential in
adolescent smoking behavior prevention. Though adolescent healthy lifestyle behaviors have little or no
association towards their smoking behavior, it is pertinent that maintaining a healthy lifestyle is important for
their future health.

Poster 7 (ID391)
Analysis of Invasive Pneumococcal Disease Pandemic and Vaccination in Children Under Age
Five in New Taipei City Between 2008～2012
Szu-Pei, Wu; Sau-Yu, Liao; Kun Ju, Tsai; Chia-Chi, Lee; Sheue-Rong, Lin
Public Health Department, New Taipei City, R.O.C

From January 2008 to December 2012, there were 175 cases of invasive pneumococcal disease in children
under the age of five. The average annual incidence rate was 19.2 per 100,000 population, but among all

159
districts of New Taipei City, Banqiao topped the epidemic at 17.7%, followed by Xinzhuang at 14.6%.
Analysis of isolated serotype strains found that increase in the 19A serotype strain was most significant.
From 2008 to 2012, the 19A strain comprised 20% (5/25), 27.3% (6/22), 61.9% (26/42), 65.9% (27/41) and
64.4% (29/45), and since 2010, the 19A strain has become the most prominent strain of invasive
pneumococcal disease in New Taipei City.
Since July 2008, the New Taipei City Government has been providing a free dose of 7-valent pneumococcal
conjugate vaccine (PCV7) to all young children aged 2-5 who have not received the inoculation or who have
not completed the age required vaccination regiment. In May 2011, 13-valent pneumococcal conjugate
vaccine (PCV13) was used instead, and between 2008 and 2012, 23,279 doses, 26,740 doses, 14,724 doses,
19,130 doses and 22,512 doses were respectively administered.
Analysis showed that most of the 175 invasive pneumococcal cases have never received serotype vaccination
for the disease, indicating that those who are not vaccinated are highly at risk for infection. Furthermore,
changes in the serotype strain greatly impact the prevention of invasive pneumococcal disease, and
vaccination is the most important tool for effectively reducing infection. Therefore, continuous monitoring of
the specific strain and timely introduction or expansion of vaccination measures is an important task in the
prevention of this disease.
Poster 8 (ID395)
New Taipei City Marginal Adolescent Drug Prevention Guidance Program
Mu-Jong Kuo, Tsui-Mi Huang, Sheue-Rong Lin
Public Health Department, New Taipei City, R.O.C.

The prevalence of juvenile drug abusers in the New Taipei City is 2%, among which deviant behavior risk
factor is 13 times higher than those without deviant behavior. Therefore, to effectively prevent and reduce
deviant behaviors such as drug abuse among New Taipei City adolescents, the New Taipei City Drug Abuse
Prevention Center is implementing an outreach guidance program targeting marginal adolescents.
In 2012, the New Taipei City jointly piloted the High Care (Temple Population) Guidance Program with
Temple Associations in its jurisdiction. The program targeted students actively involved in temple activities.
Once a week, professional psychologists lead interactive small group activities favored by adolescents.
Concepts such as personal growth, positive values and resisting drug temptations are incorporated. Students
are also taught traditional skills (Lion and Dragon Dance, drumming). The High Care (Temple Population)
Guidance Program with Temple Associations in its jurisdiction will continue in 2013.
New Taipei City jointly organized the High Care (Dropouts) Guidance Program with four junior high
schools within its jurisdiction. The program offers guidance courses for former school dropouts.
Professional psychologists lead a series of self-exploration in group sessions in which small objectives are
set to help students build positive self value, self validation, and the ability to resist temptation, and to help
them with career development. In addition, group courses are supplemented by services such as technical and
vocational education, skills training, guidance for licensing exams and career transition.

Poster 9 (ID397)
New Taipei City Health Education and Promotion Model
Huei-Lin Liao, Chang-Han Yen, Sheue-Rong Lin
Public Health Department, New Taipei City, R.O.C

New Taipei City is vast, occupying 16% of the nation’s land area. It has a population of nearly 4 million,
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accounting for one sixth of the nation’s total population. Moreover, given the urban and rural gap, there is a
great difference in population and age distribution among regions. To enhance the health and living quality
of residents, the department integrated the health and educational resources of various agencies and
subordinate departments in 2012 to construct an age and population distinctive marketing model for health
education and promotion. Different learning portfolios were designed according to the target population, and
through course instruction and practice, health education was actively promoted to increase public
competence in self-care, cultivate healthy attitudes and promote healthy behaviors in daily living.
The age and population distinct health education promotion model uses community stations and lectures
where professionals and scholars are invited to interact with participants. Age relevant recipes are compiled
(such as for infants, children, seniors, and pregnant women) to enhance public self-care knowledge and
skills. The education systems are linked to compile skill and type appropriate teaching and promotional
materials to help students internalize health knowledge. Public buses are used as mobile educational boards
to convey health messages throughout the 29 districts in the city. The far reaching features of websites and
radio stations are also used for thorough broadcast of health issues to widely circulate healthcare messages.
Also, public polls are conducted and promotional strategies are reviewed accordingly.
Given limited resources, appropriate use of educational materials and promotional strategies through
channels such as communities, schools, workplaces, medical facilities and media can comprehensively and
thoroughly promote health education and various service measures to enhance public health behaviors and
subsequently achieve the goal of health for all.

Poster 10 (ID399)
Public Health Department, New Taipei City Government Local Nutrition and Well-Being for
Seniors
Xin-Pei Chen, Chien-Ming Chou, Kuan-Chen Lin, Sheue-Rong Lin
Public Health Department, New Taipei City, R.O.C

Background/objective: The number of people aged 65 and over in New Taipei City has exceeded 343,000.
Public health is well-developed and medical care quality is satisfactory, increasing and securing the average
life expectancy of the public. Nevertheless, of the six livelihood needs of the people, namely food, clothing,
housing, transportation, education and leisure, food remains the top priority and source of health. Seniors
suffer functional deterioration such as in their teeth, gastrointestinal movement and appetite, and even related
chronic metabolic syndromes such as diabetes, hypertension and hyperlipidemia and other syndromes.
Therefore, designing a series of relevant recipes suitable for seniors with different symptoms becomes
important.
Method: Through the city government’s Local Nutrition and Healthy Living five-security program,
experienced doctors, nutritionists and chefs are specially invited to design a series comprising seven sets of
nutritious recipes based on excellent seasonal agricultural products recommended by the Agriculture
Department.
Results: The expected seven sets of recipes are Healthy Recipes for Seniors, Nourishing Recipes for Seniors,
Recipes for Seniors with Diabetes, Recipes for Seniors with Hyperlipidemia. Recipes for Seniors with
Hypertension, High Calcium Recipes for Seniors, and High Fiber Recipes for Seniors, respectively graduated
and printed in blue, orange, red, yellow, purple, indigo and green.
Conclusions: The senior recipe series provides the best nourishment and dietary therapy guide for seniors,

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hence promoting physical and mental health, improving life quality and increasing social participation, and
thereby achieving the government’s policy objective of local nutrition for seniors.

Poster 11 (ID456)
Evaluating the Effect of Physician Personal Brand on Medical Resource Allocation in Taiwan
Hai-Ming Chen, Hsin-Mei Chung
Department of Management Sciences, University of Tamkang, New Taipei City, Taiwan

Background/objective: Patients in Taiwan deeply believe that only a physician with high personal brand can
offer better medical care service. This would result in distortion of the accessibility of healthcare resources,
especially in the rural areas. However, few of past studies successfully deal with the problem of the medical
resource misallocation.
Method: In this research we employed fuzzy DEMATEL method to delete the fuzzy factors existed in
human decision making process and handle the inner dependences within a set of criteria.
Results: Through evaluating and analyzing the impact of the four aspects of physician personal brand which
are competence, value, personality and leadership on patient’s willing to be treated by a specific physician,
we found that competence is usually the most influential factor as a patient needs to designate a physician to
make treatment for him.
Conclusions: The implication of our finding is that Taiwanese Government should provide more offers and
incentives to physicians with exceptional competence in order to encourage them to stay in the rural areas.

Poster 12 (ID525)
The Impacts of Organizational Characteristics of Dialysis Centers on Quality of Peritoneal
Dialysis care
Ying-Ying Loa, Fen-Ju Chena, Li-Chen Hungb
a Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan
b Department of Healthcare Management, Yuanpei University, HsinChu, Taiwan

Background: The primary objective of this research is to examine how organizational characteristics of
dialysis centers affect on quality of peritoneal dialysis care.
Method: This study is a non-experimental, cross-sectional study. Data are derived from the public
information system of health care quality which is national data and disclosed on the Department of Health
website. We analyzed the data of second quarter in 2012. The unit of analysis for this study is the individual
dialysis center which did provide peritoneal dialysis care service. There are 118 centers in this data. The
indicators of quality of care are average Kt/V, Albumin, Hct and examination rate of Kt/V, Albumin, Hct.
Results: Means of average Kt/V, Albumin and Hct values are 2.07, 3.63 and 30.45 respectively. Examination
rates are 94.88%, 97.79% and 98.43%.The result of multivariate regression analysis showed that participate
in the CKD care program on pre-ESRD and the hospital level were the factors significantly influenced
examination rates of these three indicators. The models as a whole explained 18.6%, 15.2% and 15.3%. In
addition, participate the CKD care program on pre-ESRD, participate in CKD health promotion organization
program and the hospital level significantly affect the Hct score. The model as a whole explained 10.0%.
Conclusions: To participate in the CKD care program on pre-ESRD could increase the examination rates of
three indicators, however, it decrease the Hct score. In addition, the examination rates of three indicators and
the Hct score in primary care clinics are better than medical center. To understand what are the mechanisms
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that these factors to affect the quality of PD care is the important issue for improving the quality of PD care.

Poster 13 (ID526)
A Study on the Willingness of Nursing Staff to Provide Discharge Planning Services
Chieh-Chun, Kao
Lecturer, Department of Nursing, Ching Kuo Institute of Management and Health, & Doctoral Candidate, School of
Nursing, National Yang-Ming University, Taiwan

Background/objective: The nursing staff is specifically in charge of discharge planning services. Therefore,
the staff’s willingness to actually provide these services is critical to their success. This research is to
understand the nursing staff’s willingness to carry out discharge planning services as well as the correlations
between factors influencing that willingness.
Method: A cross-sectional, descriptive, correlational design was used to survey 260 Taiwan nursing staff
members who were purposively sampled using structured questionnaires.
Results: A total of 64.5% of the nursing staff were willing to conduct discharge planning services.
Educational training, tools and resources, human resource assignment, and self-perceived efficiency were
positively correlated with their willingness to carry out discharge planning services. Higher perceived service
satisfaction, good nurse-patient relationships, and higher resource utilization rates all contribute to elevating
the willingness to conduct discharge planning services.
Conclusion: This research is helpful in understanding the factors that influence nursing personnel’s
willingness to conduct discharge planning services, and can serve as a reference for improving the quality of
these services.

Poster 14 (ID531)
Changing Perspectives of the Interrelation between Unemployment and Health
Huei-Chu Chenga, Ingo Tammb, Hsing-Yen Hsieha
aDepartment of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan
b Department of German, Wenzao Ursuline University of Languages, Kaohsiung, Taiwan

Background: The first study on the effects of unemployment “Marienthal: The Sociography of an
Unemployed Community” (1933), was a pioneer work for further studies on the individual experience of job
loss. A lot of studies especially from the United States, Europe and Australia attempted to show that
unemployment is interrelated with negative health and high risks of morbidity and mortality. In this study we
want to review the articles of the past decades to reconstruct the transitions and patterns of the health
problems connected with unemployment.
Methods: We review and analyze the relevant Anglo-Saxon and German literature with secondary data from
the 1930ies onwards. Special focus will be laid on the changing paradigms concerning the perception of
health problems in connection with unemployment and the aspect of continued stigmatization of the
concerned.
Results and Conclusions: We observed that in the 30ies the emphasis was laid on malnutrition, bad hygiene
and apathy of the unemployed. The health problems at that time were more visible and showed a clear
interrelation between poverty, low education, unemployment and poor health. Today it becomes clear that
this connection still exists, but new aspects reveal a differentiated social cluster. The relationship can vary
according to such factors as gender, social support, financial situation and living conditions. New studies in
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many countries show the effects of unemployment on mental health like depression and suicide. Concerning
physical health results include a broad range of diseases like myocardial infarction, hypertension, increased
alcohol and nicotine consumption and growing concern about the obesity problem. In terms of social health
social isolation is pointed up reinforced by the prolonged use of electronic media. The analysis of the works
also reveals a change concerning the stigmatization of the unemployed. Despite the mentioned new aspects
research about the connection between health and unemployment remains fragmental.

Poster 15 (ID582)
Evaluation of Acute Toxicity and Teratogenic Effects of Ractopamine by Daphnia magna
Embryo Assay
Tom M. L. Hunga, Tim Y. T. Hsieha, Frank Y. M. Lina, Shih-Hsien Changa,b, Kai-Sung Wanga,b
a School of Public Health, Chung Shan Medical University, Taichung , R.O.C.

b Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung , R.O.C.

Background: Ractopamine is a drug used as a feed additive to promote leanness in animals raised for their
meat. Pharmacologically, it is a beta-adrenoceptor agonist. In this study we selected Ractopamine to
investigate their biological toxicity to the waters of the important biological indicator Daphnia magna.
Method: The methods used in this study included neonate acute toxicity test, embryo toxicity test, and
maternal hereditary influenced test. In this study, we exposed Daphnia magna maternal to 0, 10, 20, 30, 40
or 50µg Ractopamine /L for 7 days and analyzed the effects on reproductive behavior.
Results: Effects of treatment of the exposed maternals were shown embryo growth retardation, and aborted
in brood chamber. In addition, endpoints indicated that have teratogenic effect on Daphnia embryos.
Microscopic observation of the teratogenic effects showed that Ractopamine induced malformations of the
Malpighian tube, sensory bristles, and tail spine as well as function loss and death.
Conclusion: The present study clearly demonstrated that Ractopamine may cause acute toxicity and
teratogenic effect in both neonate and embryo of D. magna. It is recommended that the biological effects on
other water bodies be further investigated.

Poster 16 (ID583)
Evaluation of Acute Toxicity and Teratogenic Effects of Female Hormones by Daphnia magna
Embryo Assay
Algui K. F. Chana, Shih-Hsien Changa,b, Kai-Sung Wanga,b
a School of Public Health, Chung Shan Medical University, R.O.C.
b Department of Family and Community Medicine, Chung Shan, Medical University Hospital, R.O.C.

Background: This study selected female hormones (17β-estradiol (E2), estrone (E1), estriol (E3),
17α-ethynylestradiol (EE2) and diethylstilbestrol (DES)) to investigate their biological toxicity to the waters
of the important biological indicator Daphnia magna.
Method: The methods used in this study included neonate acute toxicity test, embryo toxicity test, and
maternal hereditary influenced test. In this study, we exposed water flea (Daphnia magna) maternal to 0,
31.25, 62.5, 125, 250 or 500μg estrogens /L for 14 days and analyzed the effects on reproductive behavior.
Results: Effects of treatment of the exposed female were shown vitellogenin induction, promote the
embryo production, embryo growth retardation, and aborted in brood chamber. In addition, the 500 μg/L of
estrogen on Daphnia maternal endpoints indicated that have teratogenic effect on Daphnia embryos.
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Microscopic observation of the teratogenic effects showed that all 5 estrogens induced malformations of the
carapace, second antenna, rostrum, Malpighian tube, sensory bristles, and tail spine as well as function loss
and death.
Conclusion: The present study clearly demonstrated that female hormones may cause acute toxicity and
teratogenic effect in both neonate and embryo of D. magna. It is recommended that the biological effects on
other water bodies be further investigated.

Poster 17 (ID661)
Patterns and Predictors of Immediate Suicide Risk After A Cancer Diagnosis
Yun-Yi Chen, Wan-Ju Cheng and Kuo-Piao Chung
National Taiwan University, Taiwan R.O.C.

Background/objective: Recent research has been shown that cancer diagnosis may increase risks of suicide.
We sought to explore related factors of immediate risk of suicide among cancer patients.
Method: For the six most common cancer types in Taiwan (i.e. breast cancer, cervical cancer, lung cancer,
colorectal cancer, liver cancer and oral cancer), this retrospective cohort study comprised cancer patients
committed suicide from 2004 to 2010, including who committed suicide within three months after receiving
a cancer diagnosis (n=148) and who did not (n=321). Using the national health insurance database, cancer
registry data and death registry data, we assess trends of immediate suicide with the Cochran-Armitage test.
Cox proportional hazard model was constructed to control for confounding variables.
Results: Result: Thirty percent (31.56%) of cancer patient committed suicide among occurred within 90
days post-diagnosis; liver cancer, colorectal cancer, and lung cancer were the highest (43.24%, 38.37%, and
37.35%, respectively). Immediate suicide rate declined in seven years (from 24.32% to 5.41%, p<.0001).
Cancer patients who were with colorectal or liver cancer (HR= 5.28, p< .01; HR=3.15, p< .05; reference
group= oral cancer), unemployment (HR=3.38, p<0.01), stage IV at diagnosis (HR=3.60, p< 0.05), with
complex chronic diseases (HR=0.01, p<0.01) may have higher risk of committing suicide soon.
Conclusions: Cancer sites, employment status, and chronic disease conditions may predict suicide during the
first 3 months after cancer diagnosis.

Poster 18 (ID715)
Analysis for Patients, Satisfaction with Community Health Institutions in Pudong New Area
Liu Yuanfenga, Jing Limeia,b, Ding Yea
aPudongInstitute for Health Development
bPublic School of Fudan University

Background: Evaluation have begun to carry out for all community health institutions in Pudong New Area
ever since 2007. Of which the indices for patients, satisfaction contain five elements: convenience, comfort,
economic, safety, efficiency.
Method: Based on 900 questionnaires for patients, satisfaction collected in 2012 evaluation, we have done a
fuzzy comprehensive analysis(FCA) and analysis of variance(ANOVA).
Results: It shows that 1) patients living in urban and rural areas are more satisfied than those living in
outskirts; and 2)people are still concerned about medical expenses.
Conclusions: The results indicate that community health institutions must make great efforts to attract
excellence talents, in order to supply patients with more safe and more effective medical services. At the
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same time, effective measures should be taken to reduce the economic burden accompanied.

Poster 19 (ID897)
Evaluation of Acute Toxicity and Teratogenic Effects of Five Commonly Used Antibiotics by
Daphnia Magna Embryo Assay
Steven S. F. Leea, Shih-Hsien Changa,b, Kai-Sung Wanga,b
a School of Public Health, Chung Shan Medical University, R.O.C.
b Department of Family and Community Medicine, Chung Shan Medical University Hospital, R.O.C.

Background: The recent monitoring of drug residues in the aquatic environment has gained much interest as
many pharmaceutical compounds can frequently be found in sewage treatment plant effluents and river water,
which may have impact on aquatic organisms. In this study we selected five commonly used antibiotics
(Amoxicillin, Erythromycin, Lincomycin, Sulfamethoxazole, and Trimethoprim) to investigate their
biological toxicity to the waters of the important biological indicator Daphnia magna.
Method: The methods used in this study included neonate acute toxicity test, embryo toxicity test, and
maternal hereditary influenced test.
Results: The study concluded that the acute toxicity of the five antibiotics to young daphnids and embryos
were Sulfamethoxazole ＞ Trimethoprim ＞ Amoxicillin ＞ Erythromycin ＞ Lincomycin, while the acute
toxicity of Sulfamethoxazole and Trimethoprim to Daphnia neonate had 48h-EC50 values were 10.3 and of
23.6 mg L−1, respectively. The effects on growth mostly occurred in the late stages of organogenesis. Of the
organs, the Malpighian tube was the most sensitive to antibiotics during embryonic organogenesis. The study
found that teratogenic effects of Sulfamethoxazole and Trimethoprim induced in embryo were higher than
those of most other antibiotics. Microscopic observation of the teratogenic effects showed that all five
antibiotics induced malformations of the Malpighian tube and tail spine as well as function loss and death.
Conclusion: The present study clearly demonstrated that antibiotics may cause acute toxicity and teratogenic
effect on both neonate and embryo of D. magna. It is recommended that the biological effects on other water
bodies be further investigated.

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Fiji （斐济）

167
Oral 1(from APACPH)
Recent Trend in the Increase of Oral Cancer in Fiji: Betel Nut Chewing - Is It A Risk Factor?
Santha Muller a, Chamath M K b, Bernadette P b, Jiesa B b
a Medical Research Laboratory (MRL), College of Medicine, Nursing and Health Sciences, Fiji National University,
Fiji
b Department of Oral Health,College of Medicine, Nursing and Health Sciences, Fiji National University, Fiji

Background: The prevalence of oral cancer in Fiji was low in comparison to some other Pacific Island
countries. However the number of cases seem to be rising steadily.1 and some smaller clinics are seeing more
oral cancer lesions.2. There was no report on the risk factors causing the increase of oral cancers except for a
study showing combinations of tobacco smoking and chewing of betel quid are the main factors 3 and a
systematic review provided evidence of the role of betel quid not containing tobacco in oral cancer
development.4, 5 There is an emerging risk of Fiji becoming a nation of chewers especially with greater
inter-island travel and the readiness to share cultural practices as per recent the cross sectional study report.6
Method: An observation for the recent trend in oral cancers was done by data collection from the
departmental register of dental clinic, CWM hospital7 Fiji with the list of cancer from the Ministry of Health
Fiji and overseas referral.
Results: As per the data collected and analyzed, for the 5 year period (2008-2012), oral cancer comprises of
20% of all cancers reported in Fiji. The histology reports confirm that 53% of cancers are SCC (Squamous
cell carcinoma) type. The sex ratio shows that male (53%) and female (47%) are equally affected by oral
cancer and a high number of cases 41.6% are reported among the itaukei (native Fijians) followed by the
indo Fijians (31.6%).
Conclusion: According to the reports, there is an increased number of cases of oral cancer presenting in the
dental clinic in Fiji since 2008. The facts that betel nuts are sold in different localities in Fiji and also
planting of areca palms in center-road garden beds and beside roads need to be explored further with the
question in mind whether the betel nut chewing is a risk factor for the trend in the rise of oral cancer in Fiji.

Oral (from APACPH)

Betel Quid Chewing and Oral Cancer in Fiji
Dr. Santha Muller PhD
Visiting Research Fellow, Department of Health Sciences, College of Medicine, Nursing and Health Sciences, Fiji
National University

Oral 2(ID1073)
Unbooked Mothers (Pregnant women with no antenatal care)
Pushpa Wati Nusair
Fiji National University

Background/Objectives: Pregnant women who access themselves to antenatal care are in a better position
for a favorable outcome for not only their babies but for themselves as well .Here in Fiji Islands we still have
problem with pregnant patients who come unbooked to labour room or those who have booked very late.
These patients are at increased risk of not only of poor outcomes for their babies but also increase the risk of
adverse maternal disability and even maternal death
Methodology: Retrospective review of Labour Ward Registrar and patient folders and the sociodemographic
168
characteristics were looked at .Also the parity and the neonatal outcomes and maternal outcomes were
looked at.
This data was collected between September 2012 to June 2013 at the Colonial War Memorial Hospital,Cent
East Division,Fiji Islands
This hospital delivers about 9000 babies per year.
Results: The percentage of unbooked mothers was small but significant.Significant in that there was
maternal death related to unbooked status and it was found that these women were more of the younger
age—That is between 20-25 years.Also they were single or in defacto relationship (not married) Came from
poor social status and had low education level.They were also in their 1 st or 2nd pregnancy and had no
knowledge of contraception.
Conclusion: There needs to be more awareness created about contraception and its availability to all classes
of patients Unbooked mothers pose particular risks and most significantly the risk of maternal death.

Poster 1 (ID909)
Betel Nut Chewing- Is It An Emerging Risk Factor for Oral Cancer in Fiji?
Chamath M. Karunaratnea, Bernadette Pushpaangaelia, Santha Mullerb
aDepartmentof Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Fiji
bMedical Research Laboratory (MRL), College of Medicine, Nursing and Health Sciences, Fiji National University,

Fiji

Background: Areca (Betel) nut, the seed of the fruit of the oriental palm, Areca catechu a basic ingredient
of a variety of widely used chewed products has an estimated use by 200-400 million people mainly Indo
Asian and Chinese. Betel nut also has a long history of use and is deeply ingrained in many sociocultural and
religious activities in countries in the Western Pacific Region countries such as the Solomon Islands, Palau,
Papua New Guinea and Guam where betel nut chewing has become a significant public health problem.The
most important consideration is Betel nut has been classified as the group 1 carcinogen for the development
of oral cancerand it precursors. There is emerging risk of Fiji becoming a nation of chewers especially with
greater inter-island travel and the readiness to share cultural practices.
Method: Hence a cross sectional study was carried out to check the availability of areca nut and its products
in and around Suva, Fiji.
Results: The study showed the availability of areca nut products at different types of outlets, the most
common locations are supermarkets (40.6%), convenience (Indian) stores (28.0%) and the Suva market
(19.0%).These include 34.3% products from India and remaining 65.7% are locally grown and packed in
Fiji. Areca nut sold in grocery shops and retail shops are at close proximity to tertiary institutions where
students from Pacific Islands consume the products while studying in Fiji.
Conclusion: There is an increased number of cases of oral cancer presenting in the dental clinic in Fiji
according to the anecdotal reports from dental practitioners in 2010. The facts that betel nuts are sold in
different localities in Fiji with low cost market prices and also planting of areca palms in center-road garden
beds and beside roads need to be explored further with the question in mind for the trend in the rise of oral
cancer in Fiji.

169
Georgia（格鲁吉亚）

170
Poster 1(ID192)
Setting of Public Health in Georgia
Irine. A. Zarnadze, Shalva. A. Zarnadze
Faculty of Public Health in Tbilisi State Medical University, Georgia

Background/objective: Georgia is a country in the Transcaucausus, has a population of 5.4 million people
of which 56% is urban and 44% rural. It covers an area of 69,000 square kilometers. The health status profile
in Georgia represents manifestations of an epidemiological transition, since the leading causes of death in the
country are circulatory system diseases, ischemic heartdisease, cerebrovascular diseases and cancer.
Widespread smoking is likely to be a keycontributing factor to this mortality burden.Starting in 90‘s, the
Government of Georgia (GoG) made several attempts to transformGeorgia’s health care system into one that
improves the efficiency, accessibility, and quality ofhealth care services and public health system.
Method: Analytic Review
Results: The first rounds of reforms focused predominantly on developing a nationwide primary health care
network. Improvements of the status of health will be shown by basic health indicators, such as children and
maternal mortality and morbidity ratios, birth rate, life expectancy, etc. The health of youth is of special
concern in all societies and efforts should be made to reduce all types of dangerous behavior. Health effects
of tobacco, alcohol and drug consumption are evident on the individual as well as the societal level. The
prevalence rates of alcohol, tobacco and other drugs use are matters of concern to public policy in most
countries, since they are important factors related to the health and welfare of the population. One of the
central ideas that drive health promotion is that the health of any individual is affected, not just by individual
lifestyle factors.
Conclusions: Public Health has an important role in the control of disease. For this contribution rational way
could be to implement health promotion strategy, which enables community to increase control over, and to
improve, their health, be involved in better functioning of service provision.

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India （印度）

172
Guest Lecture
Achyuta Samanta Ph.D.
Dr. Achyuta is a professor in chemistry, KIIT University, Bhubaneswar as well as visiting professor, at the
Open International University, Colombo. He is the founder & former chancellor of KIIT University. He also
is a ex-Chancellor, Secretary of KiiT University, Secretary Kalinga Relief & Charitable Trust, Founder
Kalinga Institute of Social Sciences(KISS), Vice President Bharat Scouts and Guides, Odisha, Member
General Body, CAPART, New Delhi, Regional Committee, CAPART and Member of University Grants
Commission
Dr. Achyuta will give a lecture at Indigenous Health on October 26, 2013.

Oral 1(from APACPH)

Education holds the key to Empowerment and Sustainable Livelihood for the Indigenous
People in India
Prof. Dr. Satyendra Patnaik
Rector, KIIT University, Bhubaneswar, India

Indigenous People have always been treated as political underprivileged groups, faced with problems
relating to cultural and linguistic preservation, land rights, ownership and exploitation of natural resources,
environmental degradation and incursion, poverty, health and discrimination. Amongst the number of
indigenous groups in Asia, the most substantial population are in India. Constitutionally recognized as
Scheduled Tribes, constituting 8% of the total population, they have a subsistence livelihood, low literacy
and a stagnant and mostly declining population.
Apart from low literacy rate, tribals have significant physical and mental health problems and exposed to
exploitation. Most of their problems are because of low literacy rate and ignorance, as a result of which
they become easy prey to social discrimination, notes a review paper prepared by the UNICEF for the
Ministerial Round table on Education for poverty eradication. An approach to human resources development
speaks about the plight of the indigenous people not having access to things that equate poverty to
subsistence and powerless existence. It is through education that individuals realize their potential to
contribute and benefit from the distribution of wealth in the economy. The transforming power of education
as the most important tools for eradicating poverty and providing a sustainable livelihood is the core to the
one man crusade of Achyuta Samanta against poverty of the Indigenous Tribals. He established the
Kalinga Institute of Social Sciences as the largest residential institution in the world for Indigenous
People--as a centre of learning with the focus on sustainable livelihood. The paper discusses how KISS could
became successful for empowering and providing sustainable livelihood to 20,000 indigenous children
through education alone designed in a strategic and practical manner.

Oral 2(ID254)
Epidemiology of Dyspepsia in Delhi: An underestimated Public Health Challenge
Sumeena Basandraa, D.K. Taneja b, G.K. Ingle c, A.S. Puri d
a SELF, Dept. of Community Medicine, Maulana Azad Medical College, New Delhi, India
b Dept. of Community Medicine, Maulana Azad Medical College, New Delhi, India

c Dept. of Community Medicine, Maulana Azad Medical College, New Delhi, India

d Dept. of Gastroenterology, G.B.Pant Hospital, Maulana Azad Medical College, New Delhi, India

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Background/objective: Dyspepsia is one of the most common gastrointestinal (GI) diseases affecting
7-40% of population worldwide. Functional Dyspepsia (FD) predominates in Asia, accounting for 50-70% of
uninvestigated dyspepsia(UID). This study was conducted to estimate the prevalence, the socio-demographic
and lifestyle associated risk factors of Dyspepsia among adults (20-50 years of age) of urban Delhi.
Methods: Multistage random sampling was used for selecting 3 districts followed by random selection of
assembly areas, blocks and the subjects by systematic random sampling in each of these blocks. A
semi-structured questionnaire was used for collecting information on identification and socio-demographic
data, questions pertaining to lifestyle, ROME III criteria for diagnosing UID and FD and Perceived stress
scale (PSS) for assessing the stress. Based on the representative prevalence and 10% possible
non-responders, 1000 subjects were contacted and 987 (98.7%) participated.
Results: The mean age of interviewees was 34.64± 17.92 years. Dyspepsia was prevalent in 32.3% (319)
subjects with significant increasing trend with age (chi-square for trend =35.4, p<0.001). On univariate
analysis, age ≥30 years, income of <2500 per capita per month, residence in North-East district, consumption
of tea, fatty food, alcohol, bidi/cigarettes, chillies, spices, analgesics and high perceived stress were the
potential risk factors. On multivariate logistic regression, age 30-39 years(OR=2.1, 95%CI=1.3-3.8),
residence in north-east district(OR=2.7, 95%CI=1.6-4.6), intake of tea (>2cups/day, OR=2.8, 95%CI=
1.9-4.0), alcohol (≥4 pegs/week, OR=2.3, 95%CI=1.2-2.4), chillies(per capita intake >0.51 gm/day, OR=
2.4, 95%CI =1.1-5.7), spices (per capita intake of >0.51gm/day, OR=2.3, 95%CI=1.2-2.4) and perceived
stress (score>16; OR=17.56, 95% CI=12-25.6) were observed as independent predictors of dyspepsia.
Dyspepsia was found to have lower odds among females (OR=0.6), unmarried (OR=0.3) and subjects with
higher number of years of education (>15 years; OR=0.4).Out of 319 subjects with UID, 86 (34.6%)
underwent endoscopy and 63 (73.2%) were diagnosed with FD.
Conclusions: Dyspepsia has been observed in about one-third of adult population of Delhi. Association with
residence suggested the role of environmental factors in causation of dyspepsia.

Oral 3(ID790)
Cardiovascular Disease Risk Factor Profiling of Group C Employees in JIPMER,
Puducherry, India
Sitanshu S Kara, Aswin Ka, Arun G Ghorpadeb
a JIPMER, Puducherry, India

b Sri ManakulaVinayagar Medical College& Hospital , Puducherry, India

Background: Settings based approach for health promotion includes conducting risk factor surveillance as
one of its component. It was aimed to estimate the prevalence of CVD risk factors among group C
employees of tertiary care hospital in south India.
Methods:A cross-sectional survey was conducted among 400 group C employees aged ≥ 20 years using
the WHO "STEP wise approach to surveillance of Noncommunicable diseases" (STEPS) methodology.
Standardized international protocols were used to measure behavioural risk factors (smoking, alcohol
consumption, fruit and vegetable consumption, physical activity) and physical characteristics (weight, height,
waist and hip circumferences, and blood pressure). Multivariate analysis was done to predict the factors
which carry independent risk of hypertension. Risk factor profiling of the staff was done using WHO/ISH
risk prediction Chart to calculate the 10-year risk of a fatal or nonfatal major cardiovascular events
(myocardial infarction or stroke), according to age, gender, blood pressure, smoking status and presence or
absence of diabetes mellitus.
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Results: Mean age in years was 40.9 (±10.4) and men constituted 81.3% of study population. Prevalence of
major cardiovascular risk factors was as follows: current smokers 12.3% men, regular alcohol intake 33.2%
among men, overweight (≥23 kg/m2) 74.5%, central obesity 78.7%, hypertension 38.8%, and history of
diabetes mellitus 13.2%. Age, gender, physical inactivity, obesity and family history of hypertension were
found to be independently associated with hypertension. The risk of developing CVD was <10% in 10 years
follow up for majority (97.7%) of participants.
Conclusion: The prevalence of CVD risk factors is high in the sample population. Employee wellness
programme should be started in the institute to combat the burden of cardiovascular diseases.

Oral 4 (ID910)
HIV Surveillance in India –Success and Challenges Ahead Madhulekha Bhattacharya
Madhulekha Bhattacharya
National Institute of Health & Family Welfare New Delhi, India

Background: HIV sentinel surveillance started in India in 1998 by National AIDS Control Organization and
gradually improved over time to become the biggest HIV Surveillance system in the globe
Method: Standardized uniform surveillance, held once a year for 3 months, in each province of India. This
began in 1998 with 180 clinic based sentinel sites for high risk groups (HRGs) represented by patients
attending the sexually transmitted disease (STD) clinics and the general population represented by pregnant
women attending the antenatal clinics. Gradually sites for core risk groups such as female sex workers
(FSWs), men having sex with men (MSM) and injecting drug users (IDUs) were added taking the total of
sites to over 1300 in 2011.In each round there was review of lacunae observed in conduct of surveillance and
corrective measures instituted. The quality parameters were observed in terms of procedure standardization,
supervision and monitoring, quality assurance in laborartories, data validation, analysis and preparation of
country report.
Results: The steps taken resulted in validated data for analysis and report. The analysis was done for HIV
prevalence and trends of HIV in each type of risk group with geographical distribution. There is decrease in
HIV prevalence since 2003 in the bigger states of south and two states Manipur and Nagaland of northeast
part of India where the control measures started early. Current surveillance anlysed data 2011, indicates that
the HIV is on the rise amongst the antenatal mothers in the states of north with low prevalence .Concurrently
HIV rates in FSWs are decreasing but slower amongst MSM and IDUs.
Conclusion:A successful surveillance system implemented on a massive scale is at it’s zenith but the
challenge has arisen now, for a surveillance system to identify additional factors which may provide clues
for control of HIV further, in the country.

Poster (ID975)
Association of Maternal Water, Sanitation and Hygiene (WASH) Practices and Premature
Delivery: A Cross Sectional Study Among Indigenous Tribal Communities in Odisha, India
Bijaya Kumar Padhi
Asian Institute of Public Health, Indonesia

Prematurity is the leading cause of death among newborns, accounting for one million deaths per year.
Despite continued national and international efforts, access to improved water and sanitation remains limited

175
in many marginalized communities. The health consequences of lacking access to water and sanitation are
severe, and particularly important for achieving millennium development goals. A cross-sectional study was
conducted in the tribal communities of Sundargarah district of Odisha, using a structured questionnaire (n =
3865). The association between maternal WASH practices and preterm birth (PTB) were estimated using
multivariable logistic regressions and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were
computed controlling for confounders. Improved WASH practices (improved sanitation (OR= 0.62, 95% CI
0.51–0.87); improved water (OR= 0.63, 95% CI 0.45–0.83); and improved hand and body washing (OR=
0.75, 95% CI 0.62–0.89)) were significantly associated with lower preterm birth for all mothers, regardless
of socioeconomic status of mother, maternal age, maternal education, sex of the infant (p < 0.01). The
maternal knowledge towards safe WASH practices was inadequate in the population studied. Hence
intervention such as improving basic sanitation and maternal knowledge to use of safe WASH practices can
make an immense contribution to health, productivity, and social development of the marginalized
community.

Poster 1(ID11)
A Cross Sectional Study of HRV Among Medical Students with Different Levels of Obesity
Ramesh Bhata, Ganaraja Bb, Meenu Sc
a Professor of Physiology, KMC, Manipal University, Mangalore, India
bAdditional Professor of Physiology

c Tutor in Physiology, KMC, ManipalUniversity, Mangalore, India

Background: Obesity is known to cause a number of life style diseases. In spite of this, the developed and
developing world is faced with increasing number of people with high Body fat. In the present study we
correlated the HRV with four levels of obesity as per WHO classification of BMI (Quetelets index) among
young students recruited from our Medical school.
Methods: 240 medical students (120 males & 120 females) were selected on the basis of their BMI into four
groups: viz. Normal (N), Underweight (UW), Overweight (OW) & Obese (OB), [n=30 each]. Their Lean
Body Mass (LBM), W/H ratio were calculated and tabulated, their HRV was recorded for 5 minutes and both
time domain and frequency domain analysis was done.
Results: The LBM was significantly lower and W/H ratio significantly higher in OW and OB groups
(p<0.001) whereas LBM was higher and W/H ratio lesser in UW group compared to normal. But women
showed higher W/H ratio and lesser LBM compared to men in the same group (p<0.01). Cardiac autonomic
control represented by HRV showed significant reduction in the OW and Obese groups (p<0.01). HRV
parameters were significantly lower in Underweight subjects when compared to Normal subjects.
Conclusions: The HRV parameters showed a sympathetic predominance as the body fat increases. Females
showed higher Body fat content compared to men. Therefore preventive measures should involve in weight
reduction and diet control with sustained physical exercise in vulnerable subjects to prevent the possible
cardiovascular and endocrine disorders which they are prone.

Poster 2(ID270)
Curse of the Occult in Fish meal Industry- Lesson to learn
JagadishRaoPadubidria, SanmathShettyb, ChakrapaniMahabalac
aSELF Department of Forensic Medicine, Kasturba Medical College, Mangalore, Manipal University
b Department of Medicine, Kasturba Medical College, Mangalore, Manipal University

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 c Department of Medicine, Kasturba Medical College, Mangalore, Manipal University

Stored wet fish consume oxygen and releases noxious gases as they spoil. Various collective gases are
released during the process of decomposition like carbondioxide, ammonia, Hydrogen sulphide, sulphur
dioxide, methane etc. Casualties are reported in fish meal industry due to accidental exposure to these
invisible toxic gases. We report a rare case of uneventful escape of five workers, accidentally exposed to
noxious gases while engaged in fish oil manufacturing tank, in Coastal district of Karnataka, India. The
possible collective noxious gas responsible for acute primary lung injury[ Acute Respiratory Distress
Syndrome], and occupational safety measures to be employed to prevent such accidental exposure have been
highlighted.

Poster 3(ID285)
Hyperamylasemia as an Indicator of Acute Pancreatitis in Severe Leptospirosis
AbulFazil
Manipal University, India

Background/ objective: Leptospirosis is a spirochetal bacterial infection of great public health importance.
Acute pancreatitis is an uncommon gastrointestinal manifestation of leptospirosis. The aims and objectives of
this study was to find the incidence of hyperamylasemia in cases of severe leptospirosis and to correlate the
incidence of hyperamylasemia with acute pancreatitis among patients with severe leptospirosis.
Methods: All patients who were positive for IgM ELISA test (IgM ELISA > 11 panbiounits was considered
positive for leptospirosis) and had features suggestive of severe leptospirosis or Weil’s disease were included
in the study. Serum amylase levels were assessed in all patients, included in the study. An ultrasound of the
abdomen was done to objectively confirm or refute the presence of acute pancreatitis in all patients included
in the study.
Results: The study included 25 cases diagnosed of Severe Leptospirosis. 24 out of 25 cases [96 %] had renal
failure. All the cases [100%] had deranged liver function tests. 17 out of the 25 [68 %] cases had
hyperamylasemia. Almost all patients show evidence of multi organ dysfunction in the form of deranged
renal function or hepatic dysfunction or both. Out of the total 25 cases included in the study, 17 cases [68%]
showed elevated levels of serum amylase.
Conclusions: It is evident from this study that despite of low reporting, the dangerous complication of acute
pancreatitis is not so rare among patients with severe leptospirosis. Hyperamylasemia is commonly seen with
an incidence of 68% among these patients. Our study shows that, threefold rise of serum amylase level
remains a very specific and cost effective test for detection of acute pancreatitis in patients with severe
leptospirosis.

Poster 4(ID339)
Tribal Health: Issues and Challenges – A Camp Based Study in North Kerala
Usha Karunakaran, Salini Kannankai, Minimol K Joseph, Jayasree A K
Academy of Medical Sciences, Pariyaram, Kannur, Kerala, India

Background: In India tribes form approximately 8% of the population. In Kerala they form approximately
1% of the population. Poverty, malnutrition, illiteracy, poor living conditions, poor utility of health services
and no knowledge about government social and health insurance schemes contribute to poor health
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conditions among them.
Methodology:
Study population: 304 tribes who attended three camps.
Study setting: Three panchayats of Kannur District
Study design: Camp based study; descriptive
Sample size: 188
Sampling method: convenience sampling
Tool: A semistructured questionnaire.
Results and discussion: Number of tribes who participated was 188 and 77% were females. All belonged to
different households. 46% were uneducated while 32% upto primary level. All belonged to low SES.Few
(8%) said they would have herbal medicines in case of illness while 80% said they would visit a doctor.
Around 59 % said they would try indigenous medicines before seeing a doctor. The nearest health facility
was more than 5 km for 34% of the tribals. Only 51% were informed about health programmes. Children in
18% of the households were unimmunized or partially immunized. Eligible couples (57%) did not accept
family planning methods. Half (49%) were not aware about government social and health insurance schemes
for the tribals.53% suffered from diseases during the past 6 months. Around 20% of the women had foul
smelling white discharge. Around 19% practiced open air defecation. 57% consumed alcohol, 49% smoked
and 59% chewed pan.
Conclusion: Health education to create awareness about hygiene, behavioral modification, welfare schemes,
steps to increase utilization of health services may help to improve tribal health. Long term goals would be to
increase literacy levels.

Poster 5(ID402)
Better Programme Outcome During YoIRI (2012-13) in 8 Districts of Odisha, India, Through
Improved Programme Management
Pramod Chandra Samantaray
Vision Foundation, New Delhi, India

Background/objective: The year 2012 was declared as the year of intensification of routine immunization
with objective to enhance efforts in areas of programme management. Odisha was behind national average
in immunization with coverage of 59.5% against country’s average of 61%.
Method: Under the national full immunization drive (2012-13), 130 blocks in 8 districts of Odisha with low
(59.5%) FI coverage were taken up for intensified immunization work during August-November 2012. The
Directorate, Family Welfare issued instructions to Collectors & CDMOs stressing upon the need to undertake
fresh microplanning, based on physical verification of droupouts/leftouts from MCTC/FHW’s working
diaries. 7 points field action plan was executed with provision for alternate vaccine delivery at inaccessible
IPs. Covergent actions jointly by DFW & DSW field staff were closely monitored during
September-November 2012. The revised microplans showed substantial increase (11 to 104%).
Results: Percentage increase in antigen wise coverage has been graphically presented. Commendable
increase was recorded in target districts (most antigens) and no child left IPs without getting antigen. No
shortage of any specific antigen was reported from any of the 130 blocks. Evidence based “due list” greatly
helped achieving targets. HMIS reported the FI figures at 84% in the year 2013-14 as against 78% in the
preceding year, vindicating effectiveness of better programme management.

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Conclusion: Immunization status of eligible children was significantly influenced by personalized contact
with target beneficiaries at grass root levels. Frequently encountered reasons for incomplete immunization
were: casual attitude of parents (mothers) towards immunization, trivial post-immunization adverse effects in
children receiving antigens but not attended by the village health workers in time. The period witnessed a
number of initiatives in effective cold chain management that ensured availability of antigens and
immunization personnel at IPs.

Poster 6(ID403)
Exploration of Anthropological Traits of Community Mindset Traditionally Influenced by Son
Preference Culminating in Female Foeticide- Indian Scenario
ShaktiswarupSamantaray
Delhi High Court, New Delhi, India

Background/objective: Recently, female feticide has emerged as a serious demographic threat in India
violating all norms of gender equity. Current ever dwindling trends in child sex ratio (0 to 6 years) is
attributable to female feticide, a consequence of son preference. A host of anthropological traits in
community mindset sustainably propel female feticide in India. As per 2011 Indian census CSR of
South-West district of Delhi is 836/1000. A 5 year exploratory study revealed several factors influencing
female feticide. Findings inter-alia point to “son preference” as the leading trait for the malady. The age old
transnational practice of female infanticide has since been replaced by female feticide because of facilities
for inutero fetal sex determination. Child sex ratio is on down hill trend in India from 1961 till date.
Method: Present study samples included 243 subjects (119 male/124 females). Study area was determined
by purposive sampling method from districts within Delhi territory with very low CSR, using SPSS (version
12). Data obtained from the study were statistically analyzed.
Results: The analysis showed 80 to 90% men & women believed, sons support them in their old age. 84%
study couples opted for sex selective abortion until the couple conceived a male foetus. 67% of study
population definitely bothered about sex of the fetus during pregnancy. 74% asserted gender equity steps
taken by country and government would stop female feticide. 75 to 86% rich and middle class couples opted
for sons.
Conclusion: Sustained/quality interactions with religious, local influential persons & community leaders,
willing to cooperate in efforts to prevent FF by sustainably persuading married couples to give equal
importance to children of both sexes, to be actively followed up at district levels under the leadership of
district Administrator.

Poster 7(ID1007)
Analysis of Flexible Financing of Public Health Facilities Under National Rural Health
Mission (NRHM) in India
Gautam Chakrabortya, ArunBahuleyan Nairb, Tushar Mokashic
aPopulation Foundation of India (PFI), New Delhi, India

bHealth Systems Research India Initiative (HSRII), Bangalore, India

cNational Health Systems Resource Center (NHSRC), New Delhi, India

Background/Objectives: Public financing systems had been traditionally characterized by rigid structures
and systems allowing little flexibility to the public systems to be adaptive to rapidly changing situations and
179
local contexts. The launch of National Rural Health Mission (NRHM) in 2005 in India, for the first time
introduced the concept of flexible financing within public health systems through “flexi-pools” and
“flexi-funds”, as a part of its mandate to carry out necessary “architectural correction” in the delivery of
public health services in the country. The health system improvements were envisaged to be achieved
through reforms in mode of financing public facilities by providing grants directly to the facilities.
Methods: The paper looks into the design and implementation issues of flexible financing approach for
public facilities and also looks into strategies for improving this method of financing. A funds flow analysis
of the district health systems was done to understand the frequency and volume of public funds vis-à-vis
expenditure undertaken across various levels of care.
Results: The study finding shows that the flexible financing has helped in improving the functionality and
service delivery of public health facilities to a great extent. But the increase in functionality has been largely
limited to about 10 to 30% of the existing facilities due to bottlenecks in absorption of funds. Even in the
case of flexi-funds, the problem of fragmentation of a funding leading to mismatch between the required
combinations of inputs still persists.
Conclusion: The study findings shows the current design of flexible financing under NRHM does not take
into consideration the differential needs of health facilities and this leads to inefficiency in resource
allocation and utilization. Instead, we recommend a “differential financing” approach for public facilities
wherein the financing of public facilities will differ according to the volume, range and quality of services.

Poster 8(ID1010)
Improving Access to Institutional Delivery Through Public Private Partnership Model:
Lessons from A Tribal District in India
ArunBahuleyan Naira, Tushar Mokashib, Gautam Chakrabortyc
aHealth Systems Research India Initiative (HSRII), Bangalore, India

bNational Health Systems Resource Center (NHSRC), New Delhi, India

cPopulation Foundation of India (PFI), New Delhi, India

Background/Objectives: The state of Odisha in India is one of the most backward states of India in terms of
health indicators with very high infant and maternal mortality rates. The state also has very low institutional
delivery and one of the main reasons for this was lack of access to affordable transport mechanisms to reach
the facilities for availing services. In order to reduce the maternal and neo-natal mortality by promoting
institutional delivery, the state introduced a scheme called Janani Express Scheme (JE) for providing round
the clock referral transportation to pregnant women through public private partnership (PPP) mode.
Methods: The study used a case-study design with the case being a health district named Nabrangpur, with
very high tribal population. Secondary data analysis was done to understand the managerial process of the
PPP scheme and was followed by in-depth interviews and FGD’s with the various stake holders of the
scheme which included beneficiaries, community, government officials and the private service provider.
Results: The study showed that after the introduction of the scheme in Nabrangpur District, there was an
increase in the institutional delivery from 14% to around 50%. This increase was mainly due to the use of JE
scheme and the users incurred very low out of pocket expenditure compared to those who used other means
of referral transport. Analysis of managerial process revealed that along with the introduction of the referral
transport mechanism, the public health service delivery was also strengthened to meet the needs of women
and children.
Conclusion: The JE Scheme shows a good example of engaging with private sector for improving the access
180
to vulnerable population in difficult rural inhabitations. Another major aspect of this partnership model is
that it has also resulted in systemic changes in the functioning of the public health system as well.

181
Indonesia(印度尼西亚)

182
Guest Lecture
Emergency/Disaster Response Preparedness for Earthquake in the hospitals in Indonesia
Based on Hospital Safety Index
Fatma Lestari, PhD
Centre for Assessment & Application of Occupational Health & Safety, Building G 3 rd floor, Room G309. Faculty of
Public Health, Depok 16424, West Java, Universitas Indonesia

Indonesia is located on the 4 boundaries of moving tectonic plates, ring of fire with 128 active volcanoes,
having largest archipelago with more than 17,000 islands, 230 million population, diversity in religion,
culture, ethnicity and traditions is prone to different types of emergencies and disasters. Emergency Health
Information System recorded that since 2004 up to 2010, there were 2260 emergencies and disasters of
various magnitudes had affected Indonesia in which health sector had to respond. There were 237,777
persons died, 929,283 persons injured, 4,941,096 became Internally Displaced Persons (IDPs) and more than
2,000 missing. Many health facilities were damaged and health staff became victims among others. As a
result, routine health systems were disrupted effecting livelihood, economy and development of the nation.
During an emergency situation after disasters occur, a community’s critical health services should be capable
to protect lives and well-being of the affected population, particularly in the minutes and hours as soon as the
impact occur. The capability of health services to function without interruption in emergency situations is
critical for human life and death. It is necessary that all health services are housed in a structures that can
resist the force of natural disasters, that equipment and furnishings are not damaged, that vital connections
(such as water, electricity, medical gases, hospital laboratory services and surgery rooms) continue to
function, and that health personnel are able to provide medical assistance. According to the PAHO Disaster
Mitigation Advisory Group (DiMAG), a safe hospital is a facility whose services remain accessible and
functioning at maximum capacity and in the same infrastructure, during and immediately following the
impact of a natural hazard. The study investigated the capability of several health services in Indonesia using
Hospital Safety Index. The Hospital Safety Index has been developed to assess the probability of a hospital
or health facility remaining operational in emergency situations. The Hospital Safety Index provides an
overview of the probability of a hospital or health facility remaining operational in emergency situations
which consider the geographical locations, the environment and the health services network surroundings.
Several hospitals and health services in Indonesia have been selected in this study to be assessed its
preparedness during a disasters. Results suggested that a different levels of hospital safety index indicating
that the capability of the hospitals remains in operations and accessible are varied. Several aspects will be
discussed to further preparing the health services during a disasters.

Oral (from APACPH)

"Indonesian Public Health Training: Practice and Research
Dr. Bambang Wispriyono PhD (wispriyono@cbn.net.id)
University of Indonesia

Oral 1 (ID105)
Ergonomic Design for Junior High School Furnitures at Jakarta, Based On Anthropometric
Data, Indonesia, 2012
Zulkifli Djunaidi

183
 Department of Occupational Health and Safety, Faculty of Public Health, University of Indonesia, Depok, West Java,
Indonesia

Background: Most of the students spend at least 5 to 6 hours of their time daily in the class room. They
have exposed to unergonomic chairs and tables (furnitures) in the class room during the school time. Their
postures and seating positions were adjusted to the unergonomic measurements of the school furnitures.
These factors assumed to contribute for the neck, low and upper back pain of the students.
Objectives: To obtain the anthropometry measurements of students body as a basic ergonomic standard to
evaluate the schools furnitures. To identify the physical symptoms that student suffered from exposure to
unergonomic measurements of furnitures in their class rooms. To propose the ergonomic design for schools
furnitures.
Methodology: 250 students were selected as respondents from 5 junior high schools of Jakarta’s province
for physical symptoms related to unergonomic furnitures.
Results: The furnitures in 5 junior high schools at Jakarta do not fitted the ergonomic standard
measurements.The unergonomic measurements of furniture related to musculoskeletal disorders among the
students such as low back pain.The study recommend the ergonomic standard of furniture measurements
based on anthropometry data to improve the quality of education resources to support the learning process of
the students, and to reduce musculoskeletal disorders among the students by improving the furniture quality

Oral 2 (ID143)
Smoking Behaviors of Street Childrens in Makassar Indonesia
Ridwan Amiruddin, Nurul Azizah, Ansariadi
Epidemiology Department, Public Health Faculty, Hasanuddin University Makassar

Background: Street children are vulnerable groups of risky behavior, one of which is smoking behavior.
Smoking behavior is influenced by several factors. This study aims to describe smoking behavior of street
children in Makassar and its relation with school status, living with parents, family history of smoking, peer
influence, and level of religiosity of the street children.
Method: The research design used was analytical observational cross sectional study. Research was carried
out in January until February 2013. The population of this study are 990 street children with the sample of
277 street children in Makassar. Sample election technique used is non probability in accidental sampling
with inclusion criteria of respondents aged 10-19 years and Muslims. Data analyzed with chi square test with
confidence interval of 95% (α=0.05).
Results: Results of this research show that 48% of street children have ever smoked and 37.2% of street
children were still smoking in the last 30 days. Results of statistical test using chi square test showed that
there is a relationship between living with parents (p = 0.002; phi = -0196) and levels of religiosity (p =
0023; phi = -0137) with smoking behavior of street children that have the strength of a weak association.
However, there was no relationship with school status (p = 0613), family history (p = 0874), and peer
influence (p = 0157) with the smoking behavior of street children.
Conclusion: Provide education about dangers of smoking, provide religious values for childreen and involve
them in religious social activities, family empowerment approach to parents to guide their children not to
smoke, and optimize function of NGOs or shelters for street children.

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Oral 3(ID154)
Socioeconomic Characteristic of Service Quality Inpatient at Labuang Baji Hospital,
Makassar, South Sulawesi, Indonesia
Asiah Hamzaha, Darmawansyaha, Onno Sahlania Hamzahb, Almawin Susenc, Aliahd
a Faculty of Public Health, Hasanuddin University, Makassar, South Sulawesi, Indonesia

b Lecturer of KOPERTIS Region IX, Makassar, South Sulawesi, Indonesia

c District Health Office at Muna South East Sulawesi, Indonesia

d Prof. Dr.H.M. AnwarMakkatutu Hospital, Bantaeng, South Sulawesi, Indonesia

Background/objektic: The aimed of this study were analyzed the differences perception of service quality
between high socioeconomic and low socioeconomic, to analyzes inpatient perception of service quality, to
analyze the gap between expected (importance) service and performance service and to determine the
dimension of the most important quality for the inpatient according to priority.
Method: Cross-sectional analytical survey, using quantitative research methods was utilized. Population and
sample are equal (N=n) totaling 232 inpatients. Data were collected with questionnaires and were analyzed
statistic test with Mann-Whitney, analysis the compared ratio performance and importance, analysis the gap
level between performance and importance, and analysis of Cartesian Diagram.
Results: The study showed that differences in educational level to the perception of service quality obtained
with p value = 0.921 (probability > 0.05), the difference level of works perception of service quality obtained
with p value = 0.508 (probability > 0.05), the difference income levels towards perception of service quality
obtained with p value = 0.927 (probability > 0.05), the level of compliance by 80% towards service quality,
the average score of service expected = 3.595 while the average score of service received = 2.795 with total
gap = -2.596, reliability gap = -0.707 and assurance gap = -0.974 are the two dimensions should be given
priority for hospitals to further improve the service quality.
Conclusions: This study indicated there is no significant differences between socioeconomic level
perceptions of service quality, inpatient perception of service quality is considered high service quality,
service received were not match with service expected of inpatients, reliability and assurance dimension that
should be prioritized for the strategy to improve of saervice quality inpatient at Labuang Baji hospital.

Oral 4 (ID167)
Unemployment, Lack of Bridging Social Capital and HIV-risk Behaviours Among Male
Injecting Drug Users in Makassar, Indonesia
Sudirman Nasira, Doreen Rosenthalb, Timothy Moorec
a Departmentof Health Promotion, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
b Melbourne School of Population and Global Health, the University of Melbourne, Australia

c Nossal Institute for Global Health, the University of Melbourne, Australia

Background/objective: Few studies have explored the relationship between economic deprivation, social
capital and and HIV-risk behaviours in Indonesia. This study aims to examine the relationship between
unemployment, lack of bridging social capital and HIV-risk behaviours (the sharing of needle and other
injection equipment) among young male injecting drug users (IDUs) in a slum area (“lorong”) in Makassar,
South Sulawesi, Indonesia.
Method: Employing ethnographic approach, semi-structured interviews and observation were conducted
with 17 male IDUs.
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Results: The study found that all these IDUs have experienced prolonged unemployment and are heavily
embedded within drug and street subculture in the “lorong”. Their unemployment status hinder them from
fulfilling their masculine identity through conventional means such as job. Unemployment deprives them of
not merely income but also status and identity. The pursuing status of “rewa” (a local concept of
masculinity) partially contribute to their early initiation into drug use and their rapid escalation into drug
dependence. Moreover, they are deeply involved in crime and offenses prior to their drug use and to finance
their drug consumption. Their unemployment and drug dependence further limit their network with people
who have job and people who do not use drugs (lack of bridging social capital) and these exclude them
from mainstream society. These circumstances exacerbate their drug dependence and play crucial role in
facilitating their HIV-risk behaviours.
Conclusions: The study showed the importance social and economic context that underly informants’ early
initiation into drug use, their escalation into drug dependence and their engagement crime and in HIV-risk
behaviours. Additionally, drug policy and drug-related health promotion programs should be more cognizant
of the social vulnerability in the “lorong” and of the need to increase access to employment amongst young
people in order to potentially decrease the likelihood of early drug initiation and dependence and their
engagement in HIV-risk behaviours.

Oral5 (ID204)
Risk Factors of low APGAR Score Infants in Luwuk, Banggai Regency, Indonesia
Ridwan Amiruddina, Erni Yusnita Lalusub
aHasanuddin University, Makassar Indonesia

bUntika Luwu Banggai, Indonesia

Background: The APGAR score is a practical method that systematically used in assessing health condition
of newborns to prevent neonatal asphyxia which can result in death.
Methods: Risk analysis of low APGAR scores using observational techniques with case-control design in
159 infants in the Luwuk city were divided into two groups: cases and controls with a ratio of 1:2. Data
collected by observation and interviews infant conditions and maternal characteristics (education level,
income, nutritional status, quality of ANC, physical activity and exposure to tobacco smoke). Analysis of the
data using chi-square test and logistic regression to estimate the risk of low APGAR score at each individual.
Results: maternal education (OR = 2.512; 1.270-4.969), income (OR = 3.535; 1.764-7.086), maternal
nutritional status (OR = 3.699; 1.608- 8.507) and quality of ANC (OR = 7.644; 3,164-18.468) at risk for low
APGAR score. physical activity (OR = 1.923; 0.770- 4.807) and cigarette smoke exposure (OR = 1.545;
0.720-3.314) didn’t proved be a risk factor of low APGAR score with lower-upper value includes the 1.
regression analysis showed a decrease OR value of ANC quality to infant APGAR score after adjustment on
income and maternal nutritional status (OR = 5.63; 2.267 to 13.985).
Conclusion: The quality of ANC is the most influential variable on the incidence of low APGAR scores in
infants with the education variables and nutritional status as a confounding variable.

Oral 6(ID269)
Measurement Model of the Theoretical Model That Affect Patient Safety Climate in Private
Hospitals in Indonesia
Muhammad Hafizurrachmana, Emma Rachmawatib

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 a Faculty of Public Health Universitas of Indonesia, Depok, Indonesia
b Faculty of Public Health Science, University of Prof. Dr. Hamka, Jakarta, Indonesia

Background/ objectives: The recent studies of patient safety have witnessed a growing concern over the
issues of patient safety climate as the first step in order to improve patient safety efforts. From the theory, a
lot of indicators influence patient safety. Recently, the study for measuring patient safety climate in
hospital area has developed and is used regularly in various countries and an assessment tool in predicting
hospital attention to patient safety. This study aims to make patient safety climate measurement models in
private hospitals with psychometric scores and reliable.
Method: The method is a cross-sectional design. In this study hospital employees serving in all department
of the five private hospitals chosen from provinces in Indonesia, were selected randomly as the unit of
analysis. The 1500 of hospital employees choose as the samples and proportional random sampling were
used. The questionnaire distributed proportionally to all hospital employees. Each variable in the model of
the study measured with 3 or 4 indicators. Data analyzed by Structural Equation Model using Smart-PLS
software
Results: Analysis showed that variable of patient safety in private hospital was influenced by all the
variables that were proposed. The transformational leadership variable was the variable that mostly affects
the patient safety climate (39.79%), variable of individually consciousness (9.90%), teamwork variable
(4.82%); and other variables that were not being researched (45.50%). The Q Square Predictive Relevance
was 69.17%. It means that the theoretical model proposed in this study can be used.
Conclusion: The model provides reliable psychometric scores and describes with good the patient safety
climate condition in each private hospital. Therefore this research recommends the proposed model to be
implemented in all private hospitals and could be used as a reference to develop similar model for other kind
of hospital both government and other private hospital.

Oral 8 (ID434)
Integrated Marketing Communications (IMC) Healthy Behavior Without Tobacco for Youth
in Low Income Family of Surabaya City
Sri Widati
Health Promotion Department of Airlangga University, Surabaya, Indonesia

Background: In the low income family of Indonesia, cigarette is the second priority of expenditure after rice
purchasing. Low income people spare 12 % of their budget on cigarettes and 22% for rice purchasing. Health
marketing communications remain using traditional method. Tobacco industries are using Integrated
Marketing Communications (IMC) to sell their product.
Method: This study applied 3 steps of data collecting. 1) to identify the IMC of tobacco industries,
government regulation, and activities of health related institutions. In this step, observational and reference
study were employed. 2) to evaluate the characteristic of low income family, IMC’s impact, and smoking
behavior of father and son by structured questionnaire’s interviews. There were 400 participants. 3) to build
IMC’s model based on the result.
Results: 1) Youth chosen television as main channel to transfer information. 2) Their favorite colors: black,
blue, red. 3) Law enforcement to ban promoting of regulation UU No. 36/ 2009 mentions that tobacco is
addictive substances and the other regulation, UU. No.32/ 2008, mention that addictive substances is banned
187
to promote. 4) There was no significant influence between respondent’s characteristic and IMC’s impact
from awareness until action. 5) There was significant influence between IMC’s impact and smoking behavior
among youth. 6) There was a significant influence between father’s smoking behavior and son’s in
knowledge. 7) Son’s smoking behavior was influenced more by friends than by the impact of IMC. 8)
Youth’s favorite activities were musics and physical exercises. 9) Youth prefer advertisement as marketing
communication.

Oral 9 (ID512)
Contribution of Smoke-Free Workplace and Other Factors in Improving Smoker's Chances
of Cessation
Meily L. Kurniawidjajaa,b, Nina R.Saria, Yessi Desputria
a Universitas Indonesia, Depok, Indonesia

bThe Indonesian Medical Association for Occupational Health, Jakarta, Indonesia

Background/objective: Smoking is harmful and can reduce productivity. In 2010, in collaboration with
WHO and in consultation with other stakeholders, The Indonesian Medical Association for Occupational
Health had developed Guideline for Smoke-free Workplace. This study aimed to investigate the contribution
of smoke-free workplace and other factors in improving a smoker's chances of cessation.
Method: A cross sectional study on 60 workers who were smokers or ex-smokers from several companies
was conducted to explore factors in improving smoker's chances of cessation. In the same time, a
semi-quantitative study using content analysis method based on the Guideline and triangulation technique
was conducted in a company, on all 12 members of program development team and randomized 60 workers,
to evaluate the smoke-free workplace program.
Results: The study showed, near all smokers (98.3%) would like to quit smoking, only 58.30% had tried to
quit. However, only 40% of them had successfully stop smoking. Among the successful quitters, workers at
the company running smoke-free workplace program tended more prevalent (46.70%) than workers at the
companies with no such program (33.30%), but was not significantly different (OR 1,75, 95% CI 0,62 –
4.97). This study also found factors improving the chance of quitting, were health problem (100%), aging,
marriage, having children and family support, knowledge and attitude; but most smokers found quitting
difficult because they were addicted (41.10%). The study revealed that the program was developed based on
The Guideline, but not all the elements within the 8 steps were fulfilled, especially the steps of Recognition
(76.11%) and Analysis (84.34%), the penalty also not well implemented.
Conclusions: It was suggested, community based health education and promotion including smokers’ family
as the target should be implemented, the free smoke workplace should be developed based on the recognition
and analysis, and consistently implemented. Smokers who addicted should be offered medical treatment.

Oral 10(ID539)
Linkages Between Climate Variability And Dengue Hemorrhagic Fever in Palembang,
Indonesia
Hamzah Hasyim
Occupational Health Safety and Environment Department, Faculty of Public Health, Sriwijaya University, South
Sumatra, Indonesia

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Background: The impact of global warming is already evident in Indonesia. Numerous studies already
documented the linkages between climate change and infectious diseases and have highlighted the
correlation between climate and dengue transmission. Mosquito borne arboviruses are more important in a
public health, cause of morbidity and mortality that it will be influenced by availability among of habitat and
environmental conditions and also climatic change because most of populations have different vulnerabilities
to climate and susceptibility to disease that may affect human health both directly and indirectly, although
the extent of the effects is unclear. According from Ministry of Health Republic Indonesia regulation no.1501
in 2010, DHF is one of diseases that has outbreak potential in Indonesia and Dengue Fever cases, one of a
global commitment to the MDGs.
Methods: Through secondary analysis, to describe trend and to identify linear correlation amongst climate
variability like rainfall and rainy days and incidence of DHF. Data will be collected from some sources like ;
trend of epidemiology of DHF from Ministry of Health of Republic Indonesia. Climate variability data from
Indonesian Agency for Meteorology Climatology and Geophysics.
Results: From the research results obtained there are correlation analysis between rainfall and DHF (pv =
0,001 and r = 0,358) and not significant relationship between rainy days and DHF (pv = 0,079 and r = 0,174)
but both of them showed a positive pattern.
Discuss: From this result by means of correlation analysis we explored the possible impact of climatological
variability events like rainfall and rainy days on the occurrence of DHF,that needed adaptation and mitigation
action to anticipate incline the DHF incidence after increasing rainfall and rainy days.
Conclusions: The result of research that will need policy to implement EWARS in Health Department, to
prepare adaptation and mitigation specially for vulnerable populations, giving the IHR to the decision maker,
to improve community awareness about PHEIC.

Oral 12 (ID554)
Household Food Insecurity and Expenditure on Cigarette Were Associated to Underweight
Among Under-five Children in East Java, Indonesia
Dini R. Andrias, Annis C. Adi
Airlangga University, Surabaya, Indonesia

Background: Underweight among under-five children is one of MDGs’ indicator for eradicating extreme
hunger and poverty. However, underweight is still prevalent in East Java Province of Indonesia, which
probably influenced by poverty and food insecurity. East Java is categorized as chronically food-insecure
area and one of the main provinces contribute to total number of poor population in Indonesia. Meanwhile,
data showed that during the crisis, household food expenditure declined; however, expenditure on cigarette
was not. This work asses the association of household food security and household expenditure on cigarette
with preschool children underweight status.
Methods: Data was obtained from the 2010 Indonesian basic health research, consist of 2247 households
with under-five children in East Java. Households were categorized as food secure if proportion of budget
allocated for food was less or equal to 60% and caloric availability per adult equivalent was more than 80%
(Jonsson dan Toole, 1991).
Results: Overall, only 19.5% households were food-secure. Multivariate analysis using logistic regression
by including household size, food expenditure, cigarette expenditure, household calorie availability,

189
household food security status, child calorie consumption and child protein consumption as the candidates of
predictors for underweight, confirmed that household food insecurity and expenditure of cigarette were
significantly associated to underweight. Children from food-insecure household had 2.183 times higher risk
of being underweight compared to those from food-secure household. While children from households with
cigarette expenditure more than 12,000 rupiahs per day had 1.296 times higher risk of being underweight.
Conclusion: This analysis concluded that household food insecurity and expenditure on cigarette were
associated to underweight among preschool children. Beside to support evidence that actions are required to
tackle household food insecurity problem in Indonesia, this analysis also recommend advocating poor people
to reduce their cigarette expenditure and allocate it to improve food quality for their children.

Oral 13 (ID598)
Under Five Mortality in Low Socio Economic Groups: Cross Sectional Survey Results in Four
Poorest Quintile Districts in Indonesia 2010-2011
Dewi N. Aisyaha, Oktarindab, Nasrin Kodima, Budhi Setiawanb
aCenter for Epidemiological Research and Surveillance, Faculty of Public Health Universitas Indonesia, Depok,
Indonesia
bUNICEF Indonesia, Jakarta, Indonesia

Background: Significant progress has been made nationally in reducing mortality rates among children
under five in Indonesia. Nevertheless, it was indicated that poorest group have greater risk for illness and
death than those in higher socioeconomic status. The main objective of this research is to estimate under-five
mortality rates in low socioeconomic groups and explore the determinants related to it.
Method: 226 villages were selected for cross sectional survey by two stage cluster sampling. The study area
was four poorest districts in Indonesia, namely Brebes (Central Java Province), Buru (Maluku Province),
Timor Tengah Selatan (East Nusa Tenggara Province) and Jayawijaya (Papua Province). By using the death
listing, eligible cases in the study area were then visited for interview using verbal autopsy questionnaire.
The individual interviews collected data on basic demographic indicators, occupational information and data
on education.
Result: A total of 596 under five deaths were observed between the study periods of 1 January 2010 until 31
December 2011. Generally, the U5MR was 18 in 2010 and 21 per 1000 live births in the following year. The
lowest under five mortality rates was found in Brebes district (11 per 1000 live births) and the highest U5MR
was found in Jayawijaya district (178 per 1000 live births) in 2011. The main causes of under-five mortality
were pneumonia and diarrhea. Most of them died at home at the age between 22-24 months. Parental
education level was low as most of them attained education only until primary level. Parents were either
farmer or unemployed.
Conclusion: The results of this study provided a foundation for policies and programs related to maternal
and child health as well as emphasized the importance of health systems management and evaluation of
interventions in low socioeconomic groups.

Oral 14 (ID622)
Homebirth Care in the Eyes of Indonesian Women in Amsterdam, the Netherlands
Tiara Amelia
Public Health Faculty, University of Indonesia, Indonesia

190
Background: the Netherlands, despite being located where the medicalization of childbirth began, 61% of
500.000 women planned home birth. Home as place of delivery is never being a choice among Indonesian
women. Therefore, an ethnographic research was conducted to explore insight of Indonesian women
regarding home birth as well as their meaning of childbirth and the considerations in choosing place of
delivery.
Method: This research was conducted on June until August 2010, in Amsterdam. Data collection was
consisted of 23 in-depth interviews (Indonesian women, husbands, midwives, gynecologist, and midwife
assistant), 1 group discussion of newly Indonesian married couple and 3 observations (immunization services
of newborn and checking pregnancy in hospital).
Result: Indonesian women followed the general “medicalization” trajectory, which is that the construction
of childbirth is a risky event that needs medical attention; which is supported by the “technocratic
imperative” idea, which follows that a body has its limitations and needs technological intervention during
delivery. This adherence to the medicalization trajectory only increases because of the stories that are
circulated about actual risky situations that occurred during home delivery. Though there is a successful
experience of home birthing but perception of safety is the most important than the ownership, conformity,
empowerment and economic. The overall perception is that hospital are perceived to be safer than home.
Conclusion: The perception of safety is most important than everything else, which falls in line with
medicalization, and the technocratic imperative. The “authority” in the perception of safety lies with the peer
group not the midwife or the gynecologist. Between home and hospital, all of which is a matter of who has
the true “authority” and power to bring knowledge which is accepted and legitimized as correct, and is both
safe and good for birthing within a particular community, wherever it may be.

Oral 15(ID639)
The Effect of Counseling and Discipline on the Increase Behavior Personal Hygiene of
Elementary School at Donggala District Central Sulawesi
Zulkifli A. Abdullaha, Sapriana Syamsuddinb, Mappeaty Nyoronga
aFaculty of Public Health, Hasanuddin University

bHealth Polytechnic of Palu, Central Sulawesi

Background/objective: School became an extension of the family in laying the foundation of health
behavior. The objective of this study is to assess the influence of counseling, discipline, counseling and
discipline as well as a combination of knowledge, attitude and practice personal hygiene elementary school
students.
Method: This research is a quasi experimental design with nonrandomized pretest posttest control group
design and proportionate stratified random sampling method. The samples were student grade one, two and
three of the four elementary schools; in SDN 1 Wombo 45 people were given health education, in SDN 3
Wani 54 people were given disciplinary, SDN 4 Wani first 40 people were given a combination of health
education and discipline, and in SDN 2 Wombo 50 people as controls.
Results: Results showed no effect of health education to increase the value of students' attitudes (pretest =
1.57; posttest = 1.62; p = 0.004), no effect of increasing the value of discipline against the student's
knowledge (pretest = 1.81; posttest = 1,86; p = 0.044), no effect of health education, discipline and a
combination of the increase in the value of the action/practice students (extension: pretest posttest = 1.99 =
2.66 p = 0.000; discipline: pretest posttest = 2.24 = 2.92 p-value = 0.000; combination: pretest posttest = 1.90
= 2.83 p = 0.004;).
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Conclusion: With a combination of more effective interventions to improve personal hygiene measures than
health counseling or discipline, the intervention is expected to be applicable to elementary school students as
part of the school program.

Oral 16 (ID684)
Environmental Health risk Analysis of Benzene Exposure at Painting Unit Workers PT.X
Jakarta 2010
Meliana Sari
Public Health Sciences Graduate Student, Department of Environmental Health, School of Public Health, Universitas
Indonesia, Indonesia

Background/Objective: Motor vehicle assembly industry is one of the industry which is growing rapidly in
Indonesia. Benzene is one of chemical used in industry which contain carcinogenic and non-carcinogenic
effects on human health. The aim of this study is to estimate and formulate health risks management from
benzene exposure in painting unit workers.
Method: This study was conducted on 178 workers at painting unit PT.X Jakarta in 2010. The research used
environmental health risks analysis (EHRA) method. EHRA method determine non-carcinogenic risk
estimated by the value of RQ (Risk quotients) and carcinogenic risk estimated by the value of ECR (Excess
Cancer Risk) for Real time and Lifetime exposure.
Results: Concentration of benzene in the workplace was 6,916 mg/m3. Average weight of workers was 66 kg
with average working period of 15 years. In the calculation of risk (ATSDR 2005; EPA 2005),
non-carcinogenic risk exposure either in realtime (15 years) and lifetime (30 years) was above 1 (RQ> 1) or
equal to 14.4 and 16.6. While the carcinogenic risk was also above the value 10 -4 (ECR> 10-4) or equal to
30.5 x 10-4 (realtime exposure) and 61 x 10-4 (lifetime exposure). Risk management efforts were done by
controlling concentration of benzene (0.07-0.14 mg/m3) and exposure time (0.13-0.28 hours/day).
Conclusions: Exposure to benzene in workers PT.X painting unit was estimated caused health effects for
both realtime and lifetime exposure. Therefore, risk management efforts should be made to control and
minimize the risks that may impact to human health.

Oral 17 (ID707)
Child Survival Program and Infant Mortality in Depok, Indonesia, 2013
Nur Sadji, Nasrin Kodim, Ratna Djuwita
Department of Epidemiology, Faculty of Public Health, Universitas Indonesia

In Indonesia, the infant mortality rate is still high in the rank of the highest sixth in ASEAN countries. In
2011, the child survival program coverage in Depok city higher than national, the Infant Mortality Rate (119
cases) and Child Mortality Rate (23 cases from 37.083 live births), relatively lower than West Java with
Infant Mortality Rate (39/ 1.000 KH) and Child Mortality rate (49/1.000 live births). The objective of this
study is to know the effect of neonatal survival program on infant mortality. This study uses retrospective
cohort study design with first observation is conducted 28 days after the infant born, in period of neonatal
survival program implementation. Population is the infant who born in Depok city in the period of 1 January
2011-20013. The number of samples is 1.693 infants, and recorded completely in infant cohort registration
form. The source data used in this study are secondary data on infant cohort registration and other supporting

192
data in the health center (puskesmas). The data is analyzed using coax regression multivariate analysis
method. The result shows that the neonatal program influences infant mortality in Depok City, in 2011-2012,
RR=18,56; p=0,000 (95% CI RR: 10,14-33,9). Neonatal health care reduces infant mortality in Depok city
after several confounding factors.

Oral 18 (ID708)
The Role of Support in Improving Quality of Life of PLHIV in Indonesia Year
2011(Qualitative Study in 10 Provinces)
Sarah. Handayani
Doctoral Student, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia

Introduction: Peer support is people living with and affected by HIV helping each other. This study aims to
determine the role of peer support on quality of life of PLHIV in Indonesia.
Methods: This study used qualitative approach. In depth interviews were conducted on key informants and
supporting informants. Key informants were PLHIV who received and did not receive peer support.
Supporting informants were peer support group coordinators, catalyst group coordinator, Local AIDS
Commission staff, Local Health Office staff, and family members of PLHIV. The instrument used was the
in-depth interview guidelines.
Results: This study reinforces the importance of peer support for HIV positive people in altering
self-confidence. Sense of kinship could have had a positive impact in dealing with accepting ones HIV
status. People living with HIV who do not receive support from peer support group are receiving support
from family members, physicians, or counselors. This study also found that people who have the support of a
peer support system are also experiencing an increase in knowledge. The ability of individuals in accessing
support, treatment and care services, results in a positive impact. Support group systems seek to assist
individuals in accessing existing services so that people with HIV feel comfortable to ask questions. Another
aspect of the quality of life is having productive activity, including working, engaging in hobbies, and family
planning. Most of PLHIV who do not have access to the peer support system are not motivated to perform
productive activities.
Conclusions: This study found that most of the PLHIV who receive support from the peer support group
have increased self-confidence; knowledge of HIV/AIDS; access to support, treatment and care; positive
behavioral changes; and productive activities. Therefore, it is recommended to optimize the efforts to
motivate and facilitate the establishment of peer support group in every district or city.

Oral 20(ID762)
Assessment of Mercury Accumulation in Dry Deposit, Surface Soil and Foodtuffs in Luwuk
Gold Mine, Central Sulawesi, Indonesia
Alimin Maidina, Anwar Mallongib, Tahir Abdullahc
aFaculty
of Public Health, Hasanuddin University, Makassar Indonesia
bDepartment of Environmental Health, Hasanuddin University, Makassar Indonesia

cDepartment of Biostatistics and Demography, Hasanuddin University, Indonesia

Background: Mercury could be taken up increasingly by plants and transferred to food chain both via plant

193
root, majority the uptake of gaseous elemental mercury through leaves via its stomata. This study aimed to
investigate the total mercury (THg) concentration in dry deposit, surface soil and its bioaccumulation in food
stuffs and its potential risks.
Methods: Sampling field survey conducted during one period of sample collection. Samples were collected
in the areas of influence of the mining and ore processing works.
Results: It shown that THg concentration in dry deposit were ranged from 1.76 to 4.00(µg m-3 day-1),
surface soil were ranged from 85.94 to 193.33(µg kg-1dw) in 0-5cm depth and 120.64 to 226.59(µg kg-1dw)
in 5-10 cm depth. Likewise, THg concentration both in brown and white rice grain were ranged from 99.1 to
181.3(µg kg-1dw) and 123.5 to 185.1(µg kg-1dw), respectively. In addition, THg bioaccumulation in
foodstuffs were ranged from 60.2 to 74.3(µg kg-1dw) in meat and 73.9 to 212(µg kg-1dw) in seed. In
coconut meat and milk ranged from 77.5 to 162(µg kg-1dw) and 36.9 to 73.8(µg kg-1dw), respectively. The
elevated THg in dry deposit were in St.4 and St.5 had average values with 3.46(µg m-3 day-1) while in
surface soil (0-5 and 5-10cm) had averages of 161.64 and 177.89(µg kg-1dw), respectively. Hence, THg
concentration in foodstuffs for brown and white rice grain, cocoa meat and seed, coconut meat and milk had
a mean of 126.86, 132.24, 65.64, 112.6, 117.24 and 54.36(µg kg-1dw), respectively. All THgs concentration
in dry deposit and surface soil were still meet the standard value for environmental risks <1, no at risk.
Conclusion: THg concentration in surface soil and bioaccumulation in foodstuffs due to results of ore
amalgam processing that correspond to the elevated THg concentration in atmospheric dry deposition.

Oral 21 (ID792)
Efficacy of Red Palm Oil and Carrot Noodle on Blood Retinol, IgG, and Nutritional Status of
Children Aged 7-9 Years
Sri A. Marliyati, Ahmad Sulaeman, Rizal Damanik, Joffa Gusthianza, Guntari Prasetya
Bogor Agricultural University, Bogor, Indonesia

Background/Objective: Vitamin A deficiency is a major cause of morbidity and mortality among preschool
children. Red Palm Oil (RPO) and carrot are rich in pro-vitamin A. The objective of this study was to
analyze the efficacy of RPO and carrot noodles on blood retinol, IgG and nutritional status of children aged
7-9 Years.
Method: Quasy experimental design was applied in this study. The treatments were: (1) control group (no
added carotene, n=13), (2) RPO group (carotene from RPO, n=11), and (3) Carrot group (carotene from
carrot, n=11). Noodles were given once a day (50 g/ss) for 8 weeks in school day. Retinol concentration,
IgG, and nutritional status were assessed at baseline and after 8 weeks.
Results: Baseline data showed more than 60% children of control, RPO and carrot group had marginal
vitamin A status (17.57μg/dl, 16.87μg/dl, and 17.28μg/dl), while after intervention were 21.32μg/dl,
23.49μg/dl, and 20.87μg/dl. There were no significant differences in retinol concentration between all groups
before and after intervention. The IgG levels of control, RPO and carrot group were 2.05 IU/ml, 2.61 IU/ml,
and 3.61 IU/ml at baseline, while at end line were 5.30 IU/ml, 14.89 IU/ml, and 9.16 IU/ml. There were no
significant differences in the IgG level between all group before intervention, while there were significant
differences between IgG level of RPO versus control and carrot group after intervention. The nutritional
status (weight for age) of control, RPO and carrot group were -1.73, -2.04, and -1.86 at baseline, and -1.41,
-1.77, and -1,46 at end line. There were no significant differences in the nutritional status between all
groups before and after intervention.

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Conclusions: RPO and carrot in noodles tend to increase retinol, IgG and nutritional status of children. After
8 weeks only IgG of RPO group was significantly different versus control and carrot group.

Oral 22(ID794)
Estimation of Iron Bioavailability from Food Consumption at Pregnant Women in Bogor,
Indonesia
Dodik Briawana,b, Intan Permatahatia, Siti Madanijaha,b, Rimbawana,b
a Dept. of Community Nutrition, Fac. of Human Ecology, Bogor Agricultural University, Indonesia
b SEAFAST Center, Bogor Agricultural University, Indonesia

Background: Nutritional anemia deficiency in the world developing countries are mostly due to low in iron
intake as well as iron bioavailability. For Indonesian RDA, iron requirement and its bioavailability was
estimated by WHO method, and in this study we estimate the iron bioavailability at pregnant women based
on Due method.
Method: The cross-sectional study was conducted in Bogor city of Indonesia by involving 203 pregnant
women in second trimester. The food consumption data was collected with 2x24 hours food recalls.
This data was from the study on “Nutritional Status and Food Pattern of Pre-Pregnant, Pregnant and
Lactating Mothers”. Due et al (1999) method was applied to estimate iron bioavailability by
considering the iron absorption enhancer and inhibitor.
Results: The anemia prevalence among pregnant mothers was 22.2%. Animal foods consumption as a
source of heme iron was still low (80 g). Meanwhile, cereals, legumes, and vegetables consumption were
318 g, 83 g and 240 g respectively. The mean iron intake was 22.3 mg lower than the requirement 26 mg.
This lower iron intake might cause about 84.2% of pregnant mothers having iron deficiency. The protein
and vitamin C as enhancer for iron absorption was 53.5 g and 39.1 mg. Meanwhile, 66.5% and 85.2% of
pregnant women were also suffering vitamin A and C deficiency (<77% RDA). The nutrients density was
calculated per 1000 kcal for protein 32.7 g, vitamin A 375 RE, vitamin C 22.7 mg and iron 13.7 mg. Heme
iron intake was 8.9 mg lower than the non-heme iron 13.3 mg. Estimation of iron bioavailability was 2.2 mg
with absorption level 9.9%.
Conclusion: The iron bioavailability is lower than Indonesian’s RDA 4.2 mg. Since the quality of food
consumption at pregnant women is still low, the iron supplementation program is important to meet about
50% of total iron requirement.

Oral 24(ID812)
Body Composition And Body Image Among Adolescents In Rural And Urban Indonesia
Hadi Riyadi, C Meti Dwiriani, Ali Khomsan, Faisal Anwar, Mira Dewi
aBogor Agricultural University, Indonesia

Background/objective: Adolescence is a transitional period from children to adults where they experience
changes including biological, cognitive and socio-emotional. The study aimed to analyze body composition
and body image among adolescents in rural and urban of Indonesia.
Method: The study involved 435 adolescents in Jakarta (urban) dan Bogor (rural), Indonesia. The samples
are male and female, age of 13 to 19 years old. The body composition data was obtained by measurement of
body weight, height and body fat. The body image data was measured by samples’ perception on their body

195
shapes based on silhouettes chart provided. Data was analyzed descriptively and inferentially. The study was
funded by the Neys-van Hoogstraten Foundation, the Netherlands.
Result: Urban adolescents tend to have higher high and very high percentage of body fat compare to rural
adolescents. The prevalence of high and very high percentage of body fat among male (36.2%) was higher
than female adolescents (7.7%). The prevalence of thinness based on BMI-for-age among male and female
adolescents was 13.6% and 4.6%, respectively. On the other hand, the prevalence of overweight was 4.2%
for male and 2.3% for female adolescents. The prevalence of overweight in urban were higher than them in
rural, while the thinness were almost the same. Adolescent nutritional status was positively related to their
body fat (p<0.05, r=0.760). According to the silhouettes, almost all adolescents (74.1-89.5%) in rural and
urban perceived that they are thin, the same perceived also stated for their ideal body shape. Regarding
their body shape, most (78.4-81.9%) of rural adolescents stated that they satisfy, whereas in urban, almost
two-third (62.2%) of female and half (45.4%) of male stated that they were not satisfy.
Conclusion: Compare to the rural, urban adolescents had higher composition of body fat, more prevalence
of overweight, and more not satisfy with their present body shapes. Almost all adolescents had negative
body image.

Oral 26 (ID844)
Factors That Influence Chronic Complications of Elderly with Diabetes Mellitus
Amrina Rosyada a, Dina D. Mulia b, Anggraini Sariastuti b, Ridho I. Syaini b
a Gadjah Mada University, Indonesia

b University of Indonesia, Indonesia

Objective: Purposes of this research were to determine prevalence of chronic complications on elderly with
diabetic and factors that influence it.
Method: The research was conducted based on data from Riskesdas 2007. The research used cross-sectional
design that represents Indonesia and based on two phases cluster as its sampling method. Descriptive and
multivariate analyses were performed on the data.
Results: The results showed that prevalence of chronic complications in the elderly was 73.1%, with
hypertension as the greatest complication. So, the treatment of the elderly who suffer from diabetes,
especially complications of hypertension, should be effective and able to minimize adverse drug effects.
Based on multivariate analysis, smoking became a major factor associated with complications (OR = 2.477,
95% CI 1.545-3.972). Others factors that could also influence are age, sex, obesity and exercise.
Conclusion: The results suggested the needs of an integrated treatment system for elderly with diabetic
complications to avoid polypharmacy that could increase the risk of adverse drug effects and even death. In
addition, regarding the risk of complications, programs to prevent complications of diabetes on elderly
should be improved, for example CERDIK that means regular health checking, avoiding smoke from
cigarette, exercise, healthy diet, adequate rest, and stress management.

Oral 27(ID849)
Zinc Levels and the Incidence of Respiratory Infection and Diarrhea in the Stunting-Wasting
Children and Normal Children
Bambang Wirjatmadi, Yustina Pacifica Maria Paschalia, Merryana Adriani
Publich Health Airlangga University, Surabaya, Indonesia

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Background/objective: Stunting describes the state of longstanding malnutrition that takes time for children
to grow and recover, while wasting can occur due to the period of a state of malnutrition which is relatively
short and which can be recovered quickly. Studying and analyzing the differences in zinc levels and the
incidence of respiratory infection and diarrhea in the stunting-wasting children and normal children.
Method: The study was an analytical observational study, design for a comparative study using cross
sectional approach. The study population was all children who were enrolled in the study site, and aged 2-5
years. Statistical analysis used were independent t-test, Mann-Whitney test, Fisher's exact test, Pearson
correlation test and Spearman's Rho.
Result: There were differences in the levels of protein (p=0,016), zinc consumption (p=0,042) the state of
hygiene (p=0,000), and environmental sanitation (p=0,001) between the two groups. There were also
differences in the incidence of respiratory infection (p=0,000) and the incidence of diarrhea (p=0,000) in the
stunting-wasting children and normal children. There was a correlation between hair zinc levels with the
incidence of respiratory infections (p=0,027) and between hair zinc levels with the incidence of diarrhea in
the stunting-wasting children and normal children (p=0,007).
Conclusion: There were differences in the incidence of respiratory infection and the incidence of diarrhea in
stunting-wasting children and normal children.There was a correlation between hair zinc levels with the
incidence of respiratory infection and zinc levels with the incidence of diarrhea in stunting-wasting children
and normal children.

Oral 28 (ID851)
Analysis of Disparities in Health Center Quality Between Rural, Coastal and Urban Areas at
Kutai Kartanegara District, Indonesia
Irwandya, Nurdin Perdanab, Dian S Rislamida, Syahrir A Pasinringia, Indahwaty Sidina, Fridawaty Rivaia
a Hospital Management Department of Public Health Faculty, Hasanuddin University, Indonesia

b WHO Office, Indonesia

Background/objective: Health development which has been implemented is still not running optimally and
evenly to reach all areas and walks of life. It can be seen by the high incidence of health care disparities that
occur in particular for remote areas. The objective of this studied to analyze Disparities of Quality Care in
Health Center between rural, coastal and urban areas.
Method: The study was conducted in 2011 on 2 rural health centers, 2 coastal health centers and 2 urban
health centers. Primary data is obtained by using a questionnaire to measure quality of Health Center in
terms of patient satisfaction (RATER Scale). Data analysis used ANOVA test and number of respondent
were 180 samples.
Results: Statistical test results showed that there are differences in the level of patient satisfaction on the
three-dimensional quality of service reliability (p = 0.01), responsiveness (p = 0.03), and tangible (p =
0.039). Assurance on the variable (p = 0.512) and empathy (p = 0.122) showed no differences.
Conclusions: There were differences in quality of care at the health centers where the quality of health
centers in rural areas is still low rather than in urban and coastal areas. Local governments need to improve
the quality of health services, especially in rural areas by improving the quality of facilities and
infrastructure, improving the response of health workers, provide services in a timely and reliable.

Oral 29 (ID916)

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 The Quality of Clinical Care Caesarean Section in Hospitals That Have Been Implementing
Quality Management Systems
Fridawaty Rivaia, Tjahjono Koentjorob, Adi Utarinib
aPublic Health Faculty, Hasanuddin University, Makassar, Indonesia
b Post Graduated of Hospital Management Department, Medical Faculty,Gajah Mada University, Yogyakarta, Indonesia

Background/Objective: In recent years the problem of poor quality in health care is a major issue,
especially regarding the impact for the patient and hospital. Various attempts have been made to achieve the
quality of service and quality of clinical care but it’s still not able to attempt improvement especially on
clinical performance. One of services provided by hospital is Caesarean Section and the trend has been
increasing from year to year. The purpose of this study was to measure the quality of clinical care Caesarean
Section in hospitals that have been implementing quality management systems (accreditation and QMS ISO
9001:2008 certification)
Methods: This research used observation method were 154 patients who had caesarean section followed
since the patient admission to hospital, surgery preparation, surgery, until post surgery and up to 30 days
after caesarean section at Dr.dr.Sardjito Hospital, using check list sheet. This research was conducted during
March to August 2012.
Results: The results showed that the quality of clinical care of caesarean section were still lower than the
standards such as respond time of decision caesarean section emergency, the timing of prophylactic
antibiotics, wound care and surgical site infections. The quality of clinical care of caesarean section were
meet the standards such as respond time of emergency patient, surgery preparations, prophylactic antibiotics
and blood transfusion in patients who experienced bleeding.
Conclusions: There are several quality of clinical care of Caesarean Section Surgery were lower than the
standards. This problems needs to become high concerns by hospital management because Dr.Sardjito
Hospital have been implementing quality management systems (accreditation and ISO 9001:2008
certification) and it should be able to have an impact on the clinical quality of care in hospital.

Oral 30 (ID958)
Hyphoglicemic Activity of Black Tea as Good as Green Tea But Better Than Mullberry Leaf
Tea on Diabetic Rats
Evy Damayanthia, Nastiti Kusumorinia, Lilik Kustiyaha, Bambang Pontjoa, Rimbawan
Rimbawana,YoyandaBaitb, Dina Ritongaa , Rohayati Suprihatinic
a Bogor Agricultural University, Indonesia

b State University of Gorontalo, Indonesia

c Tea and Quinine Research Center Gambung,West Java, Indonesia

Background/objective: The prevalence of diabetes mellitus increases in the world. Several studies have
been done using herbal to control diabetes. The aim of this study was to investigate the effect of various teas
on controlling blood glucose level and pancreatic β cell number on diabetic rats.
Method: The material used was tea (Camellia sinensis) having high cathecin content and mulberry (Morus
kanva) leaves. The study included preparation of various type of teas, analysis of phytochemical contents,
observation the capability of tea on controlling blood glucose level on diabetic rats. Total of 42 rats were
used, comprising 6 normal and 36 diabetic. They were divided into 7 groups, each group consisted of 6 rats;
normally control (NC), negative control (-C), black tea (BT), green tea (GT), mulberry leaf tea (MT), black
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tea+mulberry leaf tea (BMT) and green tea+mulberry leaf tea (GMT). Rats were given tea with dose 1
ml/day/100 g bw during 16 days, equivalent with EGCG 44.47 mg/kg bw for green tea and for black tea,
EGCG 0.36 mg/kg bw, theaflavin 11.19 mg/kg bw, thearubigin134.4 mg/kg bw. Sampling of pancreas was
done at the end of treatment using embedding parafin method. Hematoxilin-Eosin coloring method was used
to assess general morphology and the Langerhans island number, and gomori was used in coloring β cell.
Results: The results showed that GT significantly decreasedblood glucose level (p<0.05) compared to other
treatments but notwith BT. The degenerated cell numbers and necrosis of pancreatic tissue of K(-) and MT
were higher than BT, GT, BMT and GMT treatments respectively. Langerhans island numbers of BT, GT,
BMT and GMT was not significantlly different with NC. Furthermore, β cell numbers of GT and
BMTsignificantly higher than –C (p<0.05).
Conclusions: The treatments of GT, BT and BMT were able to inhibit β cell destruction.

Oral 31 (ID1054)
Psychological Violence Against Wives and Its Determinants in Bekasi 2013
Fitra Yelda, Dini Dachlia, Sabarinah, Rovika Trioclarise, Atikah Pustikasari
Center for Health Research Universitas Indonesia, Depok, Indonesia

Background/Objective: Although domestic violence is a general phenomenon occurred in the global

community, however, they were not commonly disclosed. Psychological violence as one of domestic
violence experienced by women had an impact on women and the quality of family.
Method: The study used a cross-sectional design. Total sample was 216 married females who lived in
Bekasi, West Java Province at the time of survey. Self-administered questionnaire was used, by asking
respondents to fill in the questionnaire in a secure place and afterwards put it in the closed envelope.
Results: Wives and their husbands completed junior-high school or lower level was 56% and 44%,
respectively. There were 31% of respondents working with 73% white collar husbands. On average, the age
of wives and their husbands at the time of survey was 33 and 37 years, respectively. The average duration of
marriage was 12 years. Approximately 10% of respondents married more than once. Two-fifth of
respondents had first pregnancy at the age of less than 19 years. Three quarter of wives admitted experienced
psychological violence during marriage. One-third of wives reported severe psychological violence, whereas
20% reported had mild and moderate psychological violence. The wife of blue-collar husbands had an
increased risk to experience psychological violence than the wife of white-collar husbands (OR=2.93. 95%
CI 1.2 – 7.16). However, the longer the duration of marriage, the lower the risk of having psychological
violence (OR=0.55, 95%CI 0.28-1.10). Other variables such as wife's education, husband's education, wife's
working status, duration of marriage, age of first pregnancy, and number of marriage, did not emerge as a
significant predictor.
Conclusions: Psychological violence was more frequent occurred in wives included in this study. Blue collar
husbands will cause more psychological violence than white-collar husbands.

Oral 32 (ID1060)
Safe and Short Cut Behaviour Intention Analysis Among Workers at Pertamina Hulu Enerji
Offshore North and West Java (PHE ONWJ)
Yuni Kusminantia, Dadan Erwandia, Fatma Lestaria, Iwan Jatmika b, Deddy Syamb, Karyani Manurungb
a Center
for Assessment & Application of OHS, OHS Department, Faculty of Public Health, Universitas Indonesia,

199
 Depok 16424, Indonesia
bPertamina Hulu Energy Offshore North and West Java, Jakarta, Indonesia

Background/objective: The study is purposed to obtain the intention of behaviour and contributing factors
such as attitude, subjective norm (SN) and perceived behavioural control (PBC) as adopted from belief,
attitude, intention and behaviour theory.
Method: data collected through distribute the questionnaires among 1049 workers from all levels, top
management, middle managers, supervisor and workers.
Result: the safe behaviour intention is 13.65 (index 9) and short cut behaviour (SCB) is 7.48 (index 9). The
highest values from index would indicate the positive behaviour. Means beta are attitude 0.59; SN 0.231 and
PBC 0.547. It may be seen that the most contributing factor is PBC. The study concludes that the
implementation of safe behaviour in the company is already good and contributed dominantly by external
factors rather than internal or individual factors. The company may improve the awareness, responsibility
and competency toward safety among workers. It should be supported by effective coaching and controlling
by line supervisors in working unit.

Oral 33 (ID1064)
Role of Exclusive Breastfeeding and Pneumonia Among Children Under Five years in Bogor
District West Java Province Indonesia
Resa A Dinaa, Ratna D Sukirnab
a Graduate student in Master of Epidemiology Program School of Public Health University of Indonesia
b Department of Epidemiology School of Public Health University of Indonesia , Depok,Indonesia

Background & objective: Pneumonia is one of main cause of death after diarrhea among under-five year
children in Indonesia. Pneumonia could be prevented by providing adequate nutrition, immunization, as well
as providing clean indoor stoves. Adequate nutrition among babies started with exclusive breast feeding for 6
months will improve children natural defense especially toward lower respiratory tractus infection such as
pneumonia. The high prevalence of Pneumonia might be related with the low prevalence of exclusive breast
feeding. The objective of this study is to identify the role of exclusive breast feeding with Pneumonia among
children under five years in Bogor district.
Methodology: A case control study design was conducted to achieve the objective. 107 cases and 107
control was selected. Pneumonia cases was defined by children under five who had Pneumonia and who had
been diagnosed by medical doctors at selected health center. While control was defined by those who did not
have Pneumonia. Smoker at home, indoor air pollution, level education of mother, immunization status and
nutrition status of those children were considered as covariate of the association of exclusive breast feeding
and pneumonia. Multivariate logistic regression analysis was used to analyze the data.
Result: Study showed that children whom had not given exclusive breastfeeding had the risk 6,699 times
(95% CI: 3.204-14.007) to get Pneumonia than children whom had given exclusive breastfeeding in
under-five year children after controlled by smoker at home, air pollution from cooking stoves at home,
level education of mother, immunization status and nutrition status.
Conclusion: Intervention through exclusive breastfeeding promotion, anti-cigarette program, use of stove
with perfect burst, mother empowerment, immunization, improving nutrition status should applied at each
family for decreasing morbidity and mortality caused by Pneumonia among under-five year children.

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Oral 34(ID1067)
Occupational Risk Perception and Wearing Determinant of Personal Protective Equipment
Among Small Scale Printing Operators In Makassar
M. Furqaan Naiem
Hasanuddin University, Makassar, Indonesia

Background: Printing activities cause the operators exposed to hazardous tool and substances which may
result in occupational injuries and illnesses. The use of personal protection equipment when working may
protect the operators from injuried when accident occur or illnesses when exposed to printing hazardous
agents. However, the use of personal protection equipment when working may be influenced by printing
operator’s perception on occupational safety and health risks.
Methods: The study on occupational risk perception was in descriptive design, while study on the wearing
determinant of personal protective equipment was in cross sectional design. This study was aimed to evaluate
the occupational safety and health risk perception and the prime determinant of personal protective
equipment use among operators of small scale printing companies in Makassar, Indonesia. A total 146
operators from 68 printing companies selected by purposive sampling was involved in this study.
Results: The result of study indicated that 269 (92.8 %) of 290 cases of accident occured within last one year
resulted in injuries to 106 (72.6 %) operators. Majority of operators (76.7 %) had positive perception on
safety and health risk of printing activities. Totally, 31,5 % operators never use a mask and 75,3 % operators
never use glove when working. The use of mask had significant correlation with motivation of use it (p =
0,005), its avaibility (p = 0,000), and pleasure of use it (p = 0,008). The use of gloves had significant
correlation with its avaibility (p = 0,000), and pleasure of use it (p = 0,016)..
Conclusions: Commonly the operators had positive perception to safety and health risk of printing activities.
The avaibility and the pleasure were the prime determinant of personal protective equipment use when
working in printing operators.

Poster (ID1076)
Knowledge and Attitude of Preconception Women in Relationship with the Compliance on
Consuming Multi Micronutrient Capsules, in Makassar, Indonesia
Dewi R. Rahmana, Paridahb, Anang Otoluwac
a Department of Nutrition, School of Public Health, Hasanuddin University
b Department of Nutrition, School of Public Health, Hasanuddin University.

c Medical Faculty, Hasanuddin University, Makassar, Indonesia

Background: The provision of nutritional supplements for preconception women is a new program in
Indonesia. So far, only iron tablets supplemented to the pregnant women as a national program with
relatively low compliance (18.0%) for 90 tablets, in South Sulawesi only 15%. The research objective was to
determine the relationship of knowledge and attitudes with the adherence of multi micronutrient capsules
consumption in preconception women.
Methods: The study was conducted in March-May, 2013, in the sub-district of Ujung Tanah and
Biringkanaya, Makasar City. Samples were 64 women brides and newlyweds that recruited by coensecutive
method. Data was collected through interviews using questionnaires. Compliance criteria is when respondent
consuming 100 percent of capsules. Data analysis was performed using chi-square test and Fisher.
Results: The data shows that 60 respondents (94%) who have a good knowledge of multi-micronutrient
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capsule. A total of 94% of respondents have a good attitude towards multi micronutrient capsules.
Respondents who dutifully capsules 57.3% number. Chi-square analysis showed no significant relationship
between knowledge and adherence to consume (p = 0.098), as well as between attitudes and adherence to
consume (p = 1.000).
Conclusions: There was no significant relationship between knowledge and attitudes to the compliance on
consuming multiple micronutrients capsules. Although the respondents' knowledge and good attitude, but
this is not accompanied by obedience to consume. There may be other factors that need to be investigated
further associated with consuming compliance.

Poster 1 (ID3)
Relationship Between Smoking and Chronic Complications of Elderly with Diabetes Mellitus
Type 2, In Indonesia
Indang Trihandini
Indonesia University, Depok,Indonesia

Background: Recently Indonesian doesn’t have an adequate data and research related to Chronic
Complication for elderly with DM type 2 on a group of smokers.
Ojective: to examine relationship between smoking to Chronic Complication DM type 2.
Method: The study was used data of Indonesia Survey, RISKESDAS in 2007. A total sample (elderly who
had aged 60 years ++ with DM type 2) selected by random is 1565 people. Analysis with Logistic
Regression method was used in this study.
Results: 60% of the elderly have chronic complications diseases, 36.8% of total respondents is smokers and
has OR 2.5 (95% CI, 1.54-3.97) to get Chronic Complications of DM type 2, after adjustment for age, gender,
obesity, routine physical activity. The study found interaction between gender and smokers to get Chronic
Complication of DM type 2. On the male smokers have OR 1.72 to get Chronic Complication of DM type 2,
and OR female smokers is 2.47.
Conclusions: The proportion smokers among elderly with DM type 2 is high. Mostly of the elderly with DM
type 2 have a lack of routine physical activity and consume vegetables and fruit, low educated, socio
economic status, and less access to utilize health services.

Poster 2 (ID77)
Analysis of Peer Education Towards Knowledge and Attitude of Peer Education About Early
Marriage in Makassar, South Sulawesi Indonesia
Suriah Suriah, Yeyen Afriyanti
Health Promotion and Behavioral Sciences Department, Faculty of Public Health, Hasanuddin University, Makassar,
Indonesia

Background/Objective: The research is aimed to assess the differences between the knowledge and attitude
about early marriage before and after being performed intervention, to assess the effect of peer education on
knowledge and attitude of young women about early marriage.
Method: The research used quasi-experimental study with the design of non-randomized control group with
pre-post test. The sample consisted of 60 respondents aged 15-19 years old, live in Tallo sub district

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Makassar. The research was analyzed by using wilcoxon test, independent t test, and logistic regression test.
Results: The results indicate that there is a knowledge increase and attitude alteration of teenage girls on
intervention group compared to control group. There is difference of knowledge and a meaningful attitude
between intervention group who gained peer education and control group who did not get peer education
(p-value < 0.05). Besides that, there is an influence of peer education intervention significantly on attitude
and knowledge of teenage girls. The tendency of knowledge level of teenage girls who obtain intervention of
peer education is higher 83.4 times than the teenage girls who did not get peer education intervention after
being controlled with age variable, level of education, and social activities. While the interest of young
woman who get the attitude of the peer education intervention 18.3 times higher than girls who did not get
the peer education intervention. All confounding variables show no significant effect on the knowledge and
attitude (p-value > 0.05).
Conclusions and Recommendations: Makassar Government (Public Health) is expected to promote peer
education program on community activities that involve youth. For further research purposes, it is
recommended to evaluate the behavior and characteristics of adolescents as additional independent variables.

Poster 3(ID111)
Predictor of Safe Behavior on Plywood Workers in Samarinda East Kalimantan
Iwan M. Ramdan
Mulawarman University, East Kalimantan, Indonesia

Safety behavior are still a health and safety issue that needs to be examined in more depth, because it still
main contributor to job accident. The purpose of the study was to determine which were the predictor of
safety behavior on plywood workers. Using the Health Behavior Model by Lawrence Green, quantitative
research with cross sectional approach has been conduct to 150 respondent. The independent variable
consisted of predisposing factors (knowledge of safe behavior, attitude, value, and perception), enabling
factors (various safety tools and safety procedure) and reinforcing factors (monitoring by safety and health
officers and reward-punishment system), while dependent variable is safety behavior. Data were collected by
questionnaires and observations. Safe behavior is measures by the use of personal protective equipment, not
kidding when working, not smoking when working, obidient work procedures and unhurried. Hypothesis of
the research was: there is relationship between predisposing, enabling and reinforcing factors with safety
behavior, and knowledge and reward punishment system as a strong predictors to predict safety behavior.
The data analysis used multiple regression analysis.
The result showed: there is a significant association between knowledge (p=0.005), attitude (p=0.006),
perception (p=0.004), and monitoring by safety and health officers (p=0.001) R=0.779 ( its means that
knowledge, attitude, perception and monitoring by safety and health officer have a strong reliationship with
safety behavior) and R2 = 0.776 (its means knowledge, attitude, perception and monitoring by safety and
health officer 77.6% simultaneously able to explain safety behavior). Knowledge and monitoring by safety
officer as a strong predictor to safety behavior (R2 = 0.266 and 0.311). Company are advised to maintain or
increasing the knowledge, attitude and perception of safety behavior through training and various media of
health promotion at workplace. Company also advised to further intensify safety behavior monitoring by
safety officer.

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Poster 4 (ID169) Commented [何宁2]: 此文上面原有 ID151，需删除
A Model Development of Community Based Public Health Surveillance System for Integrated
Disease Surveillance and Response (IDSR) in Bogor Municipal, Indonesia
Popy Yuniar, Tris Eryando, Artha Prabawa
Biostatistics and Population Study Department, Faculty of Public Health, University of Indonesia

Background/Objective: The main function of public health surveillance system is to provide a real-time
and early warning information for the decision makers. This information can be used to respond quickly to
the population’s health need. Even though a range of surveillance systems have been developed in Indonesia,
the Public Health surveillance system has not functioned properly, therefore frequent outbreaks occured.
Methods: The aim of this model is to give emphasis to Integrated Disease Surveillance and Response
(IDSR) with the participation of the community in case detection in their neighborhood for major outbreak of
diarrhea, chikungunya and dengue hemorrhagic fever which occur frequently in Indonesia. This system
provides core component of surveillance which are symptoms detection, individual case register and case
confirmation individual disease. The data record will be submitted to the public health center and the district
health office for reporting, analysis, and to be used for quick response action.
Result: The application has been generated to be accessed on the website. The system then promoted to
cadres and primary health officers. The information that can be generated from this system are trend number
of cases, incidence rate, case distribution disaggregated by age, sex, location and time. The case distribution
can also present in thematic map which showed area with degree of potential out brake.
Conclusion: The Information System for outbreak monitoring can provide real-time and early warning
information. It functioned optimally with the support from all level of users, involving the community,
cadres, health facility and district health officer. The system can also be replicate for any other emergency
cases such as early mitigation of disasters.

Poster (ID795)
Effect of Nutritional Counseling Nutrient Intake Blood Pressure and Outpatient Hypertension
Patients General Hospital Southeast Sulawesi Province
La Banudi, Suriana Koro, Andi Maryam
Doctotal Program Student at Public Health Faculty, Hasanuddin University, Makassar, Indonesia

Background: The cause of hypertension is high consumption of salt and fat, obesity, stress, age, sex, family
history, smoking and consumption of alcoholic drinks. The prevalence of hypertension in the world is 15% -
20%, in Asia 8% - 18% and in Indonesia 1.8% - 28.6%. counseling through leaflet as the process of assisting
clients in facing the problem of hypertension.
Objective: The effect of nutrition counseling to nutrient intake and blood pressure of hypertension
outpatients at local hospital of the Province of Sulawesi Tenggara.
Method: The study was quasi experimental will pre and post control design. Samples were divided into 2
groups; the first was given nutrition counseling and leaflet and the second (control) was only given leaflet.
Samples were hypertension patients who fulfilled inclusion and exclusion criteria: 25 samples per group.
Data of nutrient intake were processed using nutri survey. Chi square test was used to identify the difference
between the intervention group and the control group; whereas t-test was used to identify independent as

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well as dependent variables.
Result: There was no significant difference in intake of fat, natrium, potassium and magnesium (p>0.05)
between the intervention group and control group. At the end of the study there was difference between the
intervention group and control group whereby the intervention group was given nutrition counseling and
leaflet and the control group was only given leaflet without counseling (p<0.001). At the initial study there
was no difference in blood pressure between the two groups (p>0.05); how ever at the end of the study there
was difference between the group with nutrition counseling and leaflet and the group with leaflet without
nutrition counseling (p<0.05).
Conclusion: Nutrient intake and blood pressure were better in the group with nutrition counseling and leaflet
than that of in the group with leaflet only.

Poster 5 (ID201)
Risk Factors of Low APGAR Score Infants in Luwuk, Banggai Regency, Indonesia
Ridwan Amiruddina, Erni Yusnita Lalusub
a
Hasanuddin University, Makassar Indonesi
b
Untika Luwu Banggai, Indonesi

Background: The APGAR score is a practical method that systematically used in assessing health condition
of newborns to prevent neonatal asphyxia which can result in death.
Methods: Risk analysis of low APGAR scores using observational techniques with case-control design in
159 infants in the Luwuk city were divided into two groups: cases and controls with a ratio of 1:2. Data
collected by observation and interviews infant conditions and maternal characteristics (education level,
income, nutritional status, quality of ANC, physical activity and exposure to tobacco smoke). Analysis of the
data using chi-square test and logistic regression to estimate the risk of low APGAR score at each individual.
Results: maternal education (OR = 2.512; 1.270-4.969), income (OR = 3.535; 1.764-7.086), maternal
nutritional status (OR = 3.699; 1.608- 8.507) and quality of ANC (OR = 7.644; 3,164-18.468) at risk for low
APGAR score. physical activity (OR = 1.923; 0.770- 4.807) and cigarette smoke exposure (OR = 1.545;
0.720-3.314) didn’t proved be a risk factor of low APGAR score with lower-upper value includes the 1.
regression analysis showed a decrease OR value of ANC quality to infant APGAR score after adjustment on
income and maternal nutritional status (OR = 5.63; 2.267 to 13.985).
Conclusion: The quality of ANC is the most influential variable on the incidence of low APGAR scores in
infants with the education variables and nutritional status as a confounding variable.

Poster 6(ID206)
Eco-epidemiology Status Analysis of Dengue Hemorrhagic Fever (DHF) Endemicity in South
Sulawesi Province
A. Arsunan Arsin
Hasanuddin University, Makassar, Indonesia

The aim of the study is Id determine the relationship of ecological factors in the status the endemic of dengue
in South Sulawesi Province in 2011.
The type of the research was an observation; with a cross sectional study. Samples were taken from 24
regencies/cities in South Sulawesi categorized according to their endemic status towards DHF. Data analysis
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is Mann-Whitney test, Chi-squared and logistic regression.
The result of the research indicated that the endemic factor which affects endemic status of DHF of a region
is the rain drop (p=0,030), population density (p=0.44) and larva-free rate (LFR) (p=0,011. Altitude of the
region an ecological factor which was not associated to DHF endemic status (p=0,272). The most dominant
ecological factors determining the status of dengue endemic of an area is larva-free rate (LFR) (B=5.273).

Psoter 7 (ID218)
Knowledge, Attitude And Practice of Pregnant Mothers Toward Antenatal Care And Its
Relation To Lowbirth Weight
Tinuk Istiarti
The Indonesian Public Health Association, Indonesia

Background: This research was aimed at studying the risk factors affecting the rate of Low Bright Weight
(LBW) in the area of Community Health Centre Tegalrejo Magelang Regency, Central of Java, Indonesia.
The spesific aim is to observe the correlation between knowledge, attitude and practice (KAP) of Antenatal
care among pregnant mothers and the rate of LBW.
Method: The research was carried out in a case control study and a qualitative inguiry was added to describe
some important factors. The number of samples were 100 mothers who have just delivered low birth weight
babies and normal ones as the control cases. Data were collecteed through questionnaires and interview and
the analyzed using univariate, bivariate and multi variate analyses. Statistical tests were also done using
correlation of chi square, T and logistic regression test.
Result: The research result shows that there is a positive correlation between KAP of antenatal care among
pregnant mothers and LBW. The poor knowledge passive attitude and inappropriate practice signify a higher
risk of 3.43, 1,77 and 8,62 times toward LBW.

Poster (ID372)
Assessing The Target Hazard Quotients (THQs) Of Lead Via Drinking Water And Seafood
Consumption From Paniai Lake, Paniai Regency Papua, Indonesia 2013
Robby Kayamea, Yafet Pigaia, Anwar Mallongib
a Institute Study Social and Pastoral (ISSP) Wesel Meren, Paniai, Papua Indonesia
b Department of Environmental Health, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia

Background/Objective: Direct disposal waste and atmospheric deposition into th e aquatic contributed
a major pollutant level that may generate a threat to human health surround the ecosystem. This research
aimed to investigate lead (Pb) contaminations in aquatic habitat and assess the potential health risks of
seafood consumption from Paniai Lake, Papua, Indonesia. Method: Water column from lake, drinking well
water, shrimp and fishes samples were collected in one time collection in Mei 2013. Furthermore, potential
health risks were determined using target hazard quotient (THQ) equation.
Results: The results showed that, Pb in water from lake, drinking well water, shrimp, pelagic and benthic
fishes were ranged from 0.32 to 2.35 mg L-1, 0.24 to 0.95 mg L-1, 4.22 to 12.57 mg kg-1ww, 3.58 to 11.01
mg kg-1ww and 5.40 to 14.55 mg kg-1ww, respectively. The elevated Pb concentrations were observed in
shrimp and benthic fish (at the maximum concentrations of 12.57 mg kg-1ww and 14.55 kg-1ww),

206
respectively. Estimated magnitude of weekly intake (EWI) values of Pb in shrimp, pelagic and benthic fishes
showed that consumption per week for body weight of 70 kg for the local people were found to be in the
range of 4.8 to 4.4 mg/kg bw, 15.0 to 46.2 mg/kg bw and 22.7 to 61.9μg/kg bw, respectively. Hence, the
assessment of target hazard quotient (THQ) values of water from lake, drinking well water, shrimp and
fishes were in the range of 0.005 to 0.35, 0.004 to 0.14, 0.063 to 0.189, 0.077 to 0.165 and 0.081 to 0.221,
respectively.
Conclusion: All those levels have not exceeded the limit standard or < 1 for potential health risks which
mean safe for consumption. This study also suggested the magnitude of Pb release to Paniai Lake is
governed primarily by the scale of waste disposed. In case of health risks assessment by comparing with
PTWIs and THQ, (based on the shrimp and fish consumption for 70 years life span of 70 kg body weight),
the results showed that people who consumed shrimp and fish from Paniai Lake were not at risk.

Poster 8(ID261)
Early Detection of Benzene Poisoning in Informal Shoe Workers of Ciomas Shoe Industry,
Bogor District, West Java, Indonesia
Laila Fitriaa, Nurahayati A. Prihartonob
a Departmentof Environmental Health, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
b Department of Epidemiology, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia

Background: Benzene exposure is one of the main health concerns for high risk occupations such as shoe
worker. The term of benzene poisoning is used by some researchers to describe a decrease in blood cell
count due to exposure to low concentrations of benzene continuously.The purpose of the study was to
determine the occurrence of benzene poisoning in informal shoe workers in Ciomas shoe industry in Bogor
District, West Java, Indonesia.
Methods: A cross-sectional study was conducted among 259 shoe workers and 87 non-shoe workers from
February to April 2013. Blood samples were collected to evaluate the number of erythrocytes, leukocytes,
and platelets. We measured concentration of trans, trans-muconic acid, a benzene metabolite, derived from
urine samples.
Results: We found a high concentration of urinary trans, trans-muconic acid of 1206 µg/g creatinine in shoe
workers as compared to 278 µg/g creatinine in non-shoe workers. The study showed a significant difference
on erythrocytes count between shoe workers and non-shoe workers. The mean of erythrocytes count were
4.83x106/µL in shoe workers and 5.24x106/µL in non-shoe workers. However, no difference was found in
the leukocytes and platelets counts between shoe workers and non-shoe workers. The mean leukocytes and
platelets counts were 8.19x103/µL and 297.71x103/µL in shoe workers, and 8.25x103/µL and 284.01
x103/µL in non-shoe workers.
Conclusion: This study suggests benzene poisoning based on the erythrocytes count but not on leukocytes
and platelets counts. Further study is needed to investigate whether the erythrocytes count can be used as
early warning sign of benzene poisoning.

Poster 9(ID286)
The Effects of Propolis to Fasting Blood Glucose and Glucose Tolerance of Prediabetes
Patients
Zulkifli A. Abdullaha, Nilawati A. Usmanb, Buraerah A. Hakima

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 aFaculty of Public Health, Hasanuddin University
bMedical Faculty of Hasanuddin University

Background/objective: Prediabetes has been becoming a pandemic that its prevalence higher than diabetes.
Prediabetes increases risk for type 2 diabetes, heart disease, and stroke. Evidence of the benefits of Propolis
that proven through research with human subjects after evidence that Propolis has been widely tested in
animal experiments is required. The objective of the research was to analyze the effect of Propolis on fasting
blood glucose and glucose tolerance prediabetes patients.
Method: The research was a Randomized Clinical Trial (RCT). The intervention done was to give Propolis
extract 20% with the result of Biofarmaka Laboratory test of Hasanuddin University containing quercetin
content 25.29 mg/L and health education with counseling strategy. Fasting blood glucose and glucose
toleance tested by Health Laboratory Great Hall of Makassar with venous blood specimen. The samples were
64 people consisting of 32 people given Propolis and 32 given health education.
Results: The result of Wilcoxon test with 0.05 significance level proves that the giving Propolis for 20 days,
after eat with low doses (50 mg/Kg or 6 dots per day) significantly decreased fasting blood glucose and
glucose tolerance test with respectively -14.28 (p=0.000) and -23.16 (p=0.000). Fasting blood glucose abd
glucose tolerance test of health education group decreased significantly, with respectively -14.9 (p=0.001)
and -13.98 (p=0.000).
Conclusion: Giving Propolis and education are effective for changing of blood glucose and glucose
tolerance. Propolis is potential to use use as a pharmacology therapy for prediabetes

Poster 10(ID291)
Initiation of Breastfeeding Enhanches Survival Exclusive Breastfeeding on Baby Who Had
Born in Bengkulu City, Indonesia
Helda, Ronoatmodjo Sudarto
Fakulty of Public Health University of Indonesia

Background/objective: Decline in the infant mortality rate in Indonesia according to the 2003 Demographic
and Health Survey 35/1000KH has been stagnant since 2007 34/100 KH 32/100KH and 2012. To estimating,
interpreting and comparing the survival function , median , and mean exclusive breastfeding based on
initiation of breastfeeding and covariates. To know in depth the things that support and resistance the
implementation of ten steps to successful breastfeeding.
Method: A longitudinal cohort study of initiation of breastfeeding was undertaken in in RSUDM. Yunus and
by private midwifes in Bengkulu City, July 2010-June 2011. Mothers were recruited and interviewed before
discharge from hospitals. A total of 400 mothers were recruited into the study. Follow-up was undertaken
when the baby was 2 month, 4 month and 6 month.
Results: This study found that initiation of breastfeeding increased almost 2 times EB (HR 1.7 and 95% CI
1,2-2,5) .
Ante natal care increased 2 times EB ( HR 2,0 and 95% CI 1,4-3,0).
Initiation of breastfeeding and ante natal care increased 3,4 times EB (HR 3.4 and 95% CI 1,7-7,0) for
infants aged 0-4 weeks.
This study also found that ’mother's education, employment and support obtained are related to EB for
infants aged 4-24 weeks.
Mother’s education increased 1,5 times EB (HR 1,5 and 95%0,89-2,69)CI.
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Mother’s employment increased 2 times EB (HR 0,5 and 95% CI 0,27-0,98).
Support obtained by mothers increased 1,6 times EB ( HR 1,6 and 95% CI 0,96-2,56).
Ten steps to successful breastfeeding are conducted by hospitals in Bengkulu which promote initiation of
breastfeeding, by not providing bottle and help
Conclusions: This study found that EB for 0-4 infants are related by initiation of breastfeeding and ante
natal care, while for infants aged 4 -24 weeks, EB is influenced bymother’seducation, employment and
support obtained. Furthermore, Ten steps tosuccessful breastfeeding are not thoroughly implemented.

Poster 11(ID296)
The Risk of Chronic Diseases to Mental Emotional Disorder Among Adult Population in
Indonesian
Besrala, Sutiawana, Sugirib
a Faculty of Public Health University of Indonesia, Jakarta, Indonesia
b Faculty of Medicine University of YARSI, Jakarta, Indonesia

Background/Objective: Indonesia Basic Health Research (Riskesdas) on year 2007 showed that about 11.6
percent of Indonesia's population aged 15 years and above suffering from mental emotional disorder. This
study aimed to examine the effects of chronic illness to the mental emotional disorders.
Method: A cross-sectional study that used Riskesdas 2007 data. A total of 660,452 respondents aged 15
years and over who are mentally health become sample of this study. Mental emotional disorders were
measured by using modification of the Beck Depression Inventory Questionnaire. Chronic diseases such as
pulmonary tuberculosis, hepatitis, heart disease, diabetes, cancer, and stroke were measured based on
medical record diagnosis by health profesional.
Results: The results showed that two to five out of ten respondents with chronic illness will suffering from
mental emotional disorder. Multivariat logistic regression analysis shows that respondents suffering from one
chronic disease were 2.6 times greater risk for developing emotional mental disorder, suffering from two
chronic disease have risk 4.6 times higher, suffering from three or more chronic disease have risk 11 times
higher.
Conclusions/recommendation: The risk of developing mental emotional disorders was higher as more
number of chronic illnesses suffered by the respondent. It is suggested that the Ministry of Health to develop
a standard of care of chronic diseases associated with reducing impact on the mental emotional disorders and
establishment of teams for technical guidance chronic disease care.

Poster 12 (ID297)
Corelation between Ozone Concentration in Ambient Air and Asthmain Jagakarsa, South
Jakarta, 2011-2012
Vika Budi Riandini, Zakianis, Abdurrahman
Faculty of Public Health, Universitas Indonesia, Depok, Indonesia

Background/objective: Ozone is one of the most toxic pollutants which can trigger asthma. Ozone
concentration was high in many big cities in the world, including Jakarta. Jagakarsa is a district in Jakarta
with high ozone level. During 2010 to 2011, the concentration exceed threshold according to government
regulation in PP 41 tahun 1999. Meanwhile, asthma cases increased during 2010 to 2011. The aim of the

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present study was to asess the relationship between ozone and asthma admission.
Method: Bivariat analysis were used to identify associated daily ozon concentration and asthma admission.
Using simple linear regression model, we identified asthma admission through primary health care services
and linked these data with ambient ozone data (1-hr and 8-hr) from monitoring station of air pollution from
Department of Environment in DKI Jakarta. We also collected concentration of NO 2 and climate data
including global radiation, temperature, humidity, wind speed, and wind direction. Then we identify
associated daily concentration of ozone and these factors. We collected daily data from 1 May 2011 to 31
Oktober 2012. The total daily data was 377.
Result: NO2 concentration, temperature, and humidity was correlated to ozon concentration. Wind direction
during may 2011 to Oktober 2012 indicated ozone transportation from other area of Jakarta whose
anthropogenic activities was more than Jagakarsa. Nevertheless, this study could not explain the association
between ozone concentration and asthma admission due to lack of number of sample and sampling site.
Conclusions: Concentration ozone in Jagakarsa was not healthy for population especially among susceptible
group, include people who suffers asthma. We still need further research using many more daily data and
sampling site.

Poster 13(ID340)
Ciliwung’s Health Evaluation
Suyud Warno Utomo, Haryoto Kusno Putranto
Faculty of Public Health Universitas Indonesia, Jakarta Indonesia

Objective: The increasing of population in watershed of Ciliwung River followed by its activities have
caused serious problem to the health of Ciliwung. There is an increased pollution in from upstream to
downstream of Ciliwung River.
Methode: Direct observation method and obtain secondary data from various stakeholders. Field observation
consists of land use, settlements near the river, waste on the river, people’s behavior toward the river.
Results: Many lands have been used not as it has to be. Illegal settlements on riverbanks, waste disposal into
the river, municipal waste is thrown away directly to the river without treatment first, industries do not
process their waste, informal sector do not have waste processing and etc. The secondary data show the
pollution in from upstream to downstream is increasing, it even include heavily polluted
category. Upstream water quality showed : TSS 107 (mg/l), BOD 39,8 (mg/l), COD 79,3 (mg/l), Nitrit 0,08,
DO 3,92( mg/l), fecal coli 8000, Coli form 30.000. The middle stream quality showed BOD 5,12 (mg/l),
COD 15,4 (mg/l) DO 2.16 (mg/l), fecal coli 170.000 and coli form 30.000. The highest COD > 140 (mg/l),
BOD > 39 (mg/l), coli form 7.45E+07. Water pollution, the heavy metals occur along the river, especially in
the upstream. Highest heavy metal pollution in 2011 was recorded in the upper reaches of chrome-IV (0.32
mg / l), mercury (0.78 mg / l), manganese (0.59 mg / l), and cadmium (0.29 mg / l).
Conclusions: The health of Ciliwung river is interfered, pollution from upstream to downstream is
increasing, stakeholders’ role is still very low, weak coordination, and the pressure on the people is growing.

Poster 14 (ID445)
The Contribution of Premarital Permissiveness and Reproductive Related Knowledge to
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 Female Adolescent Sexual Behavior in Indonesia
Ike Anggraeni Gunawana, Annisa Nurrachmawatib
a Student of Public Health Faculty University of Indonesia
b Public Health Faculty Mulawarman University, Indonesia

Background/ objectives: Indonesia faces hidden problem where more than two million abortions performed
every year, with 30 percent involving adolescent. Female adolescent become vulnerable to the risks since
they become more permissive toward sexual behavior before marriage. This study examined contribution of
premarital permissiveness and reproductive related knowledge to female adolescent sexual behavior.
Method: Data derived from Indonesia Young Adult Reproductive Health Survey (IYARHS) carried out by
Indonesia Bureau of Statistics in 2007 with total of 19.311 young adult interviewed and 44% of them are
female (8481) as focus of this study analysis. In this paper reproductive related knowledge consists of
HIV/AIDS, STI's and pregnancy knowledge. Permissiveness reflected toward attitude pre-marital sexual
behavior. Peer influence reflect by friend ever have sex and friend experience unwanted pregnancy. The
contribution of each variable to sexual behavior was assessed using logistic regression.
Results: 1.8 percent of female adolescent convince that they had ever done sexual intercourse. The study
found that 42.3 percent had poor HIV/AIDS knowledge, 71.3 percent had poor STI’s knowledge and 90.4
percent had poor pregnancy knowledge. Result also showed that 18 percent permissive toward premarital
sexual behavior. Logistic regression analyses estimated for female adolescent with poor HIV/AIDS
knowledge approve pre-marital sexual behavior and had friend that ever have premarital sex, likely to have
sexual behavior about 51.2 percent.
Conclusions: Result indicates that there was an immense need to implement gender based reproductive
health program about STI's including HIV/AIDS. Adolescent also need life skill training such as assertive
behavior to ensure adolescent overcome peer influence. Prevention effort should also encourage parents and
peers to model appropriate sexual attitude and behavior.

Poster 15(ID446)
Visual Characteristic Among Elderly Drivers in Fukuoka City, Japan
Indri Hapsari Susilowatia, Akira Yasukouchib, Adenana
aDepartemenKeselamatan dan Kesehatan Kerja, FKM UI, Depok, Indonesia
bDepartment of Human Science Design, Graduate School of Design, Kyushu University, Japan

Background/ objective: The main range of human sight for an object can be measured on a horizontal line
in the field of sight. However, a driver’s eyesight must not only capture the below-line sight but also the
above-line sight. Since elderly drivers have decreasing on visual skill then they are at a higher risk for road
crashes. Because of that, this research will describe visual skill among elderly drivers in Fukuoka City,
Japan.
Method: This research took 10 young drivers with aged 21 – 32 years old and 25 elderly drivers as subjects.
They were divided into 2 age groups: elderly 1 was consisting 11 persons (60 – 65 years old) and elderly 2
was consisting 14 persons (over 65 years old). The visual factors were static and dynamic visual acuities by
the Kinetic Vision Tester; colour test by a 100-hue test, and response to peripheral stimuli placed at useful
field of view (UFOV) by Visual Basic program.
Results: It showed elderly drivers with lower both static and dynamic acuity than young drivers.There were
significant differences in total errors between young and elderly drivers in almost all hues, except
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green-yellow and green color. Elderly drivers experienced frequent errors in short wavelength (purple) colors.
Elderly drivers took a long time to recognize stimuli appearing peripherally. This delay not only led to
prolonged peripheral response times but also led to increased misjudgment at fixed eyes’ points because the
increased recognition times for peripheral objects carried over to fixed eyes’ judgments.
Conclusion: It is better to avoid placing signs at upper horizontal views over 3o, particularly signs with
slanted-line shapes (like triangles). It is also important to improve information-gathering technology on the
road and in the vehicle to detect traffic signs in the upper horizontal and peripheral of views.

Poster 16 (ID469)
Fitness Prediction Model (VO2max) From Selected Elementary Student in East Jakarta,
Indonesia in 2013
Ni Putu P. Wisuantari, Ratu Ayu D. Sartika
Nutrition Department, Faculty of Public Health, University of Indonesia, Depok, Indonesia

Background/objective: Low levels of fitness in children and adolescents are at increased risk of
cardiovascular disease. Some studies suggest that fitness levels in children and adolescents was still
relatively low and there is no standard model of prediction in determining the fitness status based on
VO2max in Indonesia.
Method: This study used cross-sectional design, variable of dependent was fitness and variable of
independent was sex, nutritional intake, nutritional status, and physical activity. The fitness test measured by
20m shuttle run test. The sample was 118 students.
Results: The mean value of VO2max was higher in Elementary Student 2 than Elementary Student 1
(Elementary Student 2 = 41.49 ml/kg/min; Elementary Student 1 = 39.99 ml/kg/min). In bivariat analysis,
there was a differences fitness between male and female, which is male was more fit than female. Than
nutritional intake (energy, protein, carbohydrate, thiamin, and iron), nutritional status (BMI/A), and physical
activity was significantly related to fitness (VO2max). Result of multiple regression analysis showed that
variable sex and nutritional status was the dominant predictor controlled by the interaction between the two
variable.
Conclusions: Adequate intake, good nutritional status (BMI/A), and increase physical activity are required
to improve fitness level.

Poster 17(ID478)
The Influence Education, Knowledge & Autonomy of Women to Unmet Need Contraception
Among Provinces with High and Low Fertility in Indonesia
Antika Nurinda, Milla Herdayati
Faculty of Public Health, University of Indonesia

Backgroud/Objective: The unmet need for contraception in Indonesia is still high at 9.1% in 2007, well
above the MDG target by 2015 approximately 5.0%. The unmet need is defined as women at reproductive
age (15-49) with status of marriage, who are not using any methods of contraception though they want to
delay the next child by spacing or limiting the child. Addressing unmet need could dramatically reduce
deaths related to unintended pregnancy. In literatures women’s autonomy is a potentially important but less
studied indicator of women’s ability to control their fertility. This study aims to determine whether the

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education, knowledge and autonomy of women associated with unmet need for contraception.
Method: The data for this study are from Indonesia Demographic and Health Survey (IDHS) 2007. This
study selected two provinces are Yogyakarta with low fertility rate and Nusa Tenggara Timur (NTT) with
high fertility rate. The population were marriage women at reproductive age (15-49) and sample were
marriage women at reproductive age in 1401 in Yogyakarta and 754 in NTT. Women’s autonomy is
measured by several indicators in the involvement of women in decision-making in the household (in health
seeking behavior, purchase of household, visiting family, a varied menu of food, saving money, the
treatment of the sick child). The knowledge is measured by many questions on type of contraceptions.
Results: Proportion of unmet need differ significantly between the two provinces. The Unmet need affects
women who have 3 or more children with lower education, older than 35 years with low economic status.
Unmeet on women who want to limit pregnancy in province with high fertility is higher than in province
with low fertility.
Conclusion: Knowledge and education of women affect the unmeet need in both provinces, but women's
autonomy has no effect.

Poster 18(ID497)
Risk Factors Causing Malaria Among Children Under Five Years Old in Lewoleba City,
Lembata Regency of the East Nusa Tenggara Province, NTT, 2013
Maria B.K. Beyenga, Ema Hermawatia
Environmental Health Department, Universitas Indonesia

Background/objective: Malaria incidence in infant and childhood in the East Nusa Tenggara (NTT)
Province of Indonesia has become a serious health problem. Childhood mortality of malaria in Lembata
Regency, one of regency in NTT Province, is the highest in NTT Province. Annual Paracite Incidens malaria
in this regency 137 / ‰ and Slide Positive Rate reached 16% at the 2012. The study objective is to find out
what are the risk factors associated with the incidence of malaria in infants and childhood in the district
health center (Puskesmas) Lewoleba East Nusa Tenggara Province.
Method: The study was conducted with the case-control design. All cases are patients registered malaria
in Puskesmas Lewoleba. (cases, n= 108; control, n = 108). Risk factors data were collected through
questionnaires and field observations.
Results: The results showed that the variables associated with the incidence of malaria in infants is routine
using mosquito nets at night sleep (p = 0.002, Odds Ratio = 3.085 with 95% CI = 1.543 to 6.169), mothers'
knowledge of malaria (p = 0.035 Odds Ratio = 1.888 with 95% CI: 1.081 to 3.297) and nutritional status (p =
0.000 Odds Ratio = 4.684 with 95% CI: 2.513 to 8.730). While unrelated variables are mosquito breeding
places (p = 0.059 and OR = 1.818 95% CI degree of confidence: 1.019 to 3.243), maternal education (p =
0.411 OR = 1.3 degree of confidence 95% CI: 0.760 to 2.230), the preventive behavior (p = 0.077 and OR =
1.685 degree of confidence 95% CI: 0.884 to 2.886), maternal occupation (p = 0.149 OR = 0.550 degree of
confidence 95% CI 0.266 to 1.138), and maternal history of malaria illness (p = 0.237 and OR = 1.585 95%
CI degree of confidence: 0.810 to 3.102).
Conclusion: Advice on the results of this study are promote using mosquito net, improve nutritional status of
children, and health promotion and prevention about malaria for mothers and family.

Poster 19 (ID504)
213
 The Influence Process of Polishing to Lung Function on Workers Part of Polishing in PT.
Surya Toto Indonesia 2011
Faizatul Islamiyah
Program Studi Kesehatan Masyarakat Fakultas Kedokteran dan Ilmu Kesehatan UIN Syarif Hidayatullah Jakarta

Peak Expiratory Flow (PEF) is the maximum air flow generated by a number of specific volume. PEF is one
of a faal pulmonary parameter to determine the presence of a disorder in the respiratory tract, if declining
mean overall the flow of air in the respiratory tract (Yunus, 1997).
This research topic of, the influence Process of Polishing to Lung Function on workers part of polishing is
choosen because workers on this part do work polishing for smoothing production. This research is exercised
in PT. Surya Toto Indonesia tbk, Tangerang from August to November 2011. The population of this research
is the workers on part polishing which consisted of 195 people and sample of this research totals 100 people.
This research uses the quantitative research method with cross sectional design. It utilizes primary data
through measurements. They are measurement of the Peak Expiratory Flow (PEF) with a peak-flow meters,
measurement of weight with scales body and measurement of height with microtoice. The researchers also
prepare questionnaire to workers on part polishing in PT. Surya Toto Indonesia.
The results show that there is a relationship between ages (P value 0.025), habits of smoking (P value 0.000),
time of work (0,019 P value), and customs and sports (P value 0.000), but there is no relationship between
nutritional status (0,654 P value) and history of the disease (0,812 P value). Habitual sport is most variable is
associated, beta with value 0,355 and value of partial correlation 0,404, with disturbance of function
pulmonary expiratory flow on workers part polishing in PT. Surya Toto Indonesia 2011.
Based on the results of the study, researchers give advice on the smoking workers: workers should reduce
cigarette consumption or quit smoking as well as exercise their body, so they can enhance the value of their
current PEF and reduce impaired lung function.

Poster 20 (ID519)
Psychoeducation Intervention for Deaf Adolescent Community and Its Relevant Policy
Advocacy: Case of Bengkala Village, Buleleng District, Bali, Indonesia
Hadi Pratomoa, Frieda Mangunsongb, Rachmita Harahapc, Astari Wardiahd, Revitae, Yusriati Yusuff
aFaculty of Public Health, Universitas Indonesia, West Java, Indonesia

bFaculty of Psychology, Universitas Indonesia, West Java, Indonesia

cSehjirah Foundation, Jakarta, Indonesia

dStudent, Faculty of Public Health, Universitas Indonesia

eSehjirah Foundation, Jakarta, Indonesia

fStudent, Faculty of Public Health, Universitas Indonesia

Background: The population of the above village was 2749 persons of which 1247 are males and 1502
females. About 2.2% of them are deaf or locally known as Kolok. It was worldwide popular due to their deaf
community and Balinese Kolok dancers. Many genetic studies were conducted, none related to their
psychological needs and their implication for relevant policy advocacy. The aims of this study was to
conduct an initial assessment to develop psychology intervention to build their positive-self image, enhance
their well-being and create supportive environment including policy change. A team from the Universitas
Indonesia and a deaf foundation called Sehjira conducted this intervention.
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Method: An assessment was conducted to tailor their needs of training of trainers (TOT) and existing
program and its relevant policy among local and district stakeholders. In addition, among the adolescent deaf
persons their psychological wellbeing was measured using Riff method. Adjusted training module of the
Power of the Deaf was implemented. Among local, district stakeholders and the Kolok community group
discussions were conducted.
Results: Out of 27 persons who joined TOT five trainers were selected. They took part in training of the
local stakeholders including disabled people organizations. In addition, 26 students of a local school for
disabled joined the training. Results of discussion among stakeholders and the Kolok groups indicated that a
person could become Kolok because of genetic and other problems. This disease could not be treated,
however, their education attitude and behavior are amenable to change. In addition, it is important to create
supportive environment to enhance their psychological wellbeing.
Conclusions: Raising awareness of their potential among adolescent Kolok community will become future
force for growth and development. Increasing concern among their relevant stakeholders will be conducive
for developing local and district relevant program and policy to support the disabled population.

Poster 21(ID527)
Health Status of Old Age Population in Indonesia
Purnawan Junadi
Faculty of Public Health, University of Indonesia, Jakarta, Indonesia

Background: The percentage of old age population (60 years and above) in Indonesia increasing from 6,2 %
in 1950 to 27,7% in the year 2050 (UNWPP, medium estimate). The number of those people in 2010 was
22,5 millions. The increase of both percentage and number of old age population will certainly increase
pressure in providing many basic nessessities, such as food, housing and providing special services such as
social and health.
Methods: This paper explored the health aspect of old people in Indonesia, especially chronical diseases
including cancer and disabilities, using data from National Basic Health Research in 2007.
Result: Almost half of old people had at least has 1 chronical disease (44,7%), more than twice of general
population (19,2%). The percentage of cancer had similar trend, 0,9% for old ager as compared to 0,4% for
general population. In term of body function disabilities, old age population suffered almost 4 times (41,8%)
as compared to general population (11,9%), while in term of individual and social function, 25,2% old age
population had disbilities, 3 times as compared to general population (8,6 %). One out of 8 old age
population need help either for body care, or daily living activities, or for communication.
Recommendation: Based on those numbers and their trends, this paper suggests alternatives of health
services that should be provided, and how optimally provide living arrangement so that they could positively
contribute to the Indonesian sosciety as a whole.

Poster 22 (ID534)
Serum Organochlorine Level in Horticulture Farmers and Pesticide Exposure Estimation in
Pati Regency, Indonesia
Hasnawati Amqama, Ema Hermawatia, Budi Hartonoa, Satria Pratamab
a University of Indonesia, Depok, Indonesia

b Ministry of Agriculture, Indonesia

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Background: Since 1990 Indonesian government has banned organochlorine pesticides use in agriculture.
However their distribution and the use has not been fully supervised. Previous study by Indonesian
Agricultural Environment Research Institute (IAERI) on some farmers showed that their blood serum
contain of organochlorine. The aim of current study is to analyze serum organochlorine level in horticulture
farmers and their crops, and to estimate their cumulative exposure to pesticides.
Methods: We analyzed serum organochlorine (OC) of 59 horticulture farmers and 20 crops in three villages
in Pati Regency, Central Java Province. We collected information as well about pesticide use covered
pesticide they use, Personal Protective Equipment (PPE) use, hygiene, duration and frequency of pesticides
use. Dosemeci have developed pesticides exposure estimation with quantitative approach. We used it to
estimate pesticide exposure of the farmers.
Result: From interview it’s found that only one farmer used pesticide from OC group. However, laboratory
analysis indicated 50.85% farmers and 90% crops had organochlorines. There are four kinds of OC found
namely dieldrin (44% with minimum to maximum level is 0.09 ppm-0,05 ppm/mean 0,02 ppm ), aldrin
(11.86% with minimum to maximum level is 0.06 ppm-0,11 ppm/mean 0,03 ppm), heptachlor (22% with
minimum to maximum level is 0.074 ppm-0,1180 ppm/mean 0,02 ppm) and dichloro-diphenyl-
trichloroethane (DDT) (6.78% with minimum to maximum level is 0.047 ppm-0,110 ppm/mean 0,07 ppm).
Using quantitative approach, we got the estimation value of intensity level of exposure and cumulative
exposure. However, they are not specific for organochlorine pesticides exposure, but all the pesticides used
by farmers. The mean (min-max/SD) of intensity level and the cumulative exposure is 14,3 (0-18/3.18) and
47079 (0-132600/31271) respectively.
Conclusion: There are 30 of 59 farmers had organochlorines in their blood serum. The organochlorine were
dieldrin, aldrin, heptachlor, and DDT. Nevertheless, only one of farmers reported organochlorine pesticides
use in application.

Poster23(ID535)
Evaluation of IMCI Computer Adaptation And Training Tool (ICATT) to increase the skills of
health providers in the case management of childhood illnesses
Iwan Ariawan
Indonesia University, Depok, Indonesia

Background: Integrated Management of Childhood Illnesses (IMCI) has been adopted by Indonesia as a
method for non-physician health providers. The regular IMCI training is 11 days and requires substantial
facilitator’s time and effort. To simplify the training, WHO have developed an IMCI Computerized
Adaptation and Training Tool (ICATT). By using ICATT, a distance learning and self-study can be applied.
This study compared the health provider’s skill in managing childhood illnesses who trained in regular IMCI
training and ICATT.
Method: This was a two arms cluster-randomized experiment in 10 districts in West Java. Certified
IMCI/ICATT facilitators did all trainings. The subjects of this study were midwives/nurses working in
primary health center (PHC), which had not received any IMCI training. In each district, two PHC were
selected and then two health providers were selected (total sample of 80 health providers in each group).
Certified IMCI facilitators did measurement before and after training with three real patients using standard
IMCI indicators from WHO. Analysis was done using multilevel logistic regression.
Result: The increase of proportion of health providers who checked for danger signs, before and after
training for regular IMCI training and ICATT group were 44% and 55%, respectively. For checking of
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diarrhea, cough and fever were 44% and 26%; checking of child’s weight and growth chart were 76% and
59%; checking of vaccination status were 52% and 35%; feeding practice assessment for young children
under were 61% and 38%. The average increase of index of integrated assessment was 0.39 and 0.34 (scale
0-1). All indicators except feeding practice assessment showed no different at significance level of 5%.
Conclusion: No difference in health provider’s skill improvement between regular IMCI training and ICATT,
except for assessment of young children feeding practice, which the regular IMCI training was better than
ICATT group.

Poster 24(ID545)
A Training Model for TBAs as "Agent of Change" In the Implementation of Exclusive
Breastfeeding in Bogor District, West Java, Indonesia
Evi Martha, Shinta Normala, Hartaty Sangkot
Faculty of Public Health, University of Indonesia

Background/Objective: Exclusive breastfeeding (EBF) for the first six months of a child’s life has been
promoted worldwide. In Indonesia, EBF is endorsed through the release of Government’s Regulation No.33
year 2012. Although breastfeeding has shown many benefits, some people found breastfeeding is challenging
for several reasons, as shown by low proportion of EBF in Indonesia. In regards to potential role of
Traditional Birth Attendants (TBAs) in Indonesia, particularly in West Java, TBAs in Ciampea Municipality,
Bogor District, were trained to encourage and enhance EBF in their area. To measure the effectiveness of the
training in terms of improvement of TBAs’ knowledge, attitude and practice, pre- and post-training surveys
were conducted.
Method: Survey was conducted in this study by interviewing 55 TBAs during May and June 2013 to explore
the effectiveness of the uptake of training materials about EBF by the TBAs. We examined a range of
background characteristics, source of ability to become TBAs and experience while practicing as TBAs.
Results: Our results indicate that the training was successfully giving the TBAs new insight on EBF.
Furthermore, after all the training, there was a statistically significant increased score of knowledge (p Value
0.0005), attitude (p Value 0.0005) and promotion practice of EBF among the TBAs (p value 0.0005).
Conclusion: EBF model training is proved effective in improving the knowledge, attitude, promotion
practice and implementation in EBF. The assistance after EBF training can be stabilizing TBAs KAP well.

Poster 25(ID549)
Elderly in Prioritized Districts for Food Insecurity in Indonesia More Vulnerable to
Nutritional Disturbance
Annis C. Adi, Dini R. Andrias
Airlangga University, Surabaya, Indonesia

Background: Food security is a prerequisite for the fulfillment of nutritional need. However, data showed
that the proportion of Indonesian people with energy intake <1400 cal/day was 14.47% and <2000 cal/day
was 64.21% (almost two fold of the MDGs’ target, i.e. 35.32%), which indicates that disturbance on
household food security status is still exist in Indonesia. This may give impact to the nutritional status of the
household member, mainly among vulnerable groups, such as elderly. Indonesian Food Insecurity Atlas

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classifies districts in Indonesia as prioritized and non prioritized groups.
Objectives: This study was aimed to assess nutritional status and analyze the risk of nutritional disturbance
among elderly in prioritized and non prioritized district of food insecurity in Indonesia.
Method: This study analyzed secondary data from national basic health research in 2010. As much as 3936
households which have elderly household member, from 99 districts were involeved. The districts consist of
71 prioritized districts for food insecurity (first priority: 11 districts; second priority: 25 fistricts; and third
priority: 35 districts), and 28 non priority districts.
Results: The study found that most of the elderly were low educated (83.6%), had severe energy deficiency
(69.4%), protein deficiency (57.5%), and 26.1% were underweight. Energy and protein deficiency as well as
underweight among elderly were higher in non prioritized districts. The elderly in prioritized districts had
1.380 times higher risk of getting underweight. Furthermore, there were significant association between
household food security status and energy deficiency (r=0.015, p<0.001), protein deficiency (r=0.041,
p<0.001) and nutritional status (r=0.106, p<0.001).
Conclusion: Elderly in non priority districts for food insecurity based on Indonesian food insecurity atlas
have higher risk of getting nutritional disturbance compared to those in non prioritized districts.
Recommendation: Elderly in non prioritized districts for food insecurity need to be prioritized in
accelerating nutrition improvement program in Indonesia.

Poster 26 (ID556)
Correlation and Prediction Model for Malaria Prevention Behavior in Indonesia
Dewi Susanna
Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, Jawa Barat, Indonesia

Objectives: It has been conducted a research to find a prediction model for malaria prevention behaviour
in Indonesia used the secondary data from National Basic Health Research conducted by Ministry of Health
Republic of Indonesia in 33 provinces in Indonesia.
Method: Household (HH) samples were selected base on the Population Cencus 2010. Unit sample was
Block Cencus (BC). There were selected 2,800 BC, but only 2,798 interviewed. The number of selected HH
in each BC was 25 HH and the total of HH collected and analyzed 69,300. All member of selected HH were
inteviewed as a sample. The malaria case determined by interview using quetionare for 1 year later from
the time of interview and confirmed by rapid diagnostic test (RDT). The variables to measure the behaviour
of prevention were: sleeping under bednet, using mosquito coils/electrict insecticide, using net for
window/ventilator, repellent, insecticide spray, take a pill/drug for prevention (prophylaxis), and other
methods of prevention. The all provided data was in percentage (%). The data analyzed used correlation
pearson and linear regression using 95% significancy level (alpha = 0.05).
Results: The correlation (r) of each variables was 0.22 (p=0.224) for sleeping under bednet, -0.369
(p=0.034) for using mosquito coils/electrict insecticide, -0.007 (p=0.970) for using net for window/ventilator,
0.39 (p=0.027) for repellent, -0.09 (0.633) for using insecticide spray, 0.29 ( p=0.101) for take a pill/drug
for prevention (prophylaxis), and -0.20 (p=0.60) for other methods of prevention. The prediction model from
regression linear analysis was 206.670 - 0.2433 (using mosquito coils /electrict insecticide) – 3.799
(repellent) + 9.928 (take a pill/drug for prevention).
Conclusions: The variables had contributed in malaria incidence were using burned/electrict insecticide,
repellent, and take a pill/drug for prevention.
Poster (ID761)
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 Economic Burden of Breast Cancer in Makassar, South Sulawesi Province, Indonesia
Basir Palua, Alimin Maidinb, Indrianti Sudirmanc, and A. Armyn Nurdind
a Postgradute Program, Medical Faculty, Hasanuddin University, Makassar Indonesia
b Faculty of Public Health, Hasanuddin University, Makassar Indonesia

c Faculty of Economy, Hasanuddin University, Makassar Indonesia

dMedical Faculty, Hasanuddin University, Makassar Indonesia

Background: Breast cancer is the most common cancer and is a major cause of death among women around
the world. Understanding economic burden of diseases is important to prioritize health problems and
diseases.
Method: Cost of illness (COI) analysis and Disability Adjusted Life Years (DALY) are useful method to
measure economic burden of diseases. The aim of this study is to examine economic burden of breast cancer
in Makassar and their associated factors. A cross sectional study was employed in this study.
Results: A total of 30 breast cancer death cases from a national referral hospital in the last three years were
included. In depth interviews were conducted among their relatives. This study found that a total cost of
breast cancer treatment in Makassar, covered by insurance, was US $10,000- (mean US$ 3.300) and was US
$ 2,200 from household expenditure. A total of economic burden -YLD – is US $ 7,760 (Mean 2,589), YLL
is US$1,579,680 (Mean US$ 52,656). The total of DALY is US$ 1,657,370), (Mean US$ 552.456.667.-).
The total economic burden of breast cancer in Makassar is US$ 1,824,413 (Mean US$ 60,813). From this
finding it can be estimated that the government of South Sulawesi Province need US$ 126.5 million, which
is equal to four times of their provincial annual budget, to treat all breast cancer patients.
Conclusion: there is high economic burden of breast cancer. Therefore, health promotion and prevention
measures should be prioritize.

Poster 27(ID563)
Caesarian Births: Actual Billing versus Insurance Reimbursement at Private Hospital, An
Effort to Anticipate Universal Health Coverage In Indonesia
Adik Wibowoa, Lies Nugrohowatib
a Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
b Hermina Maternity Hospital, Bogor, Indonesia

Background/Objective: In 2004, Indonesia introduced the mandatory public health insurance

scheme named Asuransi Kesehatan Masyarakat Miskin which in 2008 was evolved into Jaminan
Kesehatan Masyarakat (Jamkesmas), an MoH/government run insurance program which today
covers 76.4 million poor Indonesians. All public hospitals were automatically qualified as providers,
while private hospitals were contracted individually. Jamkesmas is one key building blocks of the
universal health coverage which to be started in January 2014. The Jamkesmas tariff was calculated
through Case-Base Group’s method using minimum unit cost of health services, hence many
private hospitals are still reluctant to join.
Method: This study calculated the total billing of SCs to create fairness and just between Jamkesmas’
payment and hospital’s claim to bring down the outstanding balance to minimum. The study population was
4471 medical records of pregnant women in 2010-2012 at a district level private maternity hospital, taking
all 450 SCs of class III ward who were eligible for Jamkesmas.
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Results: 80% underwent type1SC (nonobstetrical and nonunderlying complications) with average total
billing of USD1200, comprising components of USD380 for doctor’s fee, USD270 for room charges,
USD420 for medications, USD13 for medical equipments, USD75 for administrative fee. The highest SC bill
was on type2SC (obstetrical and underlying complications) where tumor marker diagnostic examination and
extensive antibiotic treatment came as the highest cost components. Multivariate analysis showed that type
of SC contributed most to the total SC billing. The average CBGs calculation for 450 SCs came to a claim of
only 25% from the actual billing, and this was the amount reimbursed by Jamkesmas.
Conclusions: 1. Jamkesmas to revisit its unit cost for not to widen the financial gap. 2. Results of
this study could be used to trigger the discussion, 3. Other private hospitals to conduct similar study,
4. Pregnant mothers to comply to ANC to avoid emergency SCs.

Poster 28 (ID570)
Cost and Intervention of HIV/AIDS Program Using Top Down and Bottom up Approach:
Evidence from Indonesia
Mardiati Nadjib Rifai, Amila Megraini
Faculty of Public Health, University of Indonesia, Depok, Indonesia

Background/objective: Current national policy and strategy reflect Indonesia’s commitment to respond to
the epidemic by mobilizing resources to fight the epidemic and eliminate stigma and discrimination against
PLHIV. There has been a dependency on the external funding. Modelling to assess the cost-effectiveness and
resources needed in the future is urgent, this would need information on the cost and consequences.
Method: We used bottom up and topdown approach to determine cost of prevention, care and treatment
programs. Top down approach using data from the National AIDS Spending Assessment (NASA) year 2009
and 2010. Bottom up approach was done to determine the actual costs. Outcome has also assessed,
challenges on CEA analysis was explored for better analysis.
Results: Top down approach resulted the spending for HIV-AIDS in 2009 was USD 61,276,445 (65% was
international contribution) and in 2010 was increased, but still 58% contributed by international partners.
Spending for Harm Reduction Program was USD 1,776,961 and for ART was USD 12,887,186. We
discussed the unit cost of firstline ART, secondline ART as well as unit cost per PLHIV (USD 454, 2138 and
27). Using microcosting approcah we found the unit cost for the basic programs, IDU (NSE) and OST
programs. Further analysis was conducted to explore economic efficiency, and Harm Reduction seems to be
efficient. Some programs are found to be cost-effective but linkage with program priority remain challenge
for program planners.
Conclusion and Recommendations: Contribution from external partners are still significant. These unit
cost data were used for CEA model as well as planning purposes. However, comparison with a more
normative scenario is still needed to obtain a more realistic scenario.

Poster (ID1069)
The Body Composition of Obese Adolescents in Hasanuddin University
Nahla Syariati, Saifuddin Sirajuddin, Razak Thaha
Faculty of Public Health, Hasanuddin University, Makassar, Indonesia

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Background/objective: Obesity is mostly associated with excess accumulation of body fat, especially in
adolescents who represent critical period for adipose development. This study aimed to compare sensitivity
and specification of obesity assessing based on body fat percentage (BIA) to body mass index (BMI) and
waist circumference (WC) of obese adolescents in Hasanuddin University.
Method: A cross-sectional study was conducted in Unhas, 2013. The subjects were 110 new students of
Unhas, aged between 18th -19th year old. Data were collected using systematic random sampling. Obesity
assessment used body mass index (BMI), waist circumference (WC) and body composition (BIA).
Results: BMI for Asian-Pacific population (sensitivity 100%, specify 83%) and WR based on WHO
(sensitivity 100%, specify 86%), showed better result in assessing obesity than BMI For Age based on
Kemenkes RI (sensitivity 81%, specify 98,51%).
Conclusions: We concluded that BIA is an accurate, cheap, rapid and noninvasive method in assessing
excess fat accumulation in obese adolescents. BMI and WR can be used in obesity assessment; however it
needs recommended cutoff to be applied. Either BMI cutoff for Asian-Pacific (WHO) or WR cutoff based on
WHO are suggested for obesity assessment.

Poster 29(ID599)
Establishing TB Control Through Workplace
Adi Sasongkoa, Mundi Mahaswiatib, Nita Widyantic
a Faculty of Public Health University of Indonesia, Jakarta, Indonesia
b Yayasan Kusuma Buana, Jakarta, Indonesia

c Pusyankes Rancaekek, Rancaekek-Sumedang, Indonesia

Background: An estimated of 14 million people worldwide is infected by TB and Indonesia is ranked

number 4 in 2011. Government of Indonesia has implemented DOTS approach as a national policy since
1995. Despite the successfull progress and results, MDR-TB is steadily increasing. One of the reasons is low
compliance rate in taking TB medication.
Mode of intervention: In 2007, an NGO (Yayasan Kusuma Buana/YKB) collaborated with a garment
factory to initiate TB control activity through the workplace. This initiative was supported by the District
Health Office and Sub-distric Health Centre. Early detection of suspect TB is done through the factory clinic
(inside the factory) and YKB clinic (around 150 meters outside the factory) after series of TB prevention
campaign conducted for the workers. Every TB suspect is referred to the Sub-district Health Centre to have
sputum BTA check. For every BTA+ cases, District Health Office will provide the medication (following
DOTS scheme). The factory management give sick leave between 1 – 2 months to workers undergoing
treatment. After one or two months, the workers can get back to work. To assure the compliance of the
treatment, factory management assign the workers with TB treatment to work in the morning shift.
Medication is taken directly under supervision of the factory management. With this arrangement,
compliance is fully achieved with a result of 100% cure rate.
Conclusion: This model of using workplace for TB control program provides assurance to the treatment
compliance. With full compliance, MDR-TB cases can be prevented.
Expansion: After having this successful program, an expansion to cover more factories is on the way since
2012 with the support from Ministry of Health.

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Poster30 (ID601)
Need Assessment Results on Expanding TB Control Through the Workplace
Adi Sasongkoa, Mundi Mahaswiatib, Nita Widyantic
a Faculty
of Public Health, University of Indonesia, Jakarta, Indonesia
b Yayasan Kusuma Buana, Jakarta, Indonesia

c Pusyankes Rancaekek, Sumedang, Indonesia

Background: The implementation of TB control in a garment factory conducted in collaboration with an

NGO (Yayasan Kusuma Buana/YKB) showed promising results. There is a great opportunity to expand this
model to other factories. To identify the need of the workers on this promising program, a survey was
conducted in 5 factories.
Method: A cross-sectional survey is conducted in 5 factories (three garment factories, one food company
and one electronic company with majority of workers are women), in Sumedang, West Java, in 2012.
Selection of respondent is not fully randomized due to the production activities in the factory. A
self-administered questionnaire were distributed and filled in by a total of 349 respondents.
Results: Majority of respondents (89%) are operators and the rest are supervisors. Forty one percent of
respondents are 30/less years of age with 37,5% having education of elementary and junior high schools.
Seventy three percent are married and have 1-2 children. More than 60% have been working in the factory
for more than 3 years.
Despite the endemicity of the disease, 14% respondents never heard about TB. Four main symptomps of TB
identified by respondents are chronic cough (91,1%), chest pain (54,9%), loosing weight (53,9%) and breath
difficulty.
Almost all respondents (95,7%) think that TB is dangerous disease but preventable (87,7%). Ways to
prevent TB includes improved ventilation (51,6%), no spitting (53%), nutritious food (55,3%) and sun lights
(48,7%).
According to 25,3% of respondents, there are other workers with symptomps of TB in their factory.
To prevent TB, 92,3% respondents agree to attend health education and 57,6% will participate as health
volunteers.
Conclusions: There is a concern among workers about other workers with TB and to prevent TB they agree
to attend health education and become volunteers.

Poster 31 (ID604)
Practice of Exclusice Breast Feeding (EBF) Among Mothers of Uunder-Two Year Children in
Sub-District Kajhu, Aceh Indonesia 2013
Caroline E. Wuryaningsih
Indonesia University, Depok, Indonesia

Background: EBF which is giving only breast milk to the infant for 6 months is one method to increase the
infant’s immunity. However, the practice of EBF is not fully accepted by the community in this area. The
purpose of this study was to examine the practice of EBF among different mothers of under-two year
children.
Method: This study used qualitative research methods using in-depth interviews to the Community Village
Midwife and head of the Public Health Center. In addition, FGD were conducted among the 6 groups (each
consisting 6-10 of informants) namely three different groups of mothers of different infant age, grandmothers
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of infants aged 0-23 months, fathers of children 0-23 months and cadre. Data triangulation using source and
method were employed. Data collector were members of the Faculty of Public Health staff.
Resuls: The majority of the community recognized that EBF was only giving breast milk to the infant up to
6 months old. They also agreed to practice it for a healthy infant, infrequent illness, and efficient. For those
infants who were not healthy, fuzzy and didn’t want to sleep they should be given banana or infant formula.
Almost all mothers under study did not practice EBF due to fuzziness of the infant. Lack of skills among
health workers to deliver the message, free infant formula and souvenirs for mothers who delivered in the
private clinics, and some incorrect beliefs & culture among the community were barriers to promote EBF.
Conclusions: The practice of EBF among mothers of the under-two years old was insufficient due to lack of
skills of health workers. Furthermore, the aggressive promotion of infant formula among the maternity
clinics and several cultural barriers were also identified which inhibit the practice of EBF.

Poster 32(ID605)
Overweight-Years Metric and Risk of Type-2 Diabetes
Asnawi Abdullah
Muhammadiyah Aceh University, Indonesia

Background and objectives: Recent study reported that combined the severity and the duration of obesity
into a single measure of obese-years was a better predictor of the risk of type-2 diabetes than using the
intensity or the duration of obesity alone. However, the analysis, the notion that obese-years was only
“switched on” when BMI reaches 30 Kg/m2, ignored the effect of overweight - BMI from 25 Kg/m2. This
study aimed to examine the total impact of “overweight-years” metric – combining the severity of
bodyweight and number of years lived with BMI above 25 kg/m2 on the risk of type-2 diabetes.
Methods: 5036 participants of the Framingham Heart Study were examined. The severity and the duration of
each participant lived with overweight were measured every two years for up to 48 years. Overweight-years
was defined and its relationship with the risk of type-2 diabetes was modelled using time-dependent cox
regression and compared using the Akaike's information criterion.
Results: The study found that adjusted hazard ratios of type-2 diabetes increased significantly as
overweight-years increase. Adjusted hazard ratios for the categories of 1–24.9, 25–49.9, 50–74.9, and ≥
75 overweight-years were 2.38 (95% CI:1.73-3.29), 2.79 (95% CI:1.97-3.94), 3.45 (95% CI:2.41-4.94) and
6.00 (95% CI:4.44-8.10) respectively and a dose response relationship was clearer (P value 0.00001) than in
obese-years (P value 0.01).) Per additional 10 overweight-year, the risk of type-2 diabetes increased by 6%
(95% CI:5%-7%. The goodness of fit test using AIC also confirmed that minimum value of AIC was in
overweight-years model than the intensity and the duration of overweight alone suggested overweight-years
model was a better predictor.
Conclusions: Overweight-years provides more concisely estimate the risk of type-2 diabetes than
obese-years and it is suggested to consider as an alternative model in estimating health burden related with
increasing body-weight in the population.

Poster 33 (ID606)
Development of Sound Absorbing Material Waste Based toward Green Technology: A
Literature Review

223
 Sjahrul M. Nasri a, Iting Shofwati b, Ike Pratiwi a
a Occupational Health and Safety Departement, Faculty of Public Health University of Indonesia, Depok, Indonesia
b Occupational Health and Safety Departement, Program Studi of Public health, Faculty of Medicine and Health

Sciences UIN Syarif Hidayatullah Jakarta, Indonesia

Background/ objective: Three public health problems that has not been handled are (1) the noise due to
industrial automation which are not accompanied by appropriate controls, (2) the prevalence of hearing loss
tends to increase due to noise exposure and poor lifestyle of community and (3) an increase in the amount of
not biodegradable waste. Noise Induced Hearing Loss (NIHL) is irreversible but can be prevented with
appropriate controls that prioritize the engineering controls, such as the installation of good noise barrier.
Currently, many utilize of mineral fiber to solve acoustic problem, which has an impact on health,
environmentally unfriendly and expensive.
Method: This study is a literature review of various journals to identify research development of
environmentally friendly acoustic materials as an alternative noise engineering control.
Results: Development of sound absorbing material that has done more focused on the utilization of natural
fiber which ecofriendly, biodegradable, recyclability, renewable of resources, such as rice straw, coconut
husks, rice husks and others. However, these material have shortcoming such as varying quality, low
resistance to water, has the ability to absorb moisture that can cause the fibers swell and low durability.
While the waste utilization of expanded polystyrene as lightweight concrete showed increase the
permeability coefficient in line with increasing percentage of expanded polystyrene and the appearance of air
voids. It shows more easily traversed water.
Conclusions : The phenomenon of the appearance of air voids and increasing of permeability coefficient led
to the idea expanded polystyrene utilization as sound absorbing material that can be applied as a "green
barrier" to control the noise hazard technically as a preventive measure the occurrence of cases of hearing
loss tends to increase.

Poster 34(ID607)
Revealing the Denial Facts: The Increasing Numbers of Sexually Active Indonesian
Adolescent
Annisa Nurrachmawati, Ike Anggraeni
Public Health Faculty of Mulawarman University, East Kalimantan, Indonesia

Background: Adolescents’ premarital sexual activities are increasing in Indonesia and lead to the risk of
unwanted pregnancy, unsafe abortion and sexual transmitted Infection. Unfocused program of the ministry
of health of the current phenomenon seems as a denial; this raised a concern to adolescent reproductive
health problem. This paper aim was to describe health reproductive related knowledge, attitude and need of
Indonesian sexually active adolescent.
Methods: Data derived from Indonesia Young Adult Reproductive Health Survey (IYARHS) carried out by
Indonesia Bureau of Statistics in 2007 with total of 19.311 young adult interviewed. Reproductive health
knowledge was assessed through knowledge of HIV and sexual transmitted Infection (STIs), pregnancy and
contraception. Attitude was assessed by attitude toward premarital sex and virginity. Reproductive need
reflect by family planning need.
Results: The study found that 8.1 percent adolescent had sexually active, among them only 1.93 percent
using methods to prevent pregnancy at last sexual intercourse.62.1 percent had poor STI’s knowledge,57.9
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percent had poor pregnancy knowledge,contrary to this 75.5 percent adolescent had good HIV/AIDS
knowledge. Majority adolescent approve to maintain virginity before marriage but 33.1 percent approve
pre-marital sexual behavior.Adolescent who lives in rural were 1.35 times more likely to had sexual
intercourse relative to adolescent who lives in urban. This study also found that 61.8% sexually active
adolescent need contraceptive services which could be access by unmarried adolescent.
Conclusion: Denial of adolescent sexuality has negative impact to their reproductive health. All effort to
develop any reproductive health services for adolescent will need to encompass advocating strategies
towards denial to adolescent reproductive rights. Health promotion programs also needed to educate
adolescent about health consequences of sexual activity.

Poster 35(ID608)
The Relationship Between Organizational Factors With Performance of Universal
Precautions Programs in Rsup DR.Wahidin Sudirohusodo Hospital Makassar, 2013
Irwandy, Syahrir A.Pasinringi, Sukriani
Public Health Faculty, Hasanuddin University, Makassar, South Sulawesi, Indonesia

Background/objective: Universal precautions is an effort made for the protection, prevention and
minimizing cross-infection (cross infections) among nurses and patients as a result of direct contact with
patients or body fluids which infected of infectious diseases (such as HIV / AIDS and hepatitis).
Organizational Factors according to Gibson (resources variable, leadership, supervision, job design, and
compensation) has been relationship to performance of individual.
Method: The purpose of this study was to determine the relationship between organizational factors
(resources, leadership, supervision, job design and reward) with the implementation of universal precautions
by nurse in inpatient unit of Dr.Wahidin Sudirohusodo Hospital, Makassar, Indonesia. This study used
observational analytic method. The numbers of sample were 124 nurses.
Results: This study found that the performance of universal precautions program by nurses in inpatient unit
of Dr Wahidin Sudirohusodo Hospital was categorized in good performance (94.4%).
Conclusions: The conclusions of this study found that the performance of universal precautions program
has significant relationship with leadership (p =0.039) and supervision (p = 0.042). This study also found
that the performance of universal precautions program in inpatient unit of Dr Wahidin Sudirohusodo
Hospital has no significant relationship with resources (p = 0.182), job design (p = 0.099) and reward (p =
1,000).

Poster 36(ID610)
Factors Associated With Community Preventive Action Towards Avian Influenza After An
Outbreak
Zarfiel Tafala, Anas Ma’ruf b, Endang B. Prasetyowati b, Sinurtina Sihombing b
a
Faculty of Public Health University of Indonesia, Depok, Indonesia
b
Subdirectorate Zonosis, Ministry of Health of Indonesia, Jakarta, Indonesia

Background/objective: In 2007, 2 cases were found death due to Avian Influenza (AI) in Jurug village of
Central Java, Indonesia. Until 2008, 136 AI confirmed cases including 111 deaths (CFR = 81,6%) were
reported by the government of Indonesia. In this preventable diseases, human factor is important in the

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emerging, dissemination and eradication of AI. How the community preventive action towards AI after an
outbreak was examined using Precede model (Green, 1980). The findings will be worthed in anticipating the
future repeating outbreak.
Methods: A cross sectional survey was performed 1 year after the outbreak in this area towards a sample of
215 family heads, randomly taken after a multistage process from subdistrict down to village level
(Lemeshow, 1997). The respondents were interviewed by properly trained interviewers using a pre-tested
questionnaire. Instrument used was that origined from CDC and MOH, and revised after pretested. Data
were collected in 1 week during 1998, and analysed by using bivariate analysis
Results: Many villagers (45.1%) did not perform preventive action towards Avian Influenza despite the
outbreak. Further analyses showed that the people seek medical treatment, instead of doing preventive
actions. This survey found that all predisposing factors such as knowledge (p=0,0005), attitude (p=0,002 ),
education (p=0,009), occupation (p=0,005) and age (p=0.034) of the respondents are significantly
associated with their preventive action in Avian Influenza in their village. These facts confirmed that most
people do not really know AI, and their action will stay remained despite enabling factors such as distance
and cost to health services were solved, and reinforcing factors such as information and supports were
fulfilled.
Conclusion: This Survey found that villagers did not perform preventive action against AI despite there have
been an outbreak in their village. It suggests that a sustained and effective Health Promotion must be
addressed to prevent possible the upcoming and repeated outbreak.

Poster (ID832)
Factors Associated with the Utilization (Claim) of Elderly Secondary Care Inpatient at Social
Health Insurance Main Branch Office, South Jakarta, 2012
Ekaning Wedarantia, Wachyu Sulistiadi
Health Administration and Policy Department
Faculty of Public Health Universitas Indonesia

Background: Aging process that naturally occurs in the elderly population will gradually result in decreased
body resistance. Decrease the immune system to a certain degree can lead a person to be susceptible or prone
to various diseases that increase the cost of health care. The purpose of this research is to examine factors
associated with utilization (claim) of elderly secondary care inpatient at Social Health Insurance primary
branch office at South Jakarta in 2012.
Methods: This research applied cross sectional design. Data were collected from secondary sources, for
example claim register data of elderly secondary care inpatient at Social Health Insurance primary branch
office at South Jakarta start from January to December 2012. Total sample was 3,203 claims register. The
formulated of binary logistic model statistical was using to examine factors age, sex, membership status of
insurance, type of hospital, class of treatment, diagnosis and length of stay associated with utilization (claim)
of elderly secondary care inpatient.
Results: The result of the research shows that diagnosis OR=14,132 (p-value=0,009; 95% CI) length of stay
OR=7,429 (p-value=0,001; 95% CI) , type of hospitals OR=3,794 (p-value=0,001; 95% CI), and the class of
treatment OR=1,626 (p-value=0,001; 95% CI) have significant relation with the utilization of elderly
secondary care inpatient. In the other hands age, sex, and membership status of insurance do not have

226
significant relation with the utilization of elderly secondary care inpatient.
Conclusions: Diagnosis, length of stay, type of hospital, and class of treatment are the factors associated
with utilization (claim) of elderly secondary care inpatient.

Poster 37(ID618)
Physical Activity as the Predominant Factor of Waist Circumference of Jakarta Health
Provincial Office Employees in 2013
Putri Viona Saria, Triyantib
aGraduated Student of Nutrition, Faculty of Public Health, Universitas Indonesia
b Lecturer of Department of Public Health Nutrition, Faculty of Public Health UI

Background: Waist circumference is one of anthropometric measurements, which is correlated with various
risks of degenerative diseases. Hence, this study was aimed to find the predominant factor of waist
circumference of Jakarta Health Provincial Office Employees in 2013.
Methods: This study was conducted with quantitative method and cross-sectional design. There were 108
Jakarta Health Provincial Office Employees involved as the subject of this study (adults aged 23-55 years old).
Variables studied in this study were waist circumference, age, sex, education, employee ranks, nutrients intake
(energy intake, carbohydrate intake, protein intake, fat intake, and dietary fiber intake), physical activity, and
sleep duration. Data collection was conducted in April-May 2013. The predominant factor of waist
circumference was analyzed using multiple linear regression analysis.
Results: The result of this study showed that physical activity was the predominant factor of waist
circumference of Jakarta Health Provincial Office Employees (β = -0.241, R2 = 0.457). This study found waist
circumference of Jakarta Health Provincial Office Employees was 85.6 cm ±10.9 cm, 81.0 cm ±8.9 cm in
female employees, and 91.89 cm ±10.32 cm in male employees. This study also found waist circumference
was significantly correlated with age, sex, employee ranks, nutrients intake (energy intake, carbohydrate
intake, protein intake, and fat intake), and physical activity.
Conclusions: This study suggested the preventive strategies of high waist circumference in Jakarta Health
Provincial Office Employees to be more specific in increasing the physical activity.

Poster 38 (ID623)
A Picture of Children and Their Right in 3 Regions of Palu City, Indonesia
Evi Marthaa, Tiara Amelia a Myranti a, WVI Palub
a Faculty of Public Health, University of Indonesia

b World Vision International-Palu-Central Sulawesi-Indonesia

Background/Objective: Based on Children Right Convention, child has right to be heard and considered by
elements among community in deciding children regulation. Giving a responsibility to children have to be in
line with their ability and maturity which influenced by social institutions. Therefore, a qualitative research
was conducted to know influence of institution such as school, family, community and peer group toward
children identity.
Method: This research was conducted on March until April 2012 in 3 regions of Palu city: Urban, Industry
and Indigenious. Data collection through 12 in-depth interviews (head of school, community leader, head of
children group, NGO and head of village) and 37 focus group discussions (children, parents, teachers, peer
groups).
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Result: Children identity is primarily influenced by value that constructed within peer group beside family
and community. One of values as social legitimating formed by family, school and community is a common
violence in daily life. Male children based on gender and social are more demanded to seek money as young
as possible as part of becoming a leader within family. Whereas, female children are more demanded to work
in domestic household as part of becoming a mother. In the other hand, education is still not a priority within
social institution beside lack number of schools and inadequacy of its facilities and infrastructures.
Conclusion: Seeking child’s identity is more occurred in interaction within peer group. Family and
community influence a violence value as part of culture. Internalization education as not an important value
by family and community makes children lose their orientation of education. Government support is
relatively less toward enhancing education facilities. Therefore, even though knowledge of child’s right is
increasing among children, family, community and government; it does not guarantee the successful of
child’s right implementation if still obstructed by social and cultural.

Poster 39(ID625)
Potential Safety Risk Analysis of Liquefied Petroleum Gas (Lpg) Year 2011
Ike Pujiriani
Indonesia University, Depok, Indonesia

Since 2007, the Indonesian government began to implement a policy to convert the use of kerosene to LPG
(propane and butane) in the community, especially with LPG cylinder size 3 Kgs. The dimension of LPG
cylinders size 3 kgs widely available in the market have 260 mm diameter, 190 mm tube height, 18.6 atm
pressure, and 7.3 liters volume. The policy provides a wide range of impacts, both positive and negative. One
of the negative impacts that may arise is the leakage of LPG clylinder. Its leaking can cause gas dispersion,
fire and explosion that would be bad for the environment around. Losses can be minimized by using a tube
leakage modeling software. From the modeling results it can be seen how far the distance spread / dispersion
of gas, spread of fire and explosion heat radiation due to tube leakage of propane and butane tube 3 kg. The
modeling results canbe used to estimate safe distances for evacuation, consideration and making of
emergency response plans to prepare for the early detection of 3 kg LPG cylinder leakage in the community.

Poster 40 (ID645)
Preliminary Survey from Triple Helix to Quinto Helix: A CSR Program for Berau Sanitation
Program in Improving Quality of Life
Robiana Modjoa, Rachma Fitriatib, Tri Mulyania
a Department of Occupational Health and Safety, Faculty of Public Health, University of Indonesia, Depok, Indonesia
b Department of Commercial Administration, Faculty of Politic and Social Science, University of Indonesia, Depok,

Indonesia

Background: As a form of its responsibility to the adjacent community and complying with the Indonesia
Regulation No. 40 Year 2007 Section 74, PT. X has already run Corporate Social Responsibilities (CSR)
programs aimed to improve environmental hygiene and life quality of the people. These programs are called
Berau Sanitation Program (Health Toilet). The current programs are applying a triple helix approach where a
high commitment of the local government, corporation and academicians are required. However, in order to
make the program implementation more comprehensive it is realized that community support is needed and
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then change to a quinto helix model.
Method: This preliminary survey was carried out to assess the outcome of CSR program involving 75
households from 4 villages of Berau District in East Kalimantan as total sampling. This study put more focus
on evaluating behavioral and environmental changes by comparing certain aspects precede and proceed after
the CSR program implementation. Data was collected with direct observations and questionnaire guided
interviews as well as secondary data provided by PT X, local government and public health center and
analyzed using triangulation method.
Results: It was found that community generally figured out all of requirements of health toilet and those
related impacts to human. Moreover, the community’s attitude of the using toilet was significantly increase
and showed the positive results. In addition to the stakeholders’ participant, the community was fervent
satisfied and also considered that this program has been appropriately performed and was suitable to the
community’s needs.
Conclusion: In order to improve the program, we recommended: Continuance of the health toilet needs to be
balanced by providing of the fresh water. More health education is needed to the community; Development
and application more comprehensive quinto helix model through the operational research area of PT X is
demanded.

Poster 41(ID662)
Gender Differences in Transition to Employment of FPHUI Graduates
Ahmad Syafiq, Sandra Fikawati
Faculty of Public Health, University of Indonesia, Depok, Indonesia

Background/objective: Tracer study is a study to assess the relevance of higher education by surveying
graduates after leaving the institution. One important theme in tracer study is transition to the world of work.
Faculty of Public Health University of Indonesia (FPHUI) is the leading higher education institution in
public health in Indonesia and it is important to understand the transition to employment of those graduates
through tracer study. Analysis by gender is needed to produce appropriate intervention and/or adjustment to
the education itself.
Method: FPHUI tracer study was part of university tracer study conducted regularly to trace all graduates
two years after graduation. Using census design with standardized questionnaire and administered full-online.
Total number of FPHUI graduates of regular program year 2010 was 188; response rate was 46.3%.
Results: There was no gender difference found in job seeking duration (3 months). This was similar to
median of all UI graduates but much quicker than national standard (10 months). Female graduates had
more varied method of job searching and more complex consideration in choosing the first job. Around
36.2% of female graduates worked in government institutions (male: 16.7%); 41.4% female graduates
worked in private companies (male: 58.3%); 13.8% worked in not for profit organizations (male: 16.7%);
and 1.7% open her own business (male: none). Female graduates had lower monthly salary than their male
counterparts (IDR 3.7 million versus IDR 4.8 million). One important finding is that almost half (47.0%) of
female graduates were not willing to be stationed outside city areas, while in male graduates the percentage
was 15.4%.
Conclusions: FPHUI female graduates had more complex method and consideration in job searching
compared to those of male graduates. More female worked in government/public institutions; female
graduates’ salary was lower than male; female graduates were less willing to work in rural areas.

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Poster 42(ID664)
Assessment of Maternal Nutritional Status and Perceived Insufficient Milk
Sandra Fikawati, Ahmad Syafiq
Center for Nutrition and Health Studies, Faculty of Public Health, University of Indonesia, Depok, Indonesia

Background/objective: Exclusive breastfeeding for less than 6 months contributed to the 1.4 million deaths
of infants and 10% toddlers’ morbidity. Perceived Insufficient Milk (PIM) became one of the main causes of
exclusive breastfeeding failure in the world. One cause of PIM could be by inability of pregnant women to
achieve the recommended weight gain thus mothers have the risk of giving birth of LBW infants and have
low fat reserves to produce milk. Low production of breast milk will negatively affect the confidence of
mothers to breastfeed. This study aimed to examine three studies that analyzed the relationship between
maternal nutritional status and PIM.
Method: The study was conducted in three places, namely Karawang district, Tanjung Priok sub-district and
Cilandak sub-district in 2010 and 2011. The numbers of sample in each study were 87, 100, and 100 mothers,
respectively. Maternal nutritional status was assessed by maternal weight gain during pregnancy.
Results: Prevalence of PIM in the three studies was quite high (around 35%). The results of studies showed
significant associations between maternal nutritional status and PIM with ORs (CIs) 3.7 (1.47-9.08), 3.9
(1.55-9.83) and 4.5 (1.86-11.01), respectively.
Conclusions: It was concluded that PIM was experienced by breastfeeding mothers whose maternal weight
gain during pregnancy did not achieve the recommendation and this caused the mother to stop exclusive
breastfeeding. This finding is important and can be used to change the existing perception among
breastfeeding experts and community that all mothers, regardless their nutritional status, are able to
breastfeed exclusively. The study is expected to provide input for policy makers to pay more attention to the
nutritional status of breastfeeding mothers.

Poster 43 (ID672)
Physicians Motivation in Prescribing in Risa Sentra Medika Hospital
Emma Apriliaa, Dumilah Ayuningtyasb
a Hospital
Management, Faculty of Public Health, University of Indonesia, Depok, Indonesia
b Department of Health Policy Administration, Faculty of Public Health, University of Indonesia, Depok, Indonesia

Background: Physicians are health professionals who have roles and authority in prescribing medicines to
patients. Selection process and selection of medication should be done rationally and follow the guidelines of
medication handbook that established by the World Health Organization. In Risa Sentra Medika Hospital,
There are still mostly found prescriptions writing outside the formularies, about 70% of the 100% target of
the use of formularies.
Objective: This study aims to find the physician motivation in the prescribing. The factors that influencing
viewed from intrinsic motivation factors (perceptions, interests, and aspirations), extrinsic factors (diagnosis,
consistency, and cooperation), organization (leadership, socialization, supervision, fee), the pharmaceutical
industry (promotion and benefits), as well as the policy implementation.
Method: This study was conducted with a qualitative approach and case study designs. Primary data were
obtained from interviews and observations and equipped with a document review as a form of triangulation.
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Result: The result mentioned that the physician motivation in prescribing is influenced by many factors,
among others are the diagnosis of diseases, the financial condition of the patient, the benefits from the
sharing arrangement with the pharmaceutical industry. Remuneration from external parties provides a strong
influence on the physician in prescribing.
Results: This study concluded for a follow-up, it is necessary to have clear regulation for the application of
the formularies by the Director of Risa Sentra Medika Hospital. Another essential point to consider in the
process of implementing the use of formularies is by giving a clear rewards and sanctions for physicians.

Poster 44 (ID693)
Health Insurance and 5-Year Survival Rate of Cervical Cancer Patients at National Hospital,
Jakarta, 2007-2010
NasrinKodima, GusniRahmab
aDepartment of Epidemiology, Faculty of Public Health, University of Indonesia
bAlumny of Faculty of Public Health, University of Indonesia

Background: In Indonesia, the 5-year survival rate cervical cancer is low. A lot of patients who diagnosed
cervical cancer do not return to hospital for getting proper treatment because of financial reasons. Cancer
cervix is the most frequent cancer occurred for female in at Dr. CiptoMangunkusumo National Hospital
(RSCM). The low rate of 5-year survival rate cervical cancer patients caused by several factors.This research
aim to see 5-year survival rate cervical cancer and its correlation to health insurance cervical cancer patients
at Dr. CiptoMangunkusumo National Hospital, Jakarta year 2007-2010.
Method: Design study used is cohort retrospective with survival analysis of the occurrence of dead event.
This study used secondary data source of cervical cancer medical record National general Hospital
Dr.CiptoMangunkusumo Jakarta, 2007-2010. The subjects are observed for 5 years since the cancer cervix
diagnosed
Result: The study result shows probability 5 years survival cervical cancer for the hole in RSCM in period
2007-2010 is 36%. There is correlation between health insurance status and 5 year survival rate of cervical
cancer patients (p value = 0,001). Patients who are not covered by insurance are 5,18 times (CI1,97-13,59)
likely at death risk compare to insurance covered patients. Rate adjusted with cell differentiation, education,
stadium of cancer, and hemoglobin rate as confounding variables.
Conclusion: The probability 5 years survival of patients who are covered by health insurance is higher than
patient who are not covered after adjusted with cell differentiation, education, stadium of cancer, and
hemoglobin rate as confounding variables.

Poster 45(ID697)
Utilization of Maternal Health Care Service and Skilled Birth Attendants in Jayawijaya,
Indonesia 2013
Irma Surya Kusumaa, Dewi Nur Aisyaha, Oktarindaa, Nasrin Kodima, Ratih Woelandaroeb
aCenter for Epidemiological Research and Surveillance, Faculty of Public Health, Universitas Indonesia, Depok,
Indonesia
bUNICEF Indonesia, Jayapura, Indonesia

Background/objective: It is believed that the use of maternal health care services and delivery assistance by

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skilled birth attendants (SBA) can reduce maternal and neonatal mortality as well as improve the
reproductive health of women. Even though the number of deliveries assisted by skilled health personnel in
Indonesia was high (82.2%, Indonesia Basic Health Survey 2010), the different results were shown in some
provinces of Indonesia. In this paper, we obtained more information on maternal health care service
utilization and examined factors associated with it in Jayawijaya District, Papua province, Indonesia 2013.
Method: We conducted a cross sectional study across 54 villages in Jayawijaya district, one of the poorest
quintile areas in Indonesia. 798 households who have infants and CU5 were selected by two stages cluster
sampling. Individual interviews were held to capture data on demographic and socio-economic of
respondents.
Results: The data indicated that most deliveries were at home (87.7%) with the majority (54.9%) were
delivered by family members, relatives, or neighbors with little or no knowledge of clean delivery practices
as compared to 19.4% of the deliveries were performed by trained personnel. Only 36% of mother received
antenatal care services during their pregnancy with 63.1% of them received ANC ≥4 times and only 6.6% of
them received it once. The lacks of utilization were partly due to local culture, low income and variation in
the implementation of maternal health care program as well as differences in availability and accessibility.
Both parents were lowly-educated and engaged in low-earning sector.
Conclusions: The findings of this study provide insights for planning and implementing appropriate
maternal health care service programs. We suggest improvement of maternal education to give understanding
about safe motherhood, expanding maternal health facility to reduce accessibility barriers, and socialize
Jampersal (delivery insurance) for families with low income.

Poster 46(ID726) Commented [何宁3]: 此文上面原有 ID714，需删除

Understanding Local Concept and Health Seeking Behaviors to Describe the Pattern of the
Cause of Death in Children under Five
Irma Surya Kusumaa, Nasrin Kodimb
a Center for Epidemiological Research and Surveillance, Faculty of Public Health, Universitas Indonesia, Depok
b Department of Epidemiology, Faculty of Public Health Universitas Indonesia, Depok

Background/objective: Different patterns of the cause of death in children under-five (CU5) among regions
in Indonesia indicates the existence of local issues (concept of the disease, health seeking behaviors, access
barriers) that cannot be set aside in the health program planning. By understanding it better, it is expected to
bring significant improvement in child mortality reduction. The objective of this study is to describe different
patterns of the main cause of death in CU5 by providing information about the local concept, health seeking
behaviors and access barriers.
Methods: The study was held in the four poorest quintile districts in Indonesia, including Brebes, Buru,
Timor Tengah Selatan (TTS), and Jayawijaya. The qualitative survey was carried out using focus groups
discussions of mothers/caretakers of CU5, while the cause of death in CU5 investigated separately through a
cross-sectional study using verbal autopsy questionnaire in 226 villages during 2010-2011.
Results: The main cause of death in CU5 in Jayawijaya and Brebes was pneumonia (proportions 50.0% and
30.8% respectively), while in TTS and Buru, diarrhea became the main cause (52.1% and 45.7%). Smoke
from traditional house and supernatural power was believed to be the cause of pneumonia in Jayawijaya and
Brebes. It was also found that mothers in TTS believe diarrhea was caused by cold weather, while in Buru,
mothers perceived it as a sign of growth. Perception that the disease was harmless and the use of traditional
birth attendants as caretakers worsened prognosis of the disease. The reason for choosing health provider
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relied on the cost of medicine, distance, and attitude of the health workers. Other factors affecting it were the
high cost of transportation and decision making power.
Conclusions: These findings show the importance of considering local concepts of disease and access
barriers in specific areas for the child mortality reduction program planning.

Poster 47(ID737)
Nutrition Education and Home Gardening Program to Improve Mother Nutritional
Knowledge and Children Nutritional Status in Rural Setting in Indonesia
Ali Khomsan, Faisal Anwar, Dadang Sukandar, Hadi Riyadi, Eddy S. Mudjajanto
Bogor Agricultural University, Indonesia

Background/objective: Nutritional status of community is influenced by a lot of interrelated and complex

factors. The objectives of this research were to evaluate the effects of nutrition education and home
gardening to the nutritional knowledge of mother and nutritional status of children.
Method: This research was carried out in Bogor, West Java, Indonesia. A total number of 240 mothers were
involved in this research. The experiment had been conducted for five months in the form of providing
nutrition education and implementing home gardening. The study was funded by the Nestle Foundation,
Switzerland.
Results: At baseline, the prevalence of underweight in control and intervention groups was 16.7% and
19.3%, respectively. The stunting prevalence of each was 64.5% and 46.5%, respectively, whereas wasting
prevalence was 2.7% and 2.6%. Based on the analysis of General Linear Model (GLM), it was found that
intervention had a significant impact on the nutritional status of children based on the Z-score of body
weight/age. Mother’s nutritional knowledge of intervention group increased from 46.0 to 53.6 point while
the score of control group decreased from 37.1 to 34.9.
Conclusions: The score of nutrition knowledge in the intervention group performed better than the control
group. The intervention had a significant impact to the nutritional status of children based on the Z-score of
weight for age, but not significant on the nutritional status according to Z-score of height for age or Z-score
of weight for height.

Poster 48(ID745)
Birth Attendance and Midwife Ratio in Cianjur District-Jawa Barat, Indonesia, 2013
Tris Eryando, Evi Adawiyah, Besral, Popy Yuniar
Departement Population and Biostatistic Faculty of Public Health-Universitas Indonesia, Kampus UI Depok, Jawa
Barat, Indonesia

Background/ Objective: Indonesia has developed the public health index to evaluate the health performance
for each district. One of the important variables in the index is birth attendance. Cianjur was considering as a
district with a low public health index and still face a maternal health problem, especially for antenatal care
and delivery assisted by qualified health personnel.
Methods: This research used secondary data from the Public Health Index Cianjur District Survey
conducted in 2012. The survey collected the whole 32 sub-district in Cianjur, using rapid survey procedure
with two-stage cluster sampling method. Data was analysed with a multivariable model to predict the factors
associated with birth attendance.

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Results: Mother who in touch with ante natal care (ANC) activity is already high in Cianjur District (91.7%)
but only 28.16% of them had a complete ANC. Delivery by qualified health attendance is around 61.13%.
Regression logistic model showed that a mother who delivers by qualified health attendance could be
explained by age, education, economic status, and accessibility to birth attendance and performed a complete
ANC. Using midwife ratio per village as the contextual variable for level II, multilevel analysis proved that
there was a random intercept from level I to level II, with MOR=3.09. It means there was a difference in
median of OR in the level I to level II. The difference can be explained by the supply factor, which is
measured by midwife ratio per village, with IOR (0.24 – 4.16).
Conclusions: Since the variation of IOR exceeded 1, it means the variation in the sub-district is relatively
bigger than the contextual variable (midwife ratio). Midwives were playing the very important role in
maternal health in district level. So then the effort on relocation of midwife in villages is still an important
factor to raise maternal health in district level.

Poster 49 (ID758)
Related Factors of Dry Eyes Syndrome on the Workers That Use VDT in Pestiside Factory
Lisa Wakhyu Isnainia, Tri Martianab
a PublicHealth Faculty Universitas Airlangga. Surabaya-Indonesia
b OSH Dept, Public Health Faculty Universitas Airlangga. Surabaya-Indonesia

Background/objective: In recent time, kids and adults, offices, homes, and industry become more and more
use personel computer and laptop as their part of activities. However, there are many risk factors caused by
utilization of personel computer and laptop, and many people ignored them. Along with age, human eyes
become susceptible to get dry eyes syndrome. Lack of ergonomy and environment factor are additional
factors for dry eyes syndrome. This research aimed to know factors related to dry eyes syndrome on the
workers that used VDT at PT Pupuk Kaltim.
Method: This research is analytical research. Population of the research is 55 workers with age 40 years and
aboveat PT. PKT and 35 among them are sample. Sample is determined by Simple random sampling.
Independent variables are lighting intensity, view distance, workers’ characteristics, computer monitor, and
environment factor.
Results: Statistical analysis in this research is correlation linear pearson statistics at significant level α=0,05.
The result of the research showed that what significant are respondent age = 0,000 (p<0,05), sex = 0,037
(p<0,05), work duration = 0,037 (p<0,05), work period = 0,010 (p<0,05), drugs consumption = 0,000
(p<0,05), view distance position = 0,004 (p<0,05), flat and convex monitor = 0,000 (p<0,05), blare
disturbance0,004 (p> 0,05), local lighting 0,001 (p> 0,05).
Conclusion: dry eye syndrome, a disorder characterized by the production and function of the instability of
the tear film. The incidence is more widely experienced by men and is characterized by symptoms of eye
discomfort, hot, itchy, sticky, tense. Individual or workers in order to maintain eyes health, control eyes
vision distance and gradually take some rest, and alsoget the instructin to accupational health departement to
held socialization about computer ergonomi.

Poster 50 (ID767)
Indoor Pm2,5 Concentration And The Declining of Adult’S Lung Function Around Pulo
Gadung Industrial Area East Jakarta 2012

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 Eky Pramitha
Research Center for Climate Change UI, Indonesia

Background: PM2,5 is an important indicator of health risk from particulate pollution. Exposure to indoor
air pollution of PM2,5 has been associated with an increase in lung function impairment. Consequently, the
intervention program must be started from environmental factors.
Objective: The aim of the study was to better understand the association between indoor PM2.5
concentration and the declining of adult’s lung function.
Method: Cross sectional study was conducted at around Pulo Gadung Industrial area, East Jakarta. This
study was extended from March to May 2012. Researchers have selected 109 adults from 20 to 65 years of
age by the stratified random sample to determine the incidence of lung function impairment and its
relationship to indoor air pollution due to PM2.5. Lung function was measured by spirometry test to get the
value of VC, FCV, FEV1, and FEV1/FCV. Indoor PM2.5 concentration was measured by dust track. The
Odds Ratio (OR) for the effect of indoor PM2,5 concentration on lung function in adult was analyzed by
logistic regression model. Besides that, individual variables and health housing variables were also analyzed
with the declining of adult’s lung function.
Result: The prevalence of the declining of adult’s lung function around Pulo Gadung Industrial area was
38,5%. The analysis showed significantly association between indoor PM2.5 concentration and the declining
of adult’s lung function (OR = 3,31; p value = 0,003). Other factors that influenced the declining of adult’s
lung function were gender (OR = 2,84; p value = 0,025), the duration of exposure (OR = 3,56; p value =
0,002 ), smoking status (OR = 2,60; p value = 0,040), ventilation (OR = 3,35; p value = 0,026), and humidity
(OR = 3,12; p value = 0,016).
Conclusion: Finally, the conclusion of this study is indoor PM2,5 concentration was significantly associated
with the declining of adult’s lung function.

Poster 51(ID779)
Stabilized Rice Bran Oil and Its Fractions Have Antiproliferative Activity on Cancer Cell
Lines But Not on Normal Cells
Evy Damayanthia, Deddy Muchtadia, Christofora H. Wijayaa, Hidayat Syariefa, Djoko S. Damardjatib,
Fransiska R. Zakariaa
a Bogor Agricultural University, Indonesia

bIndonesian Center for Food Crops Research and Development, Indonesian Agency for Agriculture Research and

Development, Indonesia

Background/objective: Rice bran oil (RBO) has been reported to have beneficial effects on human health,
and great potential as anti tumor activity. The objective of this research was to investigate the effect of crude
RBO and its fractions on the proliferation activity of suspended and monolayer cancer cell lines KR4, K562
and melanoma.
Method: Normal cell lines L929 and human peripheral blood lymphocytes were also used. RBO and
unsaponifiable matter (UM) from IR64 rice and oryzanol with 5 levels of concentrations, ranging
respectively from 133 to 2,132g/ml, 10 to 154g/ml, and 2 to 38g/ml respectively, were added into the
cell cultures. Cell proliferations were measured as living cells using MTT formazan after incubation for three
days at 370C, 95% humidity and under 5% CO2 gas.
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Results: The results showed that antiproliferative activities of RBO and its fractions were influenced by the
extract types and concentrations. Increased in extract concentrations augmented the percentage of inhibition
of KR4, K562 and melanoma cell line proliferation. The extract with the highest antiproliferative on the
cancer cells was RBO followed by UM and oryzanol. All extracts did not show antiproliferative activity on
human lymphocyte. The relative capacity of RBO was higher than that of UM for KR4, K562 and melanoma
cells.
Conclusions: For common health purposes, RBO seems to be more potential than oryzanol as
antiproliferative on cancer cell line not only do due to its higher yield but also do to possible synergism.

Poster 52 (ID793)
Physical Activity and Energy Intake from Calorie Beverages Among Overweight and
Non-overweight Males and Females
Dodik Briawan, Hardinsyah, Silvia Mawarti Perdana
Dept. of Community Nutrition, Fac. of Human Ecology, Bogor Agricultural University, Indonesia

Background: Nowadays, overweight is one of the nutritional problems that need concerned seriously.
Overweight has various causes, such as excessive energy intake, one of which comes from calorie beverages,
and low levels of physical activity.
Method: The data used was a part of the study on Drinking Habits and Hydration Status among Teenagers
and Adults in Some Areas in Indonesia, by involving 606 adolescents and 594 adults.
Results: The prevalence of overweight (OW) was 31.8%, which is higher among female (35.5%) than male
(27.9%). The mean of body mass index (BMI) for overall subjects was 23.0 ± 4.9 (kg/m2), and among OW
and not overweight (NOW) was 29.1 ± 3.9 (kg/m2) and 20.6 ± 2.7 (kg/m2) respectively. The mean physical
activity level (PAL) for overall subjects was 1.65 ± 0.19, among female and male was 1.62 ± 0.16 and 1.69 ±
0.21 respectively; and among OW and NOW was 1.60 ± 0.16 and 1.67 ± 0.19 respectively. The mean
energy intake from calorie beverages (EICB) was 439 ± 394 kcal/day, among female and male was 409 ±
367 kcal/day and 471 ± 420 kcal/day respectively, and among OW and NOW was 395 ± 360 kcal/day and
477 ± 408 kcal/day respectively. The five types of calorie beverages most consumed by OW and NOW were
the same i.e. tea, coffee, juice, milk and yoghurt. Contribution EICB to energy intake total is 21% and 24.2%
in OW and NOW respectively. There was significant correlation between PAL and BMI, but not for EICB
and BMI, which more likely explained by the low energy adequacy level (84.3%) among subjects and the
weaknesses of the cross sectional study design.
Conclusions: Increasing physical activity and limiting energy adequacy level is important to prevent
overweight. Further studies with better design are required in this field in Indonesia.

Poster 53(ID797)
Risk Factors of Adolescents Dehydration in Indonesia
Dodik Briawan, Hardinsyah, Gustam
Dept. of Community Nutrition, Fac. of Human Ecology, Bogor Agricultural University, Indonesia

Background: Hydration has effect on cognitive function, exercise performances, and the development of
several diseases. The objective of this research is to analyzed risk factors of dehydration in adolescents.
Method: The research was carried out through analyzing a data set of The Indonesian Regional Hydration

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Study collected in the year of 2008 and 2009 by applying a cross-sectional study design in 604 adolescents
(age 15-18 years) in four provinces in Indonesia. Subject was categorized as hydration when the urine
specific gravity (USG) ≥1.020 g/mL.
Results: The adolescent average fluid intake was 2773 ± 439 mL/day. The contribution of water intake was
61.8% of total fluid intake or 1854 ± 590 mL/day, and other beverages were 474 ± 465 mL/day or 18.3%.
Mean of the USG was 1.017 ± 0.006 g/mL, and it was founded that 44.5% of the adolescents categorized as
dehydration. The logistic regression analysis show the dehydration risk factors in adolescents were
ecological areas, gender, body temperature, fluid intake, and hydration knowledge. Subjects lived in the
lowlands have a risk of dehydration 2.74 times compare to those live in the highland. Subjects who have
body temperature outside of the normal range had a risk of dehydration 1.50 times compare to those have a
normal one. The girls have dehydration risk of 1.60 times compare to boys. Subjects consumed less fluid
have a risk of dehydration 1.67 times compared to those consumed adequate fluid. Subjects with less
hydration knowledge had a risk of dehydration 1.42 times compare to subjects with better hydration
knowledge.
Conclusion: Most of the adolescent didn’t realize when they suffering mild hydration, therefore it is
recommended to drink more water regularly.

Psoter 54(ID872)
Determinants of Acute Respiratory Tract Infection Among Under-five Children Living in
Barracks after Tsunami inAceh Besar, Indonesia, 2006.
Mondastri K. Sudaryoa, c, Yuanita Anandab , Ajeng T. Endartic
a Faculty
of Public Health, Universitas Indonesia, Depok, Indonesia
b NAD Provincial Government Office, Banda Aceh, Indonesia

c HRCCD, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia

Background/objective: After tsunami in Nanggroe Aceh Darussalam (NAD) province, Indonesia, almost
half million people were displaced. These affected people, especially under-five children, living temporarily
in barracks became more susceptible to get infectious diseases. This study was aimed to identify
determinants of the occurrence of ARI (acute respiratory tract infection) among these children.
Method: A cross-sectional study was conducted to interview parents of 652 randomly selected under-five
children living in barracks in district of Aceh Besar after the tsunami. Multiple logistic regression was used
to analyze associations between ARI and several potential determinants related to child characteristics and
living conditions in the barracks, such as age, gender, nutritional status, immunization, parent’s smoking
behavior, anti-mosquito’s smoke, cooking energy-source, kitchen, floor and wall type, ceiling, window
opening, ventilation, sun illumination and housing density.
Results: We found that prevalence of ARI among the children was very high, i.e. 60%. The logistic
regression model showed that children with malnutrition were 1.6 times more likely to get ARI, as compared
to children with good nutritional status (OR=1.6; 95% CI: 1.1–2.3). Children living in barracks which had
less sun illumination were 2 times at risk of ARI than children living in barracks with sufficient sun
illumination (OR=2.1; 95% CI: 1.5–3.0). Certain type of floor was also associated with the occurrence of
ARI (OR=0.5; 95% CI: 0.1–0,9).
Conclusions: There were 3 determinants proven as significant determinants of ARI, i.e. child nutritional
status, floor type and sun illumination. Instead of recovering child health after disaster, living in inadequate
or low support of temporary living centers (TLCs) like barracks may even induce more health problems such
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as the ARI. Maintaining high standard of TLC’s hygiene and sanitation, securing basic needs (like healthy
nutritious food) and implementing infectious diseases surveillance are necessary to prevent such problem.

Poster 55 (ID880)
Determinant Factors of Coronary Heart Disease Occurrence of the Productive Ages in
Central Bogor Village, West Java Province, Indonesia, 2012
Julianty Pradono, Asri Werdhasari
National Institute of Health Research and Development, Ministry of Health Indonesia

Background/Objective: Coronary Heart Disease (CHD) is the highest prevalence of Non Communicable
disease (NCD) in general population and community workers. It affects the morbidity, disability, and mortality
rate. Factors that are related to CHD can be controlled and the occurrence of CHD can be prevented. Aim of
this study is to identify the determinant factors that are related to CHD on residents in Central Bogor village,
Indonesia.
Method: The data for this study is based on the baseline data of 2012 NCD cohort study of Central Bogor
village in Bogor city of West Java province. Diagnosis of CHD are based on the symptoms of CHD by
interview and ECG examination. There are 4771 respondents, male and female, aged 25-65 years. Multivariate
analysis had been done to describe the factors that influenced CHD.
Results: The prevalence of CHD is 16.9% in aged 25-65 years of Central Bogor population. Risk factors that
are related to CHD in productive ages are: hypertension, 2.2 times (95% CI 1.5-3.2); stroke, 2.1 times (95% CI
1.3-3.4); followed by hyperglycemia, 1.3 times (95% CI: 1.1-1.5); and emotional disorders, 1.2 times (95% CI:
1.1-1.4); compared to population with no risk factors.
Conclusions: This study showed that hypertension is the main determinant factor of CHD that occur in
productive ages. Targeting adults with Healthy Lifestyle will raise the awareness on risk factors of CHD.

Poster 56 (ID888)
Modeling of Dengue Hemorrhagic Fever Intervention in Indonesia (A Contextual Approach)
Tri Yunis Miko Wahyono, Nuning MK Maskuri, Mondastri Korib S
Epidemiology Department, Public Health Faculty, University Indonesia, Depok, Indonesia

Backgrounds: dengue fever is a tropical infectious disease caused by virus. Incidence of the disease increase
continously every year in Indonesia. Some intervention efforts had been done to overcome the increasing,
but the incidence still increased until now. This study aims to look at the effects of interventions (use of
insecticides, larvacide and fogging) against hemorrhagic fever (DHF) in Indonesia with a contextual
approach.
Methods: systematic review and validation study were conducted as a preliminary study. Data from
Riskesdas 2007 involved 20.902 samples from 265 districts/cities. This study is an ecological study using
data of Riskesdas 2007 and additional data of coverage on larvacide usage and fogging from the Ministry of
Health RI and climate data from studies conducted by Arcari et al.
Results: The study indicate that the use of insecticides had an effect (OR = 0.49) and greatest contribution at
all level (on household level 49%, rural 58% and district level 6%) compared with effect of fogging (OR = 0,
94) and the use of larvacide (OR = 0.89). Fogging and usage of larvacide had contribution <1% to the
occurence of dengue fever in Indonesia. Combination of two interventions (use of insecticides and larvacide)

238
had the highest contribution at all level (the household level 49%), rural 59% and district level 9%)
compared to other combination of two intervention variables. Combination of three interventions variables
only provided additional of a small contribution at all level to the occurence of dengue fever in Indonesia
compared to combination of two intervention variables (use of insecticides and larvacide).

Poster 57 (ID892)
Neonatal Death and Its maternal Factors at Four Poorest Districts in Indonesia
Tri Yunis Miko Wahyono, Oktarinda MW, Nasrin Kodim
Center for Epidemiology Research and Surveillance, PHF-UI, Depok, Indonesia

Backgrounds: During 1990’s, Indonesia has been demonstrating a significant progress in reducing
under-five mortality (UFM). IMR that reached 34 deaths per 1,000 live births in 2007 (Statistics Indonesia
and Macro International, 2008). Most of the childhood mortality in Indonesia happens during infancy due to
neonatal problems. (Ministry of Health, 2008).UNICEF carried out project called REACH aimed to reach
MCH coverage improvement in the 4 poorest districts (TTS, Buru, Jayawijaya and Brebes). This baseline
mortality study was done in order to measure preliminary information on UFM in the areas.
Methods: A cross sectional study was conducted collecting all children under five (CUF) died during 2011
and 2012 (including: neonatal). All death information was taken from the list of CUF death that had been
reported by village midwives, cadres and community/religion leaders. The list was improved by doing
verification from those several sources of information.
Results: At total 206 sample neonatal death of 622 CUF deaths, had been selected as total neonatal death
found from the list. The highest proportion of neonatal cause of death (CoD) was: asphyxia (37.9%) followed
by LBW (13.6%). Majority of them (65.5%) was attended by midwives, 35% by TBA and 26.2% by medical
doctors whilst they were delivered. Their mothers had history of ANC with midwives (86.4%), TBA (12.1%)
and specialist (11.2%). The birth attendance and number of children were considered as the factors
associated to CoD of neonatal death (with p Value <0.05).
Recommendation: Some intervention related to birth attendance and number of children should be done in
the areas in order to reduce neonatal death.

Poster 58(ID923)
Description of District Income and Health Financing also the Correlation with Severely
Wasted in Indonesia 2007
Septyana Choirunisa, Asri C. Adisasmita
Department of Epidemiology, Faculty of Public Health, University of Indonesia

Background/Objective: Indonesia is a country with many provinces and regencies/municipalities. This

number of regencies/municipalities (district) make disparities in health status unavoidable, for example one
of the nutritional problem among children under five, called severely wasted. For regencies/municipalities
level, health financing is one of the factor that contribute important role in influencing health status in a
district. Since decentralization has been ruled at 2001, the regencies/municipalities have to organize their
own area autonomously. Therefore, the aim of the study is to describe the district income (the percentage of
local revenue by total district income), health financing (the percentage by total district income and total
expenditure) and examine its correlation with the prevalence of severely wasted among children under 5
years at regencies/municipalities level in Indonesia year 2007.
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Method: This research is an ecological study. Data on revenue and health financing were obtained from
Ministry of Finance, while data on severely wasted were obtained from the Indonesian Basic Health
Research (Riskesdas). There is 250 (from total 435) regencies/municipalities were being object of this
research, while the other were excluded due to incomplete/missing and invalid data.
Results: Nationally, only the percentage of local revenue by total district income had correlation with
severely wasted, although it is weak (r = 0,22). By regions, in the Western Region Indonesia and the Eastern
Region Indonesia, those variable had weak correlation with severely wasted (r = 0,20 and r = 0,53). The
graphic trend show higher percentage of local revenue and health financing, mean lower the prevalence of
severely wasted.
Conclusions: The correlation between district income and health financing for poor nutritional status cannot
be ruled out. It is important factor but couldn’t be considered as a main determinant. More valid and
complete data on district income and health financing is needed for further research.

Poster 59(ID924)
Occupational Health and Safety Culture Assessment: Case Study in Coal Mining Company in
Indonesia
Ridwan Z. Syaaf, Doni Hikmat Ramdhan, Amira Primadona, Ike Pujirian, Farida Tasya
Department of Occupational Health and Safety, Faculty of Public Health, University of Indonesia, Depok - West Java,
Indonesia

Introduction: Management in various sectors, especially among high-risk industries, realized that the
existing health and safety problems do not only depend on the sound of Occupational Health and Safety
(OHS) Management System and the behavior of individual workers, but also influenced by organizational
culture. OHS culture is a sub-set of the overall organizational or corporate culture. A lot of basic studies on
OHS Culture conducted in order to develop corporate’s OHS culture development program for their OHS
performance improvement.
Objective: To describe OHS culture profile as a baseline to develop future behavioral-based OHS program
in an Indonesian Coal Mining Company.
Methods: The study was designed in qualitative and quantitative approach. The assessment used
questionnaire, interview, Focus Group Discussion (FGD) to collect data to obtaining description of workers’
perception of coal mining company which are located in East Borneo, day to day OHS practice, and
organization and OHS management system.
Results: Workers’ personal appreciation of risk has the lowest score. Meanwhile, the personal priorities and
need for safety has the highest score. These study show that workers have a mindset to put the safety on their
priority and they also have the strong need for safety at work, but unfortunately the appreciation of the
workers against the risks in the workplace is still lacking. Therefore, most of worker must be increase their
risk knowledge in order to increase their risk awareness. The result from the assessment of combination of
safety culture aspects can be seen that the company has little value to the work environment.
Conclusion: In general, the appreciation of the workers against the risks in the workplace is still lacking and
the work environment in the company still does not support workers to behave safely.

Poster 60(ID926)
Knowledge of Iron and Folic Acid (Ifa) Supplementation Amongst Pregnant Women in Lebak

240
 and Purwakarta District, Indonesia: A Qualitative Study
Christiana R. Titaleya, Ratu A. D. Sartika RADb, Dini Dachliaa, Amry Ismaila, Rita Damayantia, b
aCenter for Health Research, Universitas Indonesia, Depok, West Java Province, Indonesia

bFaculty of Public Health, Universitas Indonesia, Depok, West Java Province, Indonesia

Background/objective: The provision of iron/folic acid supplement (IFA) has been recommended to prevent
iron-deficiency anemia during pregnancy. One of the objectives of this study is to collect women’s
perception towards IFA supplementation and barriers in using IFA supplements in Lebak and Purwakarta
Districts, Indonesia.
Methods: A qualitative research was conducted mainly with pregnant women in second trimester onwards
and post-partum women within 42 days after delivery. Data were collected in March 2012 in Lebak and
Purwakarta Districts using in-depth interview and Focus Group Discussion (FGD). In total, there were 55
in-depth interviews and 4 FGDs in Lebak, 57 in-depth interviews and 8 FGDs in Purwakarta, with a total of
183 informants.
Results: Almost all women recognized IFA tablets when the tablets were shown to them. Generally, mothers
were aware about the benefit and dosage of IFA supplements. However, some misconceptions about IFA
supplements occurred in both areas. Most respondents (mothers, their husbands, cadres and traditional birth
attendants) associated anemia with hypotension, and IFA tablet was perceived as a medicine used to increase
blood pressure. Some mentioned that mothers might develop hypertension if they took IFA tablets when they
had normal blood pressure. According to mothers, side effects of IFA supplements were rarely mentioned by
health personnel, including midwives, during antenatal visit. Taking IFA tablets were associated with some
side effects such as nauseous feeling, dark stool and constipation, hindering women from taking the
supplements. Amongst husbands, community leaders and traditional birth attendants, only few were aware of
IFA supplements and its dosage.
Conclusions: Health education about how to deal with side effect of IFA supplements is important for
women in these areas. Health personnel should be encouraged to provide sufficient counseling to mothers.
Efforts to increase compliance and decrease misconception in the community about IFA supplements should
become a priority.

Poster 61(ID950)
Ferritin and Oxidative DNA Damage (8 hydroxydeoxyguanosine) Levels in Pregnant Women
in Gowa, Indonesia
Veni Hadjua, Muhammad Nur Hasana, Yustiyanty Monoarfab, Anang Otoluwac
a Department of Nutrition, School of Public Health, Hasanuddin University

b School of Paublic Health, University of Tompotika, Luwuk

c Faculty of Medicine, Hasanuddin University

Background: Oxidative DNA damage has been associated with preeclampsia, small for gestational age
(SGA), and intrauterine growth restriction (IUGR). Oxidative DNA damage has been also correlated with a
deficiency of body iron stores. Therefore, it is important to know levels of body iron stores (ferritin),
oxidative DNA damage, as well as their relationship in pregnant women. This study is part of an umbrella
research on the effect of Moringa oleifera leaf extracts supplementation in preventing maternal DNA
damage in Gowa district, Indonesia.
Methods: The research was carried out from January to December 2012 at Gowa, South Sulawesi,
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Indonesia. The study design was cross-sectional. Sixty-nine (69) eligible pregnant women participated in the
study. Measurement of ferritin using immunochemiluminescent method. 8 hydroxydeoxyguanosine
(8OHdG) was examined by Elisa. Data analysis was performed by Pearson correlation.
Results: The results showed that the average of ferritin level was 102.35µg/l. Of 69 samples obtained, 3
(4%) respondent have ferritin level below normal. Average levels of 8OHdG was 55.08pg/ml. There was
significant relationship between ferritin levels and the 8OHdG (p=0.041). The relationship was negative,
which indicates that the higher levels of ferritin, low-growing 8 OHdG levels.
Conclusions: There was significant negative correlation between levels of ferritin and oxidative DNA
damage in pregnant women.

Poster 62 (ID957)
Factors Associated With Anemia Incidence in Endemic Area of Malaria at Mamuju Regency,
West Sulawesi Province, Indonesia
Ansar Mursahaa, Nurpudji Astuti, Nurhaedar Jafar
a Center for Food, Nutrition and Health Research of Hasanuddin University, Makassar, Indonesia
b Nutrition Department of Medical Faculty of Hasanuddin University, Makassar, Indonesia

c Nutrition Department of Public Health Faculty of Hasanuddin University, Makassar, Indonesia

Background/objective: Anemia is one of the common complication found in acute and chronic malaria.
But, in endemic area of malaria, another factor could give any major contributions to anemia beside
parasitemia of malaria. This study was aimed to explore factors associated with anemia in endemic malaria
area, Mamuju Regency, West Sulawesi Province.
Method: This study was an observational study with cross-sectional design conducting in Mamuju Regency,
West Sulawesi Province with 4401 samples. The sampling method used was multi-stages random sampling.
Data collection include blood smear (malaria), structured questionnaire (family data), anthropometric
measurement (nutritional status) and biochemical examination (Hb). Data analysis used SPSS program
version 16.
Results: Study result showed that anemia prevalence was 29.4% with the highest in children under five
(45.6%) and the range of anemia prevalence by subdistrict was 18.6% to 64.3%. The bivariate statistic test
result showed that malarial parasitemia (p=0,000), food consumption pattern of family (p=0,001), and
Socio-economic status (p=0,000) significantly associated with anemia (α=0,05). The Hb mean was lower in
samples with positive malaria (p=0,000), less of variety of food consumption pattern (p=0,006) and low
socio economic (p=0,000). Multivariate analysis showed that malarial parasitemia contribute more on
anemia incidence.
Conclusion: Combating anemia in Mamuju Regency need an integrated effort through combating malaria,
increase of socio economic status and dietary pattern with food diversification.

Poster 63(ID964)
The Impact of NSDEP-PWs Intervention to the Performance of Posyandu in the Villages of
NICE Project, Maros Distirct, Indonesia
Abdul Razak Thahaa, b, Muhammad Hatta Rahmanc, Andi Firman Jayad, Singgih Supriambodod, Wahyunid,
Endang Ruswiyani Ee, Anang Samudera Otoluwaf
aSchool of Public Health, Hasanuddin University, Makassar, Indonesia

bDanone Institue Indonesia, Makassar, Indonesia

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 cDistrict
Government of Maros, Makassar, Indonesia
dDistrict
Health Office of Maros, Makassar, Indonesia
eMakassar Islamic Universty, Makassar, Indonesia

fSchool of Medicine, Hasanuddin University, Makassar, Indonesia

Background: Posyandu (Integrated Health Care Post) is an institution of public participation which is
managed by Kader (volunteer field workers) at the village level. The performance of Posyandu in 1980-1990
era is very good but has deteriorated in early 2000s. NSDEP-PWS (Nutrition Service Delivery Enhancement
Package for Posyandu Workers) is an intervention of the NICE Project in Maros District to improve
Posyandu performance.
Method: Workshop conducted in 44 NICE villages (compared to 57 Non-NICE villages) for 32 hours or 4-5
days with adult learning approach. Participants are Kader, village midwives, and the heads of sub-village,
and the observers are health workers, village chiefs and community leaders. Materials that include: collecting
family profile data, data processing, identification of child and maternal with the health-nutrition problems,
developing the spot map, Posyandu activities, referral system, growth and development of children
monitoring, and sustainable nutrition program planning. Intervention impact measured by Posyandu
performance indicators include D/S (participation coverage), N/D (relative achievement coverage) and D/S
(total achievement coverage). S = total number of under five, D = number of under five are weighed, and N
= number of under five who gained weight.
Result: The impact from early intervention (2009) to 2012 in the NICE villages respectively for the D/S are
69%, 83%, 91% and 95% compared to non-NICE villages of 61%, 64%, 64% and 68%; N/D for NICE
villages respectively 78%, 83%, 84%, and 88% compared to non-villages NICE respectively 76%, 78%,
78%, and 77%, and N/S on NICE villages respectively 54%, 83%, 84% and 88%, compared to non-NICE
villages respectively 51%, 53%, 53% and 52%.
Conclusion: NSDEP-PWs have a significant impact on the increase of Posyandu performance soon after the
intervention 2009 and sustained until 2012.

Poster 64(ID969)
PM2.5 Exposure and Lipid Profile Among Male Highway Toll-workers in Jakarta
Doni Hikmat Ramdhana, Robiana Modjoa, Gatot Suhariyonob, Nita Irmasaria and Astri Yuniartia
a
Department of Occupational Health and Safety, Faculty of Public Health, University of Indonesia, Depok, Jawa Barat
16424, Indonesia
b
Center of Technology of Radiation Safety and Metrology, National Nuclear Energy Agency, Indonesia

Introduction: The major health problem in urban area is traffic air pollution in which dust particulate is the
most pollutant present on air. Exposure to particulate has been associated with cardiovascular effects
including atherosclerosis. We suggested that exposure to particulate matter (PM2.5) would be associated with
increased lipid levels in highway toll-workers that were exposed to particulates pollution every day.
Objective: The objective of study is to investigate the effect of PM2.5 exposure on lipid level of highway
toll-workers.
Methods: PM2.5 concentration for 8 hours exposure was measured using gravimetric analysis. The blood
samples were taken for analysing cholesterol profile. In total, the samples were consist of 30 highway
toll-workers who worked in the office and 30 highway toll-workers who worked in highway toll gate area.
Results: The study showed that the PM2.5 concentration of the highway toll-workers was higher than

243
that of the office workers. In contrast, the biochemical level of total cholesterol, LDL and TG were
significantly higher in office workers than in highway toll-workers.
Conclusion: Based on the results, PM2.5 exposure did not increase lipid level of highway toll-workers.

Poster 65(ID974)
The Correlation of Malaria Prevention Behaviour in Indonesia
Budi Hartono, Sri Tjahjani Budi Utami, Desi Susanna
Public Health, Universitas Indonesia, Depok, Indonesia

Background/objective: The effort to avoid mosquito bites introduced by the government were sleeping
under bednet, using mosquito coils/electric, using repellent, and insecticide spraying , using a ventilation net
or take a prophilaxis pill as a prevention method. The objective of the analysis was to know the correlation of
the proportion between sleeping under bed net, using mosquito coils/electric, using repellent, and insecticide
spraying.
Method: The data selected form secondary data conducted by Ministry of Health through Basic Health
Research in 33 provinces in Indonesia. There were four variables analyzed, they were sleeping under bednet,
using mosquito coils/electric, using repellent, and insecticide spraying. The data analyzed used pearson
corrrelation in 95% of significant level.
Result: The result showed that the use of repellent had a strong correlation with insecticide spraying (r=0.67;
p < 0.05) and a mild and negative correlation with repellent (r=-0.37; p = 0.036). The rest variables did not
correlate to each other (p > 0.05).
Conclusion: The people in the 33 provinces in Indonesia tended used insecticide spraying and sleeping
under bed net together with using repellent.

Poster 66(ID992)
Practice of Female Circumcision among Under-five Female Children in Bukittinggi, West
Sumatra, Indonesia, 2011.
Mondastri K. Sudaryoa, Darmayantib
a Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
b Bukittinggi City Health Office, Bukittinggi, Indonesia

Background/ objective: In Bukittinggi city, West Sumatra Province, Indonesia, female circumcision (FC)
had been practiced until now. There hasn’t been any study done in this community. This study was aimed to
elaborate FC from reproductive health, tradition and religion perspectives.
Method: This study combined quantitative survey, interviewing 210 randomly selected mothers of
under-five female children, with qualitative study, through in-depth interview toward 5 key informants of
religious and traditional leaders, midwives and mother. Statistical associations to identify FC potential
determinants were also measured.
Results: FC prevalence among under-five female children in Bukittinggi was high (68%), although local
government’s regulation does not support FC. About half of mothers (49%) did FC to their female children at
ages between 41 days and 1 year, together with hear cutting and ear piercing ceremonies. FC was done by
cutting (55%), pricking/ scratching with needle/ scissor (13%) very tiny portion of clitoris. Low percentages
of bleeding (7%) and infections (5%) complication were reported. Most mothers believe that FC is religious

244
(81%) as well as traditional (78%) obligations. This religious/traditional belief was important potential
determinants of FC (PR=1.7; 95% CI; 0.6-5.0). One religious leader and one custom leader said that FC is a
religious law needed to maintain good ethics/moral. Contradictory, another religious leader and a midwife
argued that it is not an Islamic obligation. Apart from this dispute, 57% of mothers and almost all (91%)
family members still supported FC. Mother’s approval of FC was also significant determinant of FC (PR=1.6;
95% CI; 1.3-2.0).
Conclusions: FC among under-five female children was frequently practiced among mothers in Bukittinggi,
although local government does not support this. Although Islamic religious leaders do not have the same
view concerning necessity of FC, most mothers still approve FC and have beliefs that FC is an important
religious/custom/traditional obligations.

Poster 67(ID1027)
Breastfeeding and Reduced Risk of Ovarian Cancer
Asri Adisasmita
Faculty of Public Health, University of Indonesia

Background/Objectives: Breastfeeding has been inversely related to ovarian cancer risk in general
population. However, the association has given inconsistent results. Ovarian cancer incidence is low in
Indonesia compared with high income countries, but it has increased in recent decades, particularly among
urban women. The reasons for this pattern are not known although they are likely related to reproductive and
lifestyle factors. The present hospital-based case-control study uses data collected from out-patient subjects,
visiting "Dharmais" Cancer Hospital, Jakarta, in 2013.
Methods: We conducted a 1:2 case-control study consisted of 71 cases and 140 cancer controls. Data on
breastfeeding and other ovarian cancer risk factors (including reproductive factors) were collected by
interviewing subjects using a standardized questionnaire, whereas confirmed diagnosis of ovarian cancer was
taken from medical records. All cancer controls were cervical cancer patients. Conditional logistic regression
was used to estimate the association between ever having breastfed, as well as total duration of
breastfeeding, and risk of ovarian cancer.
Results: An inverse association was evident between total duration of breastfeeding and ovarian cancer, with
adjusted odds ratio of 0.31 (95% CI: 0.12 - 0.80; p=0.000) among those who breastfed their babies for 1-24
months, and an OR of 0.13 (95%CI: 0.06 - 0.31; p=0.014) among those with more than 24 months of
breastfeeding history compared to those who never breastfed; showing a dose response relationship. Ever
lactating was associated with decreased risk, with adjusted odds ratio of 0.17 (95% CI: 0.08 - 0.39; p=0.000).
Conclusions: A reduction of ovarian cancer risk with prolonged breastfeeding was shown among the study
subjects. Health campaign focusing on breastfeeding behavior by appropriately educating women would
contribute to reduce breast cancer burden.

Poster 68(ID1040)
Profile of Anthropometric, Biochemical, and Body Composition Assessment of Obese
Adolescent Among Student of Hasanuddin University, Makassar, Indonesia
Nurpudji Astutia,c, Ria Qadariahb, Iriyani Harunb, Kurnia Yusufb, Nahla Eva Syariatib, Rahmawati
Syarifuddinb, Wilma Dian Todingb, Ansar Mursahac
a Nutrition Department of Medical Faculty of Hasanuddin University, Indonesia

245
 b Nutrition Department of Public Health Faculty of Hasanuddin University, Indonesia.
c Center for Food, Nutrition and Health Research of Hasanuddin University, Indonesia.

Background/Objective: Obesity prevalence in adolescent is increasing in developed and developing country,

and this would increase the risk for early cardiovascular disease. This study was aimed to describe the
measurement profile of anthropometry, biochemical, and body composition of obesity adolescent among new
student in Hasanuddin University, Indonesia.
Method: This study was a cross-sectional study. Screening of Obese (IMT) was done to all new student.
Obese student was randomized with systematic random sampling to obtain the main sample. The chosen
samples (62 samples) was taken their vena blood to biochemical assessment and body composition using
BIA. Data were analyzed using SPSS program version 16.
Results: The study result showed that obesity prevalence among adolescent (new student) was 7.9%.
Obesity more prevalent among female (8.1%) than male (7.6%). BIA assessment showed mean of body fat
percentage and visceral fat level was 37.26±7.9% dan 11.36±2.5 respectively. Biochemical assessment
showed mean of lipid profile for total cholesterol, LDL, HDL, and Triglyceride was 181.7±33.9,
120.36±31.8, 43.7±7.7 dan 96.3±43.6, mean of HsCRP, apoB, HbA1c and GDP was 2.95±2.9, 94.12±21.3,
5.47±0.29 dan 87.4±9.5.
Conclusion: Obesity prevalence among new student adolescent is quite high. Mean of biochemical
assessment show the point in border line of normal which indicate the increasing of cardiovascular disease.

Poster 69 (ID1041)
Behavior of Female Sex Workers in Drug Abuse to the Increasing Cases of HIV in Indonesia
Amry Ismail, Agus D Setiawan, Dadun
Center for Health Research, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia

Background: Prevalence of drug abusers in group sex workers is high in some countries. In Indonesian
female sex workers group, whether it is also experienced in female sex workers in Indonesia. The existence
of the myth that drug use is considered to provide the sensation of sexual excess or increased stamina, it
often makes most female sex workers unknowingly doing risky sexual behavior. This could increase the HIV
AIDS and STIs among female sex workers and their clients. Objectives of the study wanted to see the picture
of the risk behavior of female sex workers against drug abuse and the use of condoms.
Method: The study using two approaches, qualitative and quantitative, this study interviewed 2041 female
sex workers indirect and direct female sex workers. The study covered 15 cities of the 15 provinces in
Indonesia. Data at analysis from the study illicit drugs in female sex workers in 15 cities of the Indonesia,
2010. (Colaboration Center for Health Research, Universitas Indonesia with Narcotic National Board,
Republic of Indonesia)
Result. On the study of drug abuse rate was 25.2% last year and last month prevalence rate of 17%. Habits
of drugs user as female sex workers has a devastating effect on risky sex such as not using condoms.
Condom use 33% last month. This can increase the transmission of STDs and HIV.
Conclusion. Groups of female sex workers would be at risk when using drugs while having sex. Prevalence,
low condom use will increase the prevalence of HIV. It takes effort to increase awareness of sex workers
themselves to be able to behave in a healthy way to have sex.

Poster 70(ID1044)
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 Physical Working Environment Risk Factor on Acute Respiratory Infection (ARI) for
Workers of PT. X Garment Industry Indonesia in 2013
Nurussakinah, Ririn Arminsih W
Department of Environmental Health; Faculty of Public Health, University of Indonesia, Depok, Indonesia

Background: Garment Industry of PT. X is an industry leading on making clothes for export. Garment
Industry production process involves cotton and textile raw materials usage. According to Policlinic Data,
Acute Respiratory Infection is a number one disease during 2010-2012. This research aims to determine
physical working environment risk factor toward acute respiratory infection to material, cutting and sewing
workers of PT. X Garment Industry.
Methods: This research uses cross sectional study with 102 samples of material, cutting and sewing workers.
Results: Number of workers infected acute respiratory infection are 39 workers (38.2%) and average
temperature, humidity, lighting at working area are 29.7 o C, 69% and 231 lux. Unexpected result in this
research showed that percentage of workers who use PPE (mask) and infected by ARI (39,7%) more than
workers who don’t use PPE (36.4%).
Conclusions: Working environment factor, personal characteristic and behavior are not significantly related
to acute respiratory infection toward workers. PT. X have to provide proper PPE (mask) to their workers and
prohibit them from using masks made from fabric remainings.

Poster 71(ID1046)
Smart Anti-Smoking Youth : A Creative Education Method to Prevent the Increasing Number
of Youth Smoking Prevalence in Indonesia
Zahrina Laborahima
Indonesia University, Depok, Indonesia

Background: According to the research results of the Global Youth Tobacco Survey (GYTS) by WHO in
2006, said that Indonesia exists at 24.5% boys and 2.3% of children aged 13-15 years woman smokers.
Implementation of specific regulations yet about the impact of tobacco control in Indonesia led to
distribution of cigarettes is still not under control. Cigarettes can be easily bought and sold at a price that is
relatively inexpensive and affordable even by students though. People can still smoke freely in any place.
Objectives: Education is an effective way to provide knowledge and awareness of the dangerous of smoking
to adolescents. Through the school can do a method of health promotion interventions by a motion to print
the anti-smoking healthy generation. Younger generation is expected to be an agent of change that can
prevent an increase in the prevalence of smokers.
Methods: With the observation, review of the literature and practical of intervention,. This Papper will
explain the findings of a medical intervention performed on junior high school students. Through the
intervention methods and creative movement to prevent of young smokers with the theme "Smart Youth
Anti-Smoking".
Results: The expected result from this experiment is that a lot of teens understand the dangerous of smoking
and in the end were able to decimate the prevalence of smokers in Indonesia, especially young age.
Conclusions: Health promotion to young people about the dangers of smoking and finding the right method
in its implementation becomes important to do. Movement "Smart Teen Anti-Smoking" has been done in
SMP Negeri 6 Depok. Children who have been given intervention is very enthusiastic and ready to be

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anti-smoking ambassador. From the results of pre-test and post-test conducted on the murid2 also attributed
an increase in knowledge about the dangers of smoking.

Poster 72(ID1072)
Comorbidity effect on Early Re-hospitalizaion among Heart Failure Patients in Jakarta,
Indonesia
Meisinta Florentina, Pandu Riono
Indonesia University, Indonesia

Background: Heart disease is becoming one of mainproblems for chronic disease inIndonesia. Heart failure
is one important problem among heart diseases. Re-hospitalized of heart failure patient made additional
burden health care costs, and also earlyre-hospitalizationof heart failure patients, especially with comorbidity
lead to increasing the risk of mortality.
Objectives: To study the comorbidity effect on early re-hospitalization of heart failure within 30 days after
discharge from first hospitalization.
Methods: Using Heart Failure Registry of Harapan Kita Hospital-Jakarta, we analyzed all 147 cohorts who
first time hospitalized within October 2009-Oktober 2010.
Results: The incident of early re-hospitalization or re-hospitalization within 30 daysafter discharge is18,7%.
Comorbidity is associated with early re-hospitalization of heart failure. There aredifferenteffect of
comorbidities between maleandfemale patients. The risk of malepatients withoutorwithonecomorbidityon
early re-hospitalizationis 3.1(95% CI:0.8-11.6) higher compare to femalepatients without or with
onecomorbidity, andthe risk with morethanonecomorbidityis 2.6higher (95 %CI:0,4-17, 9). When amale
withmorethanonecomorbidityincreasedthe risk to 4.1 higher (95% CI:0,97-16, 96).
Conclusion: The study shows the evidence of comorbidity effect on early re-hospitalizationof heart failure
patients is different among gender differences. The increasing risk of early re-hospitalizationamong male is
higher and concomitant with the number of comorbidity.

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Japan（日本）

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Guest Lecture (from APACPH)
Progress in Infant Health in Okinawa, Japan
Tomiko Hokama
University of the Ryukyus, Okinwa, Japan

The infant mortality rate (IMR) in Okinawa was estimated to be 75 in 1950. In the sixty years since then the
infant mortality rate (IMR) in Okinawa has fallen to 2.4/1000 one of the lowest in the world. As an
economically vulnerable remote island prefecture of Japan, Okinawa has had difficulties in service delivery,
in deploying an adequate health work force to remote islands.
The dramatic improvement in health in Okinawa can be attributed to improving living standard and universal
health care system. In analysing the health service almost all of the attributes can be discerned. These include
good leadership and governance with community support, a good health financing system that provides
resources for all, a well-performing health workforce, access to essential medical products, vaccines and
technologies of assured quality, a well-functioning health information system and research, and good service
delivery. Strong leadership and governance based on the maternal and child health law has enhanced child
health system. Establishment of the educational institutions for medical doctors and public health
professionals located in the islands has enhanced the workforce.
There are many islands and island nations in the Asia-Pacific Region, each with its own history and culture
that influence the health of its residents. Many of these small islands are fragile and are vulnerable to outside
environmental, social and economic influences. Okinawa’s public health and primary health care model for
infants has been very successful and may be applicable to child health in island nations in theAsia-Pacific
region.

Guest Lecture
Effects of Particulate Air Pollution on Respiratory Symptoms and Pulmonary Function in
Japan
Masayuki Shima
Hyogo College of Medicine, Hyogo, Japan

Air pollution is recognized as a major health problem in many countries. In particular, the health effects of
airborne fine particulate matter (PM2.5) have become a major concern. A panel study was conducted to
evaluate the acute effects of exposure to PM2.5 on daily peak expiratory flow (PEF) and wheezing among
asthmatic children who were hospitalized in a suburban district in Japan. The PM2.5 concentrations were
monitored at a monitoring station proximal to the hospital. Moreover, PM2.5 concentrations inside and
outside the hospital were also measured. The changes in PEF in the morning and evening were significantly
associated with increases in the average concentration of indoor PM 2.5 24 h prior to measurement. The
change in PEF was also significantly associated with outdoor PM2.5 concentrations, but the changes were
smaller than those observed for indoor PM2.5. The prevalence of wheezing in the morning and evening were
significantly associated with indoor PM2.5. The odds ratios for wheezing relative to the lowest quartile of
indoor PM2.5 concentrations of 15.4μg/m3 or higher were significantly associated with increased wheezing in
the morning. Wheezing in the evening was associated with indoor PM 2.5 concentrations ≥11.0μg/m3. In
addition, wheezing in the evening was also associated with stationary-site PM2.5 concentrations ≥18.2μg/m3.
In this way, exposure to considerably low concentrations of PM2.5 was associated with PEF and wheezing

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among asthmatic children. Indoor PM2.5 had a more marked effect than outdoor PM2.5 or stationary-site
PM2.5. In conclusion, effects of short-term exposure to considerably low concentrations of PM2.5 on
respiratory morbidity among asthmatic children were shown. The role of chemical constituents and sources
of PM2.5 in the health effects should be further evaluated.

Oral 1 (ID287)
What Are the Further Competencies Required for Regional Health Workers in Japan?
Tomoko Tachibana
National Institute of Public Health, Japan

Background/objective: Japan has been facing various regional healthcare-related issues, including new
health and medical issues and healthcare prevention against environmental risks, in recent years. In order to
resolve these issues efficiently, regional healthcare workers (= RHWs) who can design policies and conduct
overall management, and have a systemic understanding of healthcare-related social systems and the effects
that the social and natural environments have on health and safety, are required. This study aimed to clarify
the “shared professional abilities,” those are the further competencies required for RHWs so as to develop
and prepare a “Model Human Resource Development Competency Required for RHWs” in Japan.
Methods: Review, arrangement and supplementation by a focus group consisting of 8 Delphi members.
Subjects: 1) Ministry of Health, Labour and Welfare (=MHLW): Report of Review Meeting on present
education of RHWs for the appointment of the new term which stated three abilities required of the new
RHWs: basic abilities, political abilities, professional abilities (subcategorized as “cross-field professional
abilities” and “characteristic abilities by profession”; 2) Researches on how to develop and acquire human
resources to promote regional health safety, Research Reports during 2011–2012; 3) MHLW: Report on the
review board of regional healthcare policies.
Results: We successfully integrated individual goals for 8 categories, “Design/Planning abilities,
Information gathering/ Investigative research abilities, Ability to operate regional healthcare projects, Ability
to support individuals, families and each group, Health risk management abilities, Cooperative, coordinative,
social resource development abilities, Project evaluation abilities, Public health sense and target goals for
cross-field professional abilities required for RHWs. Supplemented competency includes the abilities to plan,
organize and direct as well as run necessary projects while striving to ascertain regional residents’ needs for
regional healthcare policies and to actively support municipalities.
Conclusions: Supplemented competency includes running necessary projects to actively support
municipalities.

Oral 2 (ID318)
Effect of Awareness of Household Expenses on Social Rehabilitation
Takaaki Ikedaa, Kunio Kikuchia, Masaaki Kikuchia, Tomotaka Ishiyamaa, Takamasa Tsurumib, Toshiyuki
Inouec, Sachie Shoujid, Takeshi Kikutanie
a Department of rehabilitation, Kikuchi Neurosurgery and Orthopedic Clinic, Koganei, Japan

b Department of rehabilitation, Kanagawa University of Human Services, Yokosuka, Japan

c Tannpopo Support Clinic of home health care, Musashino, Japan

d Department of in-home care support center, Musashino Red Cross Hospital, Japan

e The Nippon Dental University Tama Oral Rehabilitation Clinic, Koganei, Japan

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Background: According to a previous study, a positive correlation exists between awareness of expenses
and actual expenses (Mondo T). In addition, a positive correlation has been demonstrated between social
activities and health (Teresa E). We hypothesized that social rehabilitation of elderly handicapped
individuals could change the awareness of household expenses. Therefore, we organized a social
rehabilitation program for elderly handicapped individuals who use our rehabilitation center under the
Long-term Care Insurance System. This study examined the effect of awareness of household expenses on
social rehabilitation.
Methods: In total, 20 individuals (Group A: 8 males, 12 females, mean age: 70.2 ± 3.5 years) were
approached and asked to establish an independent circle to participate in social community activities. As a
control group, 20 individuals (Group B: 10 males, 10 females, mean age: 71.0 ± 2.9 years) were randomly
selected. A questionnaire was administered consisting of two questions: “What do you think are your highest
expenses every month?” and “What do you think are your lowest expenses every month?” This study was
approved by Kikuchi Neurosurgery and Orthopedic Clinic.
Results: There was a correlation in the degree of care received by Group A and B (p ＝ 0.01, p < 0.05). For
Group A, “drinking and eating expenses” was the most frequent response to question 1, and “cultural
amusement expenses” was the most frequent response to question 2. In Group B, “medical and nursing care
expenses” was the most frequent response to question 1, while “cultural amusement expenses” was the most
frequent response to question 2. Although, there was not a correlation between Group A and B in their
highest expenses (p = 0.17), there was a correlation in their lowest expenses (p = 0.03, p < 0.05).
Conclusions: These results demonstrate that social rehabilitation is an effective way to reduce medical and
nursing care expenses.

Oral 3 (ID720)
Parents and School Connectedness as Protective Factors for Multiple Risk Behaviors Among
Thai Female Adolescents
S. Pilar Suguimotoa, Teeranee Techasrivichiena, Patou M. Musumaria, Suwanna Ruangkanchanasetrb, Teerarat
Tassanapitikulb, Monrudee Chokprajakchadb, Masako Ono-Kiharaa, Masahiro Kiharaa
aDepartment of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan

bAmbulatory Pediatrics and Adolescent Unit, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital,

Mahidol University, Bangkok, Thailand

cRamathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Background: Adolescents often engage in a number of risky behaviors, placing themselves at risk for
serious health problems including HIV, sexually transmitted infections, and unplanned pregnancy. Many
studies in the West have shown an association between risk behaviors and indicators of connectedness
among young people. Given the limited number of previous studies in Thailand, we sought to examine the
role of connectedness and risk behaviors among female adolescents.
Methods: We conducted a cross sectional survey among 2768 female students from grade 10 to 12 in eleven
schools in Bangkok, Thailand from June to September 2012. Data was collected using a computer-based
self-administered questionnaire built from results of a previous qualitative study. We assessed ever having
had sex, alcohol, smoked, visited nightlife entertainment places, and met Internet strangers face-to-face.
Connectedness was assessed using subscales from the Hemingway Measure of Adolescent Connectedness
(mother, father, school, teacher, and friends). We carried out bivariate and multivariate logistic regression
analyses.
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Results: Overall, 61.0% of students reported ever having had alcohol, 15.5% had sex, 14.6% smoked, 10.3%
visited nightlife entertainment places, and 8.5% met Internet strangers face-to-face. The higher students
scored on the mother connectedness scale, the less likely they were to report any of the risk behaviors
assessed in our study. Father connectedness was a protective factor for ever having had sex, alcohol and
smoked. Whereas, those with higher school connectedness were less likely to have ever smoked, visited
nightlife entertainment places or met Internet strangers.
Conclusion: Parent and school connectedness showed to be protective factors related to more than one risky
behavior. Our study highlights the fact that cooperation between mother and schools to reduce female
adolescent risk behaviors may provide wider positive effects. Cultural and age-appropriate strategies for Thai
youth need to be developed. Further studies, however, are needed to understand the experience of Thai male
adolescents.

Oral 4 (ID753)
Prior HIV Testing Experience and Risk Personalization Are Associated with Positive Intention
to Future Testing Among A Probability Sample of General Population in Nonthaburi,
Thailand
Teeranee Techasrivichiena, S. Pilar Suguimotoa, Patou M. Musumaria, Niphon Darawutthimaprakornb,
Sureeporn Punpuingb, Bhekumusa W. Lukhelea, Christina El-saaidia, Masako Ono-Kiharaa, Masahiro Kiharaa
aDepartment of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan

bInstitute for Population and Social Research, Mahidol University, Nakhonpathom, Thailand

Background: Studies on HIV testing in Thailand are limited to high-risk subgroups. However, Thai sexual
culture has evolved intensely during past years and HIV epidemic is no longer confined to certain
sub-populations. We aimed to estimate the rate of HIV testing experience in the general population among a
probability sample of one province in Thailand to serve as baseline data. We further identified reasons for
testing or not testing, facilitators for testing and explored associated factors for positive intention to future
testing.
Method: We conducted a cross-sectional survey in Nonthaburi, Thailand in October-December 2012 using
self-administered questionnaires in internet tablets among 2,138 men and women (aged 15-59 years)
identified through a three-stage household sampling. To account for the effects of multistage sampling, we
used Complex Sample module of SPSS 21 for all statistical analyses.
Results: Of all respondents, 918 (42.9%) reported ever been tested for HIV. The most prevalent reasons for
testing were: attending antenatal care (35.6%), routine health checkup (34.3%), employment application
(15.1%), and blood donation (14.1%). The major reasons for not testing were “I have no risk” (82.2%) and “I
have low risk” (14.4%). Most common facilitators for testing were: “if testing was provided for free”
(32.6%), “somewhere nearby” (31.3%), “anonymous” (29.7%). Regarding future testing, 48% expressed
positive attitude. In the logistic regression analysis, positive attitude towards future testing was associated
with prior HIV testing experience (OR=1.92, p<.001), high HIV risk personalization (OR=1.95, p<.001), the
perception that HIV infection is increasing in Thailand (OR=1.30, p=0.019), and in Nonthaburi (OR=1.37,
p=0.015).
Conclusion: As Thailand is a country with generalized HIV epidemic, increase in testing rates may
contribute to HIV transmission control. Testing should strongly be promoted through culturally appropriate
programs incorporating risk personalization. Providing friendly and stigmatization-free services to create a

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positive experience could lead to future intention of testing.

Oral 5 (ID764)
Prevalence and Reported Reasons of Unplanned Treatment Interruption Among Patients on
Antiretroviral Therapy in the Democratic Republic of Congo
Patou M. Musumari, S. Pilar Suguimoto, Teeranee Techasrivichien, Christina El-saaidi, Bhekumusa Wellington
Lukhele, Masako Ono-Kihara, Masahiro Kihara
Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan

Background/objective: “HIV Treatment as prevention” is rapidly emerging as one of the key preventive
strategies for HIV transmission. However, the success of such strategy critically depends on patient
adherence to antiretroviral therapy (ART). Unplanned treatment interruption is a particular pattern of ART
non-adherence that has been associated with detectable HIV-RNA, thus increasing the risk of HIV
transmission during unprotected sex. The current analysis capitalized on data primarily collected to assess
the level adherence to ART and associated factors among HIV-positive adults in the Democratic Republic of
Congo (DRC), and particularly aimed at documenting the prevalence and self-reported reasons for ART
interruption and restarting the treatment.
Method: Patients were consecutively recruited into the study from three private and one public health
facilities in Kinshasa, DRC, between April and November 2012. ART interruption was defined as treatment
interruption of at least 7 consecutive days since ART initiation.
Results: A total of 898 participants completed the study. The median age of participants was 44 years, and
the majority was female (72.2%). The median treatment duration was 41 months. Most participants were on
first line regimens (97.9%). Treatment interruptions were reported by 103 participants (11.4%). Among
reasons for interrupting ART, 36 (34.9%) participants travelled, 17 (16.5%) were unable to pay for the
medical consultation or for transport, 8 (7.7%) felt depressed, and 8 (7.7%) had pill fatigue. On the other
hand reasons for re-starting the medication mainly included relapse (26.2%) and return from the travel
(26.2%).
Conclusion: We found that ART interruption was relatively common among HIV-infected patients in our
sample. Our results indicate the need to comprehensively address reasons that trigger ART interruption in
order to effectively support and promote patient retention in care and to maximize the benefits of ART in
both treatment and prevention of HIV/AIDS.

Poster 1 (ID183)
BOP (Base of the Pyramid) Business's Impact on Global Health: Future Prospects on Utilizing
BOP Business
Satoko Horiia, Yusuke Kamiyab
a Department of International Health and Collaboration, National Institute of Public Health, Saitama, Japan
b Osaka School of International Public Policy, Osaka University, Osaka, Japan

Objective: This study elucidates the impact of BOP business on global health and discusses about what
points should be considered for the effective use of BOP business on global health.
Method: By using of multidiscipline databases, we conducted literature review about BOP business and
derived the impact of BOP business on health outcome.

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Results: BOP business’s impact on health outcome was categorized into following two types. The first is
improvement of the health situation by answering to the needs of the BOP people and releasing them from a
BOP penalty by making them as consumers of health-care products and services. The second is equilibration
of the social determinants of health of the BOP people by involving them into a co-creation process as
producers or sellers. Various outcomes came out depending on what companies deal with. Though some
studies showed the improvement of health situation by introducing BOP business, it was difficult to identify
the causal effects of the business on the health outcome or improvement of health indicators since there are
few cases evaluate the outcome by the empirical design.
Conclusion: BOP business can be utilized as a development approach in global health cooperation when
BOP business can satisfy the needs of the BOP people and release them from a BOP penalty and when it can
address social determinants of health of the BOP people. Combining these two methods could make the
impact further. However, the impact of BOP business is not clearly defined so far. In order to use BOP
business as a sustainable development approach on global health, it is necessary to introduce
Evidenced-Based Practice (EBP) into a BOP business cycle and to produce evidence by implementing
impact evaluation on representative BOP projects.

Poster 2 (ID487)
A Study Analysis of the Sense of Burden and Amounts of Trips of Nursing Staff in Providing
Nursing Care
Hitomi Kamiyaa, Asuka Yamadab, Eiji Satohc, Daisuke Matsushitad and Toshiro Kumakawae
a Graduate School of Science and Tech. for Future Life, Tokyo Denki Univ,Tokyo,Japan

b Department of Architecture, School of Science and Tech. for Future Life, Tokyo Denki Univ, Tokyo, Japan

c Graduate School of Engineering, Utsunomiya Univ, Tochigi, Japan

d Department of Architecture, Okayama University of Science, Okayama, Japan

e Department of Health and Welfare Services National Institute of Public Health, Saitama, Japan

Background: This paper is positioned as part of a study that examines ward planning by analyzing and
studying the effects of the amounts of nurses’ trips, their numbers of years of work experience, and their
roles on their sense of burden in providing nursing care. How ward planning should be has been evaluated
and examined by means of the amounts of nurses’ trips in providing nursing care in the past. However, ward
planning has not fully been examined in terms of how nurses feel about it, or their “sense of burden in
providing nursing care”.
Objective: This paper aims to obtain the fundamental knowledge to study the effects of ward planning on
nurses’ sense of burden in providing nursing care, by examining whether a difference arises in their sense of
burden between different hospital departments with the same conditions of ward planning.
Method: We conducted a field survey of the amounts of nurses’ trips in a day and their sense of burden in
providing nursing care on nurses in the orthopedic and cardiology wards of a hospital with multiple-corridor
wards.
Results/Conclusions: In a histogram of the question items, differences were seen in nurses’ sense of burden
between hospital departments. A tendency was observed in the correlation coefficients between the amounts
of their trips and the question items in the questionnaire survey pertaining to nurses’ sense of burden in
providing nursing care that the more amount of trips a nurse made, the more sense of achievement he/she
gained in direct nursing care and the less years of experience he/she had in total as a nurse. Then, we
illustrated the causal relationships between the items in a path diagram considering indirect relationships and
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discussed their effects on nurses’ sense of burden in providing nursing care.

Poster 3 (ID492)
Progress of the Research on Current Situation of Clinical Trials in Asian Area
Yoshitoku Yoshida
Department of Healthcare Administration, Graduate School of Medicine, Nagoya University, Japan

Background/objective: We should consider how to build up Asian clinical trial network all over Asian area
to conduct clinical trial in Asia more safely and effectively. In case of researching the current situation about
clinical trial in Asian area, Review Report like Japan has not yet been available. Therefore to investigate it,
we conducted the questionnaire method in Beijing and Shanghai as the first country among Asian area. Now
we are planning to study this research in Taiwan, Korea and Singapore to expand the Asian clinical trial
network.
Method: Current situation in the quality of clinical trials in China was investigated by the questionnaire
method delivered to the medical doctors belonging to the medical institutes in Beijing and Shanghai in which
clinical trials had been conducted. A total of 145 questionnaires in Beijing and 162 in Shanghai were
administered: all 307 questionnaires were completed.
Results: A further 30.9% participated in the audits and inspections conducted by an external authority and
24.2% reported receipt of the audit findings. This 24.2% is consistent with the results of a previous study in
Japan (17.8%) that reported the mean results over 10 years (1999–2008) of the on-site GCP inspection
conducted by Pharmaceutical and Medical Devise Agency of Japan. Our research suggests that clinical trials
in Beijing and Shanghai are conducted and monitored vigorously. As the next step, we checked the
feasibility of conducting the similar research in Taiwan. We discussed this issue last February in Taipei, and
finally we decided not to conduct this research in Taiwan, but we keep contacting to discuss the possibility of
co-research regarding to this issue to build up the network.
Conclusions: To conduct clinical trial in Asia with viewpoint of patient’s benefit, we need to build up the
Asian clinical trial network immediately. This paper shows the progress of the research activity that should
be expanded to all over Asian countries.

Poster 4 (ID587)
A Study on Assessment of Medical District in a Provincial City in Japan
Takayuki Miyakea, Eiji Satoha, Toshiro Kumakawab, Nobuo Mitsuhashia
a Utsunomiya University, Japan

b National Institute of Public Health, Japan

Background/objective: In Japan, medical care system has been developed by configuring the medical
district per two or more cities as one unit to be able to complete necessary medical care in the medical
district. However, in fact, many patients are flowing beyond the medical district, due to the influence that
medical facilities are unevenly distributed. These tendencies are especially seen in the urban area.
Therefore, this study aims to obtain the knowledge towards reconstruction of medical care system by
pointing out the problem of the current medical district and proposing how to configure the medical district
based on the population distribution in the region.
Method: As the analysis method, the medical care system was evaluated by population distribution, medical

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facility distribution and traveling distance of the residents from the road network to the medical care
services. At this time, the analysis was conducted in two patterns which are assuming there is a transfer of
the user beyond the medical district and assuming the medical facilities of outside of the medical district in
which the user resides are not used. Further, the difference between the theoretical medical district that
based on population distribution and the actual medical district was compared.
Results: As the result, it was clear that medical facilities were located in more than necessary in urban areas
and were very insufficient in mountainous areas. Therefore, it found that there was necessity to construct the
medical district not depend on the framework of government because medical care system hadn’t been
developed on the basis of the actual condition in the region.
Conclusions: In Japan, the equity and efficiency of medical resource is required for reduction of social
common capital. Therefore, it is necessary to properly allocate medical resources by redefining the medical
district that serves as a reference to develop the medical care system.

Poster 5 (ID624)
A study on Restructuring of the Childcare Facility for Reduction of Stress from Child Rearing
in Local CIties, Japan
Miku Satoh, Eiji Satoh, Nobuo Mitsuhashi
Utsunomiya University, Japan

Background/objective: In Japan, the employment rate of women is an upward trend since 2003. However,
the rate of the women in the 30's is the lowest in terms of age class. On the other hand, the rate of the women
in the 20's and 40’s are high. This shows that many of the women’s situations, retired works after childbirth
and marriage, return to work after a child rearing term. The reason is that the balance of work and childcare
is so difficult for them in Japan. In addition, the amounts of supply and demand of the nursery have not
matched. It is not desirable on mental health that workers suffer under the influence of marriage and
childbirth. To change this situation, it is important to ensure the expansion of childcare measures and the
flexibility of work styles of men and women. And, to make a foundation that can balance work and childcare
is required.
Method: This study aimed to clarify the consolidation structure by statistics (using Geographical
Information System) and the case study in the actual local city.
Results: This study obtained the following results. (1) Categorized the status of land use and population
change. (2) When the institution that is less than 80% of capacities begins to be conspicuous, it is the
tendency that nursery’s consolidation is started. (3) Moreover, nursery’s consolidation was considered on the
basis of the location of institutions and population change of a surrounding area. (4) Integration of the
institutions that have long distance is difficult.
Conclusions: Judging from the numerical value, the optimum arrangement of facilities was proposed.
Specifically, it is to leave small-scale childcare facilities to the depopulated areas and to replace facilities of
capacity in accord with the number of children.

Poster 6 (ID731)
A Study of Nursing Meals to Improve Quality of Life for Older People
Ikuko Matsuia, Misaki Harigaeb
a WayoWomen’s University, Chiba, Japan

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 b Saint-Care Holding Corporation, Chiba, Japan

Background: Protein-energy malnutrition and aspiration pneumonia caused by salivary hypofunction have
become serious problems in Japan as the elderly population has increased. In response, a range of
food-thickening agents has entered the market recently. This study aims to identify their distinctive
properties and to find the most suitable one for nursing meals. In addition, we recommend the kind of
nursing meals that will help the elderly maintain and improve their quality of life.
Method: We examine the solidity, cohesion, and adhesiveness, among other qualities, of four additives in
ten foodstuffs using a t-test to measure differences in thickness. We also conduct a sensory evaluation and
rank the additives accordingly.
Results: Sample 1 (starch) and Sample 2 (guar gum) require sufficient quantity and time before reaching a
safe thickness. In addition, the evidence suggests that their thickness is reduced by the enzymes in sputum. In
the sensory evaluation, Sample 2 tasted bitter and astringent. It is clear that these samples may reduce
aspiration, but they can also affect the taste of food. Sample 3 (xanthan gum with sodium gluconate) can
thicken food in less than 10 minutes, but it does not maintain thickness, particularly in the case of foods
containing minerals and pectin. The amount and density added to each meal had to be altered because of the
additive’s lack of stability. Sample 4 (xanthan gum) thickens foods quickly and retains the consistency for
some time in all foods. Furthermore, it has stability and does not affect the taste of food. It is the best product
for nursing meals at this time.
Conclusions: Sample 4, made of xanthan gum, is available for both home care and nursing care. We
recommend Sample 4 as the most suitable for improving the quality of life of the elderly.

Poster 7 (ID867)
Disease Characteristics of Visitors Attending A Clinic in Timor-Leste
Miya Komatsua, Mileisy Ramirezb, Swandari Djojoc, Tsutomu Kitajimad, Maria Lopesb Saroj Jayasinghee
a An alumna of Graduate School of International Cooperation Studies, Kyorin University, Tokyo, Japan

b CLINICA SIDARA, Australian Relief and Mercy Serviced Ltd., Dili, Timor-Leste

c Public policy and management, Dili, Timor-Leste

d Graduate School of International Cooperation Studies, Kyorin University, Tokyo, Japan

e Faculty of Medicine, University of Colombo, Sri Lanka

Background/objective: Health statistics are vital to plan and evaluate health services. National health
statistics of Timor-Leste are available but the data at a local level is patchy, especially those of small
communities. Such data would be important to tailor the current health services to better fit the health needs
of the community. This study aims to describe the disease pattern of the visitors to a clinic in a community as
a step toward improving community health services in Timor-Leste.
Methods: The study was conducted at a clinic run by an international NGO in the community with
population of 7000, located 12km away from the capital of Timor-Leste. A team, comprised of a physician, a
nurse, and a clerical staff opens the clinic three mornings a week. We collected date, age, sex, and
diagnosis/symptom of each visitor from January to December 2011 from the registration book of the clinic
and entered them into Microsoft Excel for analysis. The ethics committees at Ministry of Health,
Timor-Leste and Kyorin University approved the study.
Results: In 2011, 843 persons made 1454 visits to the clinic, 311 male (496 visits), 531 female (957 visits),
and 1 unknown. The age distribution of the visitors was 1-14 years 436; 15-64 years 374; ≧65 years 41. A
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Total of 1389 diseases/symptoms were classified into 58 diseases according to ICD-10. The three leading
causes of the visits were acute nasopharyngitis (511), Acute bronchitis (84), Other functional intestinal
disorders (68).
Conclusion: A majority of the clinic visitors had acute infectious diseases. Problems relating to chronic
diseases or injuries were rather rare. This may reflect the limited clinic-hours and the relatively young
population of the community. A comparison with the data from other health facilities could help to further
understand the disease pattern of this community.

Poster 8 (ID898)
Does Antiretroviral Therapy Increase Risky Sexual Behavior of the Recipients? A Result from
A Cohort Study In Khon Kaen, Thailand
Tsutomu Kitajimaa, Yasuki Kobayashib, Kanjana Sanugulc, Sukunta Muadthongc, Nonglak Pagaiyad
a Graduate School of International Cooperation Studies, Kyorin University, Tokyo Japan

b Graduate School of Medicine, The University of Tokyo, Japan

c Sirindhorn College of Public Health, Khon Kaen, Thailand

d Ministry of Public Health, Bangkok, Thailand

Background/objective: Antiretroviral therapy (ART) improves the health condition of people living with
HIV (PLHIV). However, there are concerns that their improved health conditions lead some of them to
engage in risky sexual behavior, which could increase new HIV infections. In Thailand, access to ART is
much improved over the last 10 years, but the evidence about the relationship between ART and sexual
behavior of PLHIV is scare. This study aims to describe whether sexual behavior of PLHIV has changed
since they started ART in Thailand.
Methods: The study followed 146 patients from 13 public hospitals in Khon Kaen Province, Thailand for
three years between November 2009 and December 2012. Inclusion criteria were those who (1) started
receiving ART after January 2009, (2) were aged between 18 and 49, (3) were able to read and write Thai,
and (4) gave us the informed consent. We collected the data from the patients once a year with a
self-administered questionnaire about their sexual behavior in the 3 months prior to the survey.
Results: The proportion of those who was sexually active slightly increased from 44.5%, 52.1%, to 48.6% in
3 years. The Majority of them used a condom every time they had sex (72.3%, 72.4%, and 74.6%), but the
proportion of the HIV discordant couple that did not regularly use a condom in their sexual conducts
increased from 22% to 32%. The proportion of those who had sex with more than one person increased
from 9.2% in the first year to 13.2% in the 2 nd year, but decreased to 8.5% in the 3rd year.
Conclusion: The findings from this study does not indicate that ART patients increasingly took risky sexual
behavior after the initiation of the therapy, though health care providers may need to give closer attention to
the HIV discordant couples to prevent new HIV infections.

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Kazakhstan（哈萨克斯坦）

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Poster (ID967)
Ntersectoral Collaboration Role in Health Protection Initiatives in Kazakhstan
Maksut Kulzhanov
Republican Center for Health Development

Health and wellbeing are the important definitions in population life that depends from different including
social and economical determinants where most important part occupied by intersectoral collaboration.
Intersectoral collaboration became more and more important part in health and wellbeing achievement as in
the world, so in Kazakhstan. During last several years Kazakhstan is on the way of big changes in health
sector. There is health system reorganization, implementing the patient-oriented system, modernization of
payment system, quality assurance implementations, and technical capacity building of health services.
Thanks for these efforts Kazakhstan could reach positive trends in morbidity and mortality rates in short
period of time. But this is only one part of the on-going reforms in health sector in the country. There is
another one which concentrated on capacity building of medical specialists, and one another is oriented to
health education of population, development public health programs on prevention of communicable and
noncommunicable diseases. Health behavior and literacy are the basics of the health promotion initiatives
and share responsibility of population in health protection. Several initiatives are going current time in the
country. There is pilot project on disease management including treatment and primary prevention of most
extended disease – hypertension. Other one is preventive program planned to pilot of health education for
potential risks of stroke among risk population. Prevention of road trauma is one of the programs that
integrated decision between different sectors – health, education, police, other. There is discussion on reasons
of such kind of trauma and their weight index in rising of trauma and develop the appropriate measures. Thus,
there is next step in health sector changing in Kazakhstan that oriented for increasing role of intersectoral
collaboration in health status improvement.

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Republic of Korea（韩国）

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Guest Lecture
Information Systems Approach to Workplace Health Promotion
Young Moon Chae, Ph.D.
Yonsei University, Korea

With significant increases in healthcare costs, the workplace health promotion (WHP) programs have been
identified as a potentially effective approach to reduce risk factors for chronic diseases for workers at small
firms. WHP programs are more essential to the smaller firms due to poor work environments and lack of
younger workers, whereas larger firms tend to recruit younger and healthier employee. Purposes of this study
were to develop and validate performance indicators for evaluating WHP programs based on a logic model
and to develop an executive information system (EIS) to monitor health status of workers by using the
performance indicators for small manufacturing firms.
Seventeen experts for occupational health were asked in a questionnaire for the content validity of indicators.
Furthermore, fifty eight healthcare managers from each worksite responded to the reliability testing and
construct validation survey with the response rate of 84.1%.
Inter-rater agreement index was used for testing the content validity. To test for the reliabilities and construct
validity of the latent variables, composite reliability and the average variance extracted from confirmatory
factor analysis were used. Structuring equation modeling was used to analyze the relationships among
constructs. Finally, 35 performance indicators from 11 constructs were selected.
The indicators were used in EIS for evaluating the performance of health promotion programs at worksites in
order to identify the relative strengths as well as the weaknesses of the WHP program at a particular
workplace in comparison with other firms. We evaluated health promotion programs for 156 worksites by
using these indicators and EIS.
We found that performance indicators and EIS can help identify activities that had clear correlations to their
WHP program goals or desired outcomes.

Guest Lecture
SOHN Myongsei
Asian Institute for Bioethics and Health Law, Department ofBioethics & Medical Law, Yonsei University,
Seoul, Republic of Korea.
Dr. Sohn will give a lecture at Law & Ethics on October 26, 2013

Oral 1 (ID412)
Cost-effectiveness Analysis of Alcohol Control Strategies in South Korea
Hye Young Seoa, Seok-Jun Yoonb, Ji-Hyun Yoona; In-Hwan Ohc, Young Ae Kima, Jae-Hun Jeongb, A-Rim Kimd
a Department of Public Health, Graduate School, Korea University, Seoul, Korea

b Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea

c Department of Preventive Medicine, College of Medicine, Kyung Hee University, Seoul, Korea

d Graduate School of Public Health, Korea University, Seoul, Korea

Background: Hazardous alcohol use is an important risk factor for injury and chronic disease. Heavy
alcohol use has increased the global burden of disease. Like most countries, South Korea has implemented
interventions for reducing alcohol consumption as well, but little is known about their potential costs and
effects. This study aims to assess the costs, effects and cost-effectiveness of alcohol control policies at the
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country-level.
Methods: A cost-effectiveness modeling framework developed by the World Health Organization (WHO)
was used to estimate costs, effects and cost-effectiveness of alcohol control policies, including taxation,
restricted sales access, advertising bans, brief physician advice and roadside random breath testing. Regional
cost-effectiveness estimates for WPRB were contextualized by including country-level data derived from
published reviews and government agencies. Costs were measured in Korean won (₩) for the year 2010;
country-level intervention effects were expressed in disability-adjusted life years (DALYs) averted;
cost-effectiveness was gauged in terms of average and incremental cost-effectiveness ratios (CERs).
Results: In South Korea, the most effective and cost-effective intervention was taxation (1.2 million DALYs
averted per year; CER < ₩92,460 (US$81) per DALY averted. Brief advice in primary care was the most
costly intervention to implement. Compared to WHO-CHOICE (CHOosing Interventions that are Cost
Effective) regional estimates, targeted strategies such as restricted sales access or brief intervention are
expected to facilitate more cost-effective interventions in WPRB, whereas population-wide measures, such
as taxation are recommended in South Korea.
Conclusions: Interventions to reduce the burden of alcohol have proven cost-effective; especially, a
population based approach has been shown to be more effective than targeted strategies in South Korea. The
first priority is maintaining current taxation, followed by increasing current level of taxation and advertising
bans. The differences between WHO-CHOICE regional cost-effectiveness estimates and contextualized
results highlight the importance of country-level analysis.

Oral 2(ID566)
The Economic Burden of Epilepsy in Korea, 2010
Jaehun Junga, Hye-Young Seob, Young Ae Kimc, In-Hwan Ohd, Yo Han Leea, Seok-Jun Yoona
a Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea

b Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University,

Seoul, Korea
c Graduate School of Public Health, Korea University, Seoul, Korea

d Department of Preventive Medicine, College of Medicine, Kyung Hee University, Seoul, Korea

Objectives: The purposes of this study were to evaluate the prevalence of epilepsy and to estimate the cost
of epilepsy in Korea, 2010,
Methods: This study used a prevalence based approach to calculate the cost of epilepsy. Claims data from
the Korean National Health Insurance and data from the Korea Health Panel, the Korea National Statistical
Office’s records of causes of death, and Labor Statistics were used to estimate the cost of epilepsy. Patients
were defined as those who were hospitalized or visited an outpatient clinic during 2010 with a diagnosis of
epilepsy(ICD-10 codes G40-G41). We classified the costs as related to epilepsy into direct costs and indirect
costs. Direct costs included both medical and non-medical care expenses and the indirect costs consisted of
lost productivity and premature death
Results: We found 115,415 treated cases of epilepsy during 2010. The annual prevalence of treated epilepsy
was 228 per 100,000 population, and higher in men. The age-specific prevalence was highest in teenagers.
The total economic burden of epilepsy was 536 billion KRW. Indirect costs(304 billion KRW) were 1.3 times
greater than direct costs(232billion KRW). By gender, Male(347 billion KRW) were more burdened than
women(189.billion KRW). The estimated cost in young age younger than 20 years old was 24.5% of the total
burden of epilepsy. The total annual cost of epilepsy reached 0.05% of the Korea’s GDP and 0.64% of total
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medical expenditure.
Conclusions: The prevalence of epilepsy found in the Korean population is comparable to those in
developed countries. But a Significant portion of the economic burden of epilepsy is borne by people in
young age. To reduce the economic burden of epilepsy, effective prevention and treatment strategies are
needed.

Oral 3 (ID705)
Factor Analysis for Healthcare Expenditures and Its Future Trends in Korea
Jihyun Yoona, Seok-Jun Yoonb, Hye Young Seoa, Young Ae Kima, Jae-Hun Jeongb, A-Rim Kimc
a Department of Public Health, Graduate School, Korea University, Seoul, Korea

b Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea

c Graduate School of Public Health, Korea University, Seoul, Korea

Background: Over the last few years, healthcare expenditures have decreased in many OECD countries
after years of continuous growth. In Korea, the growth rate of healthcare costs has also slowed over past 4
years. Predicting the future evolution of healthcare cost is one of the crucial challenges facing Korea in the
context of the demographic and social changes occurring in Korea. This study analyzes and projects the
determinants of national healthcare expenditures and attempts to draw implications with healthcare policies.
Methods: We used qualitative research methods by conducting an in-depth review of the literature to
examine the factors influencing health care costs and determine how much those factors affect total
healthcare spending.
Results: Key driving factors of healthcare spending in Korea were major coverage expansions,
fee-for-service as the dominant payment method, absence of a gatekeeper, technological progress, an aging
population, increased per capita income, and prescription drug abuse. Recent studies found that factors
affecting this recent slowed growth have generally been attributed to the recession. There were also
longer-lasting causes, such as personal health investment for ‘healthy aging’ and improved sanitary
conditions. Results from studies projecting the impact of each factor on future healthcare spending were as
follows; The demographic effect accounts for an average increase of 1.9 % of the GDP by 2050, an increase
in income by 2.3%, in health status by 0.3-0.8%, and a jump in technological progress of 6.3% of the GDP
by 2060.
Conclusions: This study provides a comprehensive and current look at healthcare spending trends by
incorporating results from an in-depth review of prior studies. Population aging, widely known as a major
determinant of health spending growth, may not be the sole cause anymore. A comprehensive approach
would be needed to cope with emerging trends in healthcare expenditures.

Oral 4 (ID1077)
Analysis on Cost Accounting of Cataract Surgery in South Korea: Focusing on Ophthalmic
Clinics and Hospitals
Kook Hoe Yuna, So Yoon Kimb, Myongsei Sohnc
aDepartment of Medical Law & Ethics, Yonsei University, Seoul, Republic of Korea
b Department of Medical Law & Ethics, Yonsei University College of Medicine, Seoul, Republic of Korea

c Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea

Background: In South Korea, the diagnosis related group (DRG) payment system applies to seven
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categories of medical services — cataract, tonsils, appendix, hernia, hemorrhoids and uterine surgeries, and
cesarean sections. Starting from this July, the system will also apply to not only clinics and smaller hospitals
but also larger hospitals. So, this study aims to calculate the appropriate cost of cataract surgery, and to
derive the proper system for pricing cataract surgery service fees.
Methods: For this assessment, we developed a questionnaire and circulated randomly. The costs of cataract
surgery of 44 different institutions (38 private clinics and 6 hospitals) in South Korea were collected using
indirect surveys for 2011. The cost is composed of direct and indirect costs. We exclude some lens and tests
which are not covered by insurance.
Results: The result showed that average cost is 820,729won and medium cost is 762,214won. In terms of the
type of medical institutions, private clinic showed 803,526won, hospitals showed 954,356won. Also, it was
categorized at the three levels according to the number of surgery: The result shows 814,606won in Group 1
(under 120), 848,252won in Group 2 (121 to 130) and 794, 255won (above 131).
Conclusion: Current DRG cost in Korea seems to not to cover the prime cost enough. Because it
could be possible for low cost to result in lowering quality of surgery, the recommendations are the
health insurance cost calculation taking account of all cost factors and reflecting medical
circumstances practically to ensure quality of cataract surgery for people.

Poster 1 (ID283)
Analysis and Utilization of Public Data in the Age of Big Data -Health Related Data Linkage
Among Agencies in Republic of Korea
Boyoung Junga, b, Myongsei Sohnc, d, e, Soyoon KIMimd, e
a Department of Public Health& Institute of Health Services Research, Yonsei University College of Medicine, Seoul,
Korea
b Department of Research, Health Insurance Review and Assessment Service, Seoul, Korea

c Dean of Graduate School of Public Health Department of Medical Law and Ethics, Yonsei University

d Department of Medical Law and Ethics, Yonsei University College of Medicine, Seoul, Korea

e Asian Institute for Bioethics and Health Law and Ethics, Yonsei University, Seoul, Korea

Background: Many government agencies have health related data in Korea. Each agency’s data, however, is
able to use only its limited purpose and not to be connected to other agencies. The characteristics of the
health related data is also sensitive, since it contains lots of personal information. The objective of this study
is to improve the quality of health services research by liking health related data while protecting personal
information. The benefit of linked health related data is also expanded to areas of clinical researches and
health policy.
Methods: This study will research theories and empirical cases of foreign countries. After comparative
analyzing nature of the data for each Korean agency, the study will propose conceptual modeling and data
management system.
Results: This study will propose the examples utilizing linked data of the national level which prevent the
personal information.
Conclusion: In order to take advantage of the linked health related data, it is necessary to work all agencies
together. According to other foreign countries that have advanced health data management system, it is
required to have an organization that specialized and in charge of the tasks. All types of supports for proper
operation are strongly needed.

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Poster 2 (ID335)
Suggestions for the Improvement of Obstetric No-fault Medical Malpractice Compensation
System in Republic of Korea
Yeon ho Lee a, Jiyong Parkb, Sohn Myongseic, So Yoon Kim d
a Researcher on Public Health Law and Bioethics, Asian Institute for Bioethics and Health Law; Ph.D Student, Graduate
Program in Medical Law & Ethics, Yonsei University, Seoul, Republic of Korea
b Attorney at Law, Researcher on Public Health Law and Bioethics, Asian Institute for Bioethics and Health Law,

Yonsei University, Seoul, Republic of Korea

c Dean, Graduate School of Public Health, Yonsei University; Researcher on Asian Institute for Bioethics and Health

Law, Yonsei University; Professor, Department of Preventative Medicine, Yonsei University College of Medicine,
Seoul, Republic of Korea
d Researcher on Asian Institute for Bioethics and Health Law; Associate Professor, Department of Medical Law &

Ethics, Yonsei University College of Medicine, Seoul, Republic of Korea/ corresponding author

Background/objective: Despite the frequency of obstetric no-fault medical malpractice cases, the current
insurance and patient compensation system is inadequate. In the event that these cases result in serious
adverse events such as death or disability, the societal responsibility is necessary. According to the law, the
Korea Medical Dispute Mediation and Arbitration Agency has been executing an obstetric ‘No-fault Medical
Malpractice Compensation Service’ since April 8, 2013.
Method: The legislation in Japan was referred in the process of analyzing since the legislation in Japan is
most similar to that of Korea.
Results: The main differences between Japan and Korea are in the compensation coverage, funding, amount
of compensation, and the existence of negligence. In reference to funding, while Japan’s healthcare
institutions need not make substantial contributions due to a state insurance system, Korean law stipulates
that the cost be between the state and the establisher of the healthcare institution. Japan also compensates for
infant cerebral palsy up to 300million won, regardless of the healthcare institution’s negligence, in the form
of pensions, but Korean regulations set a maximum of 30 million won.
Conclusions: The medical criteria for compensation coverage in Korea should be established following a
mock implementation based on theoretical study to determine a criteria for severity classification, and to
identify and modify problems in the timing and process of assessment in order to provide more practical and
objective medical evaluation standards.
Current laws restrict compensation to 30million won maximum, but in order to promote practical damage
relief and to strengthen its position as a social compensation plan, the compensation reward should be raised.
Furthermore, as a long-term aspiration, it would be desirable not to limit compensation to no-fault instances,
but to include both no-fault and negligence cases to help with early resolution of medical dispute and protect
obstetric medical infrastructure.

Poster 3 (ID348)
Policy Implications for Expansion of National Health Insurance Coverage to Ultrasound; A
Comparative System study
Donghyun Leea, Myongsei SOHNb, So Yoon Kimc, Eun chul Parkd
aAsian Institute for Bioethics and Health Law; Master Course, Graduate Program in Medical Law & Ethics, Yonsei
University, Korea, Republic Of
b Graduate School of Public Health, Yonsei University; Researcher on Asian Institute for Bioethics and Health Law,

267
Yonsei University; Department of Preventative Medicine, Yonsei University College of Medicine, Korea, Republic Of
c Asian Institute for Bioethics and Health Law; Department of Medical Law & Ethics, Yonsei University College of

Medicine, Korea, Republic Of

d Department of Preventative Medicine, Yonsei University College of Medicine, Korea, Republic Of

This paper covers the policy implications for expansion of National Insurance Coverage to ultrasound by
studying previous papers about related policy and gathering expert’s opinion. This paper suggests a method
of application to Korea by comparison with countries that have insurance coverage for ultrasound such as
Japan, Australia and US in terms of expansion limits, level of man power and system of checking machines.
In terms of NHI coverage standards, there is no detailed regulation for classification of subjects, testing time
and the number of testing currently in Korea but only classifies test type by about 290 anatomical standards.
Therefore, it is neccesary to be more specific in classifying actions by making a rule of upper limit for
number of tests allowed per day and minimum testing time. Moreover, an evaluation system and detailed
rules are required in order to guarantee the quality of testers and equipment, and experts in ultrasound need
to be trained by means of certification and education. Also, in order to provide superior ultrasound, standards
for evaluating equipment quality should be prepared by improving old hardware and parts of the system
where standards are not present.
Current policy direction for NHI coverage to ultrasound only dictate criteria by budget, but discussions have
not covered management after the expansion. However, standards for man power and medical apparatus is
required in order to provide high quality health care service.
An objective analysis, resonable evaluation indicator and policy making is requied after controling coverage
and evaluation rule by setting a database for man power distribution, education and status and quality of
equipment. Furthermore, various and concrete standards together with national support and regulation is
demanded in order to make this solution a boost to the health industry like in the US and Australia.

Poster 4 (ID357)
Building the Patient Safety System: Based on the Patient Safety Databank
Mi Jin Leea,b, So Yoon Kima,b, Myongsei SOHNa,c,d
aAsian Institute for Bioethics and Health Law, Yonsei University, Seoul, Republic of Korea
b Department of Medical Law and Bioethics, Yonsei University College of Medicine, Yonsei University Health System,

Seoul, Republic of Korea

c Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea

d Department of Preventative Medicine, Yonsei University College of Medicine, Yonsei University Health System,

Seoul, Republic of Korea

Background/objective: The objective of this study is to develop a patient safety system and as part of such
development, it shall propose matters regarding the patient safety databank.
Method: The study adopts the comparative institutional analysis. In proposing a suitable patient safety
databank, the study applies the comparative institutional analysis method to analyze and compare the
background of establishing the institutions, legal bases and organizational and functional aspects of relevant
institutions in England, the USA and Republic of Korea.
Results: As a result deducted from the comparative institutional analysis, all three countries including
England, the USA and Republic of Korea share the common characteristics in that there is an increase in the
number of medical disputes and interest on patients' safety has been heightened. In particular, England and

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the USA have both conducted preliminary studies on the adverse events that occur to patients hospitalized
for a certain period of time. However, there has been no such preliminary studies carried out in Korea, and
just recently「The Act of Medical Malpractice Damage's Relief and Mediation for Medical Dispute
Resolution」was enacted and the Korea Medical Dispute Mediation & Arbitration Agency was established in
response to the elevated interest on resolving medical disputes. This implies that it is focused on
post-treatment, in other words resolving the medical accidents after they occur.
Conclusions: England and the USA that have agencies similar to the patient safety databank retain legal
bases for such agency and run an organization team. The agencies of both countries are organized as
affiliates under the Ministry of Health. These organizations have functions including data collection, analysis
and feedback of data regarding medical errors. It is essential to identify current status and develop a wide
range of approaches and feedback system based on the status to achieve an ultimate goal, the safety of
patients.

Poster 5 (ID388)
A Study on the Causes of the Medical Accidents from Analyses of Rulings on Malpractice
Lawsuits in Orthopedics in ROK
Won Leea, Mi Jin Lee b, So Yoon Kim c, SOHN Myongsei d
a Researcher on Public Health Law and Bioethics, Asian Institute for Bioethics and Health Law; MPH of Yonsei
University, Seoul, Republic of Korea
b Post Doctor, the Department of Medical Law and Bioethics, Yonsei University College of Medicine, Yonsei
University Health System, Seoul, Republic of Korea; Researcher on Public Health Law and Bioethics, Asian Institute
for Bioethics and Health Law, Yonsei University, Seoul, Republic of Korea
c Associate Professor, Department of Medical Law & Ethics, Yonsei University College of Medicine, Researcher on

Public Health Law and Bioethics, Asian Institute for Bioethics and Health Law; Seoul, Republic of Korea
d Dean, Graduate School of Public Health, Yonsei University; Director, Asian Institute for Bioethics & Health Law,

Yonsei University; Professor, Department of Preventative Medicine, Yonsei University College of Medicine, Seoul,
Republic of Korea

Background/Objective: The use of health services has increased and general medical technology has
developed in ROK. Even though the high quality of health care services were provided, the malpractice
lawsuits has increased steadily. The rise in medical disputes has caused a rapid increase in corresponding
side effects. These side effects not only negatively affect patients and their families, but also health care
professionals and ultimately threaten public health. Previous researches show that orthopedics comprises a
large proportion of malpractice suits and expected to increase due to a prolonged average life span and surge
in chronic osteoarthritis. Through analyses of rulings on orthopedics malpractice suits, the purpose of this
study is to understand trends of medical accidents in orthopedics. Based on this evaluation, this study aims to
categorize the causes of these medical accidents.
Methods: Analysis of medical malpractice suits in orthopedics, 343cases whose incident numbers date from
2005 to 2010 was performed. As study method, quantitative analysis was conducted with SAS 9.2 for
understanding current situation.
Results : 1. The average period of lawsuits, from the happening of the medical accident to end of the ruling,
took 4.23 years.
2. The most frequent procedure of the cause of the medical accidents was surgery, 159cases, 46.36%.
Secondly, diagnosis and examination accounted for 24.78%.

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3. When surgeries are main procedure of the causes of medical accidents and as a result of examining the
types of surgeries, the spine surgery had the highest percentage of 49.1%.
4. For the result of the accident, the highest number of cases was disability with the percentage of 40.8% and
this percentage was followed by 26.8% of afteraffects and complications.
5. For the injured body part of the accident, spine comprised a large proportion of all.
6. 26.2% were the number of cases of infection outbreak.

Poster 6 (ID398)
Regulatory Issues on Personalized Medicine and Genomics in South Korea
So Yoon Kim, Hannah Kim
Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Republic of Korea

The medical paradigm is shifting toward a standard of prevention, diagnosis, and treatment of diseases that
reflect each individual’s genetic characteristics - personalized medicine. Following this trend, the Republic
of Korea, based on clinical trials and new Health Technology Assessments, has introduced and developed
new drugs and medical technology. The current regulations, however, do not provide enough legal evidence
for revolutionary medical technologies such as genomic research, gene therapy, and/or cell treatments to
become practicable.
Given this, the following study discusses the need for an integrated system that, within the existing
framework, permits the use of the creativity and originality of researchers in the production of scientific
knowledge that was hitherto restricted. In addition, it introduces current trend on legislation about
personalized medicine and application of genomics by supplementing established laws in Korea.

Poster 7 (ID400)
Impacts on the Legal Guidelines for Protecting Genomic Information of Human in South
Korea
Hannah Kima, So Yoon Kima, Grace Sung-Hae Kimb
a Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Republic of Korea
b Asian Institute for Bioethics and Health Law, Yonsei University, Seoul, Republic of Korea

After the completion of Human Genome Project, personalized medicine and human genomic research have
been recognized as nation’s next generation industrial momentum given its huge potential in the future. In
Korea, however, the genomic research using genetic information is increasing, the laws on genomic research
and to protect the genome information still has ambiguity in its system. Various measures have been taken to
improve the problems and recent Guideline for Protecting Genomic Information is using comprehensive
approach to review and deal with problem that can be occurred in the clinical research field.
This presentation, therefore, will provide the background, method and issues, including governance for
genomic research, collection of genomic data, disclosure of information, exchange of genomic information,
and the consent of the guideline.

Poster 8 (ID523)
An Exploratory Study on Pharmaceutical Company's Performance and Growth in South
Korea

270
 Jaeheon Heo
Seoul Cyber University, Seoul, South Korea

Background/objective: Pharmaceutical companies produce pharmaceuticals, raw materials, vitamins, health

functional foods for market. Among diversified products, the reimbursement prices of medicines are
regulated under the National health insurance system in South Korea. I tested the effect of the portion of the
reimbursement products on corporates' profits.
Method: To analyze the effect of the portion of the insurance products on corporate performance, panel data
on 100 top production pharmaceutical companies in 12 therapeutic markets (classified by ATC3 code
system) were collected for the period of 2004-2007 from KNHI’s drug benefit database and official public
statement of company performance released by the Korean Investment and Securities.
Results: On the multivariable panel model, it was found that the portion of total pharmaceutical production
was founded to be a significant factor on the ratio of gross profit to net sales and return on assets(p<0.01).
Although not statistically significant, the production amount of reimbursement products in some
therapeutical insurance markets seemed to be a negative factor on the ratio of gross profit to net sales.
Meanwhile, according to Gibrat's law of proportionate growth effect, the growth rate of a given firm is
independent of its size at the beginning of the examined period. I used GLS(generalized least squares)
techniques to test whether Gibrat's law holds for the same analyzed pharmaceutical firms in the some
selected market for the period 2004-2007. Empirical result rejected the law and it provided some support for
the expectation that reimbursement markets might evolve into more competitive markets.
Conclusions: Phamaceutical companies are very important actors for producing and supplying good quality
medicines. Monitoring market change and the firm’s characteristics such as product mix and size could be
helpful to understand the effect of pricing policy.

Poster 9 (ID524)
An analysis of factors that are related to the persistence of metabolic syndrome over two
consecutive years
Young Ae Kima, Seok-Jun Yoonb, Young Tae Kima, Dong Woo Kima, Jae Hoon Jung b, Hye-Young Seoc, Jihyun
Yoonc, Arim Kimc
aGraduate School of Korea University, Department of Public Health, Seoul, Korea;

bDepartment of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea;

cGraduate School of Public Health, Korea University, Seoul, Korea

Background: Economic development and the adoption of a westernized lifestyle have led to a rapid increase
in the prevalence of metabolic syndrome in the world. The South Korean government has included metabolic
syndrome screening in the national health screening program since 2009 as a preventive measure for
cardiovascular diseases. However, few studies have investigated the persistence of metabolic syndrome
among the South Korean population. Therefore, this study analyzed factors that may be related to the
persistence of metabolic syndrome over two consecutive years.
Methods: This study included 3,369,443 individuals who were either diagnosed with metabolic syndrome
using the NCEP ATP III guidelines or found to be normal over two consecutive years between 2009 and
2011. A chi-square test was used to assess the relationship between several demographic characteristics and
the presence of metabolic syndrome over two consecutive years. Independent risk factors were analyzed by a
logistic regression model.

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Results: A total of 61.6% (2,075,861) of the 3,369,443 subjects included in the study had been diagnosed
with metabolic syndrome for two consecutive years. Across all individuals with and without metabolic
syndrome, 25.4% were 50years old or older and 3.8% were 20years old. Independent factors that were
significantly associated with metabolic syndrome included male gender[odds ratio (OR),1.71; 95%
confidence interval (CI),1.71-1.72], residence within a metropolitan city(OR 1.21, 95%CI 1.21-1.22),
medical aid(OR 2.10, 95%CI 1.83-2.42), non-regular exercise (OR 1.29, 95%CI 1.28-1.30), alcohol
consumption (OR 1.11, 95%CI 1.10-1.11), and smoking (OR 1.40, 95%CI 1.39-1.41).
Conclusions: This study has identified factors that are related to the persistence of metabolic syndrome over
two consecutive years. A prospective study is needed to assess the causal relationship between these factors
and persistent metabolic syndrome.

Poster 10 (ID670)
Utilization Behavior and Satisfaction of Premier Rooms by Types of Medical Institutions in
South Korea
A-Rim Kim a, Seok-Jun Yoon b, In-Hwan Oh c, Young-Eun Kim d
aGraduate School of Public Health, Korea University of Seoul, South Korea
bDepartment of Preventive Medicine, College of Medicine, Korea University of Seoul, South Korea

cDepartment of Preventive Medicine, College of Medicine, Kyung Hee University of Seoul, South Korea

d National Evidence-based healthcare Collaborating Agency of Seoul, South Korea

Background/objective: The price difference between premier room and shared standard room is a big issue
which in turn has a negative impact on the out-of-pocket expenditure of private household in South Korea.
The aim of this study is to elucidate the utilization behavior and satisfaction of premier room users in order
to provide data which could be used in implementing service improvement policies.
Methods: The study population was the people who were admitted to hospital under the National Health
Insurance from October 1st to December 31st, 2012. We randomly selected patients using proportional
stratified sampling from the NHI database. The questionnaire included the utilization behavior, freedom to
choose whether or not to use and satisfaction of Premier rooms. We conducted a telephone survey from June
3rd to 14th, 2013(n= 5,256).
Results: 1279 out of 2097(61.0%) service users who used premier room had no choice in deciding which
inpatient room to stay. Of those, the case at the tertiary general hospital was 53.7%, while the primary
hospital was 17.4%. The most widespread reason for using the premier room was lack of shared standard
room, reported in 82.5%. 55.4% and 14.4% of these service users were in tertiary general hospital and
primary hospital respectively. Satisfaction rate of premier room users who experienced poverty of choice
was 21.4%: Tertiary general hospital showed 56.9%. Of those satisfied service users, 44.5% reported
superior facilities as a basis of their experience. 57.3% was from the tertiary general hospital.
Conclusions: Our survey showed that most service users experienced lack of choice in choosing which type
of inpatient room to stay in tertiary general hospital. Therefore, it seems necessary to improve policies in
implementing increased number of shared standard rooms in tertiary centers. Also further research on
management status of premier rooms and standardization environment in inpatient rooms may be required in
the future.

Poster 11 (ID808)

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Perception and Knowledge on Personalized and Genomic Medicine in South Korea: Based on
‘Experts Survey for Personalized and Genomic Medicine’
Danbi Cho a, Hannah Kim b, So Yoon Kim c
a Researcher, Asian Institute for Bioethics and health Law, Yonsei University, Seoul, Republic of Korea
b Researcher, Basic Physician resident, Asian Institute for Bioethics and health Law, Yonsei University, Seoul,

Republic of Korea
c Director of the Center for ELSI Research, Associate Professor, Asian Institute for Bioethics and health Law,

Department of Medical Law and ethics, College of Medicine, Yonsei University, Seoul, Republic of Korea

Purpose: The aim of this study is to explore the improvement of the genomic research and the application of
clinics and to carry out the policy recommendations in the future by understanding physicians’ experience,
perception and attitude related to the personalized genomic medicine.
Method: A total of 99 complete responses from physicians who are working on personalized genomic
medicine were collected. The structured questionnaire was used and data was collected through the process
of Editing-Coding-Key·in-Programming and analyzed by SPSS (ver.19) .
Results: The respondents who have experience using the genetic information for inspection, diagnostics,
treatment, prognosis of disease and disease prevention, the percentage of using the genetic information was
higher than those who did not. Most of respondents have the accurate knowledge about clinical practice in
general, but with respect to gene therapy and protection of human genetic information, people are vulnerable
in their knowledge. About the question on the present perception level of personalized genomic medicine in
South Korea, the respondents answered that level of knowledge should be developed and industrial
promotion should be needed. Also, they responded that the recognition about the protection level of personal
information and the regulatory level of related study is needed. About half of the respondents reported that
education for health professionals and people other than health professionals need to be improved. Regarding
social atmosphere, proper interests and information exchange is needed and investment in the private sector
and government is important.
Conclusion: To improve personalized genomic medicine, law and institutional device for activating genomic
research should be needed. However excessive commercialization of genetic testing and treatment can be a
social problem where the problem comes from the personal information extrusion. In order to solving these
problems, appropriate information should be exchanged through improving education and social atmosphere.

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Malaysia（马来西亚）

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Guest Lecture
The Role of NGO in Community Screening for Breast Cancer Among Females of Malaysia
Maznah Dahluia, Sophia Mohd Ramlia, b
aDepartment of Social and Preventive Medecine, Faculty of Medicine, University of Malaya,
bFamily Health Development Division, Ministry of Health, Malaysia

Introduction: Breast cancer is the most common cancer among women in Malaysia. Malaysia adopts
opportunistic clinical breast examination (CBE) in health clinics. A non-governmental organization (NGO)
had conducted an outreach CBE screening programme via a mobile clinic to get more women screen for
breast cancer. The aim of the study is to justify its role by evaluating the program; comparing it with the
usual approach of screening.
Methods: Opportunistic CBE screenings by trained nurses were done among women who came for Pap
smear screenings in health clinics in Klang district, Selangor. Women with abnormal CBE findings were
compared with the State Breast Cancer Registry to ascertain their breast cancer status. The mobile outreach
CBE screenings were done by trained retired nurses and volunteers in the outskirt and rural areas. Women
with abnormal breast findings were referred and followed up until their final diagnosis reached. The
outcomes of the study are breast abnormality detection rate and breast cancer detection rate by the two
approaches. Data were analysed using chi square test for categorical variables.
Results: The detection rates for CBE abnormality among those screened through opportunistic CBE
screening were shown to be significantly lower than those screened by the outreach CBE screening
whereby the CBE abnormality detection rates are 0.5% (84/15,279) and 3.1% (48/1543) respectively
(p<0.001). Breast cancer detection rate was higher for the outreach CBE screening (0.2%, 3/1543) as
compared to the opportunistic screening (0.07%, 10/15,279).
Conclusion: There is potential for the outreach CBE screening programme in increasing early detection of
breast cancer in a developing country. The role of NGO in community screening for breast cancer is
important especially among females at rural areas. Collaboration with the NGO would enhance the screening
services by making breast cancer screening accessible for women.

Guest Lecture
Mental Health in Asia
Wah Yun Low, Zahra Fazli Khalaf
Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Mental health is a key determinant of well-being and quality of life, and considered as an integral part of
development. Asian countries have reached considerable improvements in economic conditions and the
quality of life during the last decades. At the same time, people of Asia face several mental health challenges.
The rapid economic improvement associated with increased urbanization impacts the family system and
changes the daily life patterns of the people. High prevalence of depression, increased divorce rates, the
amount of alcohol consumption, the tendency toward substance abuse, and the occurrence of criminal, as
well as suicidal behaviors have challenged the mental health of people in Asian societies. Also the worst
natural disasters occurred in Asia threatened the general well-being and mental health of many people.
Although considerable differences are seen in different countries of Asia, it seems that the decline of the
mental health condition is common and widespread.
Despite the emphasis on mental health care at the international level due to huge burden of mental illness, it
275
has not been a high priory in Asian region. Few human and financial resources are directed towards mental
health care and only a small proportion of people are covered by such care. Number of psychiatric personnel,
number of psychiatric beds available per population and number of social workers are very low compared to
European countries; protection of the rights of people with mental illness is inadequate and rehabilitation
services are scarce or concentrated in urban areas, and often unaffordable.
There is an urgent need for improvement in the provision of mental health care in Asia. It has to be
prioritized in the government policies and national strategies. Reforms must be focused on integration of
mental health into general health care, incorporation of mental health units into primary care, and promoting
training system of mental health professionals in basic primary care.

Guest Lecture
Mohd Amin Jalaludin Ph.D.
Former Deputy Vice-Chancellor, A specialist in the field of Otorhinolaryngology (Ear, nose & throat) at
University of Malaya Specialist Centre.
Dr. Mohd Amin Jalaludin graduated from the University of Malaya with an MBBS degree in 1982. He had a
distinguished academic career in the field of otorhinolaryngology and also in the specialized field of Head
and Neck Surgery. He was the Head of the ENT Department from 1996 to 2000 and later became the Dean in
April 2000. In June 2000, he assumed the position as the Director of the University of Malaya Medical
Centre, a post he held until he was appointed to the Deputy Vice-Chancellorship in August 2006.
Dr. Mohd will give a lecture at Health Management and Health Policy on October 26, 2013

Oral 1(from APACPH)

Prevalence and Trend of Communicable Diseases Among the Orang Asli (Aboriginal)
Population in Peninsular Malaysia Over the Years
Abdul Karim Russ, H
Faculty of Medicine, University Kuala Lumpur Royal College of Medicine Perak, No 3., Jalan Greentown, 30450 Ipoh,
Perak, Malaysia.

Background: The Orang Asli (Aboriginal) are minority indigenous people of Peninsular Malaysia,
numbering a total of 147,412 and comprising 0.6% of the national population in 2004. This presentation aims
to review the important communicable diseases mainly helminth, melioidosis, leptospirosis, tuberculosis,
malaria, hepatitis A, yaws and STDs.
Methods: Literature reviews and author’s studies on seroepidemiology of Burkholderia pseudomallei
causing melioidosis and Rural Medical Mobile Mission (RM3), to assess the magnitude and trend of the
health problems.
Results: According to earlier studies and reports in the 1970s and until now, the health of the Orang Asli
population has been low in comparison to the general population of Malaysia.
In intestinal helminth infections, earlier studies during the 50s to 70s showed very high prevalence ranging
from 91% to 99%. In the 1990s, the prevalence varied between 24% to 92%; and recently in 2012 a study
reported 50% of Orang Asli population to have at least one intestinal parasitic infection. For melioidosis
surveillance in West Malaysian state of Kelantan, the results showed low exposures among the Orang Asli
communities of Pos Hendrop (7.14%) and Kg Tohoi (13.14%). Increasing prevalence of seropositivity in
those engaged in agricultural activities were found. Reports of Hepatitis A among the communities correlate

276
with inadequate sanitation and risk of faecal contamination. Malaria and filariasis are still a problem in
isolated areas close to the forest areas and hydroelectric project. Tuberculosis, leptospirosis, yaws and STDs
were reported in endemic areas.
Conclusion: Inadequate sanitation and untreated water consumption contributes to high prevalence of water
borne diseases. Melioidosis, leptospirosis, malaria, filariasis and other communicable diseases mentioned
remains an important health hazard among the indigenous communities.

Oral 2(from APACPH)

Rural Health Training Model at Universiti Malaya Sabah: PUPUK: Rural Health Perspectives
F. Robinsona, A. Farisa, N. OoThaa, W. Shoesmitha, K. SawNainga, K. Mudina, O. Alib
aSchool of Medicine, Universiti Malaysia Sabah (MALAYSIA)

bSchool of Medicine, UniKL Royal College of Medicine Perak (MALAYSIA)

Background: The Universiti Malaysia Sabah (UMS) School of Medicine curriculum which is of
‘community socially driven’ has introduced a unique ‘PuPUK’ programme (A University & Family
Partnership for Community Wellness Programme) into its undergraduate five-year medical degree
programme.
Objective: To provide an opportunity for medical students to engage with the family as a basic unit at a rural
community early in their professional life and gain some family based health intervention throughout their
undergraduate study. PuPUK programme is also aimed to increase community awareness on the role of
university in the development of the community especially in the rural area.
Methods: During the beginning of their 1st year study in the medical school, these students are put in pairs
and are allocated to ‘foster’ families who are from the rural areas of Kudat district of Sabah, whose
occupations are largely farmers. The medical students would do an average three visits annually to their
foster family, and conduct interviews and join activities with them throughout their undergraduate study.
Students are required to prepare records on visits and annual year reports to be assessed by their supervisors
who would provide guidance and advice in the course of the PuPUK programme.
Results: Till 2012, PuPUK programme has already been implemented to the 10th batch of Universiti
Malaysia Sabah medical students with a total of 632 students and 317 families. Through these smart
partnership between university (students and academicians) and the rural community, both benefited in the
sharing of knowledge transfer, understanding of cultural beliefs and sensitivities of different ethnics, as well
as the health-related behaviour of the rural community, which would assist both parties in building
community empowerment for health in the rural community, while partaking the task to produce culturally
and socially driven of evidence based medicine doctors. Students in their 4th year after identifying specific
health issues of importance in a particular village will engage in health promotion activities, as well as
introduced simple forms of health intervention programmes within their family.
Conclusion: The implementation of PuPUK programme is received well by the local authority and rural
families of Kudat and over the years has enable better cooperation in the change to a better awareness on
self-healthcare with improve healthy lifestyle as proven findings in the students’ reports. PuPUK also has
good potential in enabling the production of more rounded community engaged doctors.

Oral 3(from APACPH)

Socio-demographics & Behavioural factors affecting Betel Quid Chewing Cessation in

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 Malaysia
Ghani WMNa, Zain RBb, Herzog Tc, Jalaludin MAd, Walter Pe
aOral Cancer Research & Coordinating Centre (OCRCC), Faculty of Dentistry, University of Malaya, 50603, Kuala

Lumpur, Malaysia
bDepartment of Oro-maxillofacial Surgical & Medical Sciences, Faculty of Dentistry, University of Malaya, 50603,

Kuala Lumpur, Malaysia

cPrevention & Control Program, University of Hawaii Cancer Centre, Honolulu, HI 96813, USA

dDepartment of Otorhinolaryngology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

eDepartment of Public Health Sciences, JABSOM, University of Hawaii, Honolulu, HI 96822, USA

Introduction: In Malaysia, oral cancer is ranked sixth and fourth most common among Indian males and
females. Unpublished data from OCRCC showed that betel quid chewing is the most common risk habit
(40.5%). This study aims to assess betel quid chewing and cessation habit among Malaysians, and factors
influencing chewing cessation.
Method: Indians were targeted for this study as this habit is mainly practiced by the Indians. After obtaining
formal approval from the local government authorities, community leaders were sought and permission to
carry out the study in their locality was obtained. Data was collected by face-to-face interview at the
respondents’ home via a structured questionnaire.
Results: Majority of the respondents are females (86.0%) while ex-chewers constitute only a small
proportion (16.8). Mean number of years chewing was 26.6±19.7 years, initiation age of 28.7±14.6 years.
Friend’s influence (46.0%) was the strongest factor for initiation, and main reason to keep chewing was most
friend chews (24.8%). Chewing is important during anniversaries (28.8%) and while hanging out with
friends (24.1%). Motivation (70.3%) was the most common method in attempting to quit, some of them
wished they never started chewing (20.9%), some of them never considered quitting (20.3%). Health
concerns were the main quit reason (82.4%). There was a significant difference between current and
ex-chewers in amount of money spent and reasons why chewing is important (p<0.005). In attempting to
quit, there was significant difference (p<0.005) in education level, ingredients used in quid, initiation age and
chewing frequency chewing. Factors affecting confidence to remain non-chewers are method used to quit
and reason of quitting (p<0.005).
Conclusions: Friend’s influence plays an important role in initiation and also cessation of this habit.
Different factors were found to be influencing how/why some managed to quit, attempts to quit and
confidence to remain as a non-chewer.

Oral 4 (from APACPH)

The Prevention of Non communicable Diseases Among Malaysian Aborigines
Osman Ali
Royal College of Medicine, University Kuala Lumpur, Malaysia

Objective: The paper is to discuss the magnitude of NCDs among Malaysian Aborigines (better known as
Orang Asli), its trend and the current intervention program to overcome the increase in the incidence of
chronic disease.
Method: The literature on this topic for the last 10 years were reviewed. Since the published data on this
issue is quite limited in Malaysia, data from other institutions and countries experiences will be used to
provide supporting evidence.

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Results: In general, the health status of the indigenous people is relatively poor compared to the general
population. This is probably associated with their choice to remain in their isolated environment, which is
normally remote part of the country, inaccessible to education and economic activities. However in many
countries, rapid infrastructure development and modernization in their vicinity has changed the lifestyle of
this population and subsequently changed their health status and health seeking behaviours. Most of this
population has adopted dietary habits that are high in animal foods, fat and sugar, foods with greater energy
density and decreased fibre, less active lifestyles, smoking, drink alcohol etc, These has exposed them to
NCDs such as heart disease, obesity, diabetes mellitus, hypertension and cancers. In Malaysia, about 30% of
the adult population of the Orang Asli is hypertensive, 1% diabetes mellitus and less than 1% of heart
diseases and cancers. Although the magnitude is still small and under control, there is evidence that the
prevalence of NCDs among the Orang Asli of Malaysia is on an increasing trend in accordance to
socioeconomic development. Ministry of Health and Orang Asli Development Department has been actively
engaged with this population to prevent the future epidemic of NCDs among them and at the same time to
bring them to a national mainstream of development.
Conclusion: Epidemiologic and nutritional transition has an impact on the livelihood and health status of the
indigenous population in all countries. Due to rapid socioeconomic development, these population has been
exposed to both communicable and NCDs at the same time. Government in many countries including
Malaysia has taken great effort to improve their wellbeing through integrated health care system, primary
health care and aggressive health promotion.

Oral 5(from APACPH)

Motorcycle Accidents: Impact of Prevention Policies - Malaysia
Hoe, Victor C.W.
Centre for Occupational and Environmental He alth-UM (COEHUM), Department of Social and Preventive Medicine,
Faculty of Medicine, University of Malaya

Traffic accidents rank fifth among the leading medically certified cause of deaths in Malaysia and the second
commonest among men. Despite implementation of various preventive measures over the years the number
of traffic accidents continues to rise. The number of vehicles involved in accidents increased by 19.7%
(635,024 - 760,433) over a five-year period from 2006-2010. Although the number of motorcycles accident
only accounted for 15.8% of those vehicles, they contribute to 58.7% of the total fatalities. The aim of this
study was to review the current preventive initiatives focusing on reducing motorcycles accidents.
Methods: Systematic review of peer review literature, accidents statistics, initiatives and policies related
prevention of motorcycle related injuries.
Results: Malaysia has been involved in several initiatives to reduce the motorcycle related injuries. These
initiatives included mandatory usage of helmet for every motorcycle users (rider and pillion), regulation of
compulsory use of headlight for all motorcyclists, implementation of motorcycle lanes on highways, road
safety education in schools and the establishment of the Malaysian Institute of Road Safety Research
(MIROS) which is responsible for conducting research to develop evidence-based intervention programmes
to enhance road safety. Those initiatives did not lead to a decrease in the number of motorcycle accidents due
to constant increase in the number of motorcycles, but the rate of accident per-vehicle did see a decrease
form 1.400% to 1.273% (2006-2010). The number of rider and pillion casualties has also seen a decrease of
59.5% over the same period, however the number of fatalities remains almost unchanged.
Conclusion: More research and initiatives is needed to be to reduce fatalities related to motorcycle
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accidents.

Oral 6 (ID215)
Maternal Marital Status and Other Risk Factors of Adverse Birth Outcomes Among Young
Malaysia Women
Norhasmah Mohd Zaina,b, Low Wah Yuna, Sajaratulnisah Othmana
aFaculty of Medicine, University Malaya, Malaysia

bSchool of Medical Science, Universiti Sains Malaysia, Malaysia

Background: Birth outside marriage is associated with negative social and health implications. Illegitimate
births have increased in Malaysia, but data on the pregnancy outcomes related to maternal marital status is
unclear. This study evaluated birth outcomes of premarital pregnancy and other factors influence the
outcomes among young Malaysian women.
Methods: This prospective cohort study was conducted in four locations in the Peninsular Malaysia, at six
hospitals and six shelters. Pregnant women with and without marital ties at the point of pregnancy diagnosis
were interviewed and shortly after childbirth. A structured questionnaire was used to gather information on
socio-demography, risky behaviors, social support, psychological problems, quality of life, coping skills, and
antenatal and birth data.
Results: Of the 506 women that were recruited during pregnancy, 229 unmarried and 213 married women
were succeeding to follow up until childbirth (response rate 87.5%). Compared to married women, the
unmarried women were more likely to have a spontaneous vaginal delivery (p<0.001), preterm birth
(p=0.007) and low birth weight baby (p<0.001). Marital status were not significantly associated with Apgar
score, birth deformity, intra-partum complication and warded in special care unit. After adjusting
socio-demographic, risk taking behavior, prenatal data, social support and mental health factors in
multivariate logistic regression model, marital status were significantly associated with preterm birth
(OR=1.66; 95% CI 1.05, 2.61) and low birth weight (OR=3.61; 95% CI 1.98, 6.57). In the final model, other
factor significantly associated with preterm birth was antenatal care (OR=4.92) and factor associated with
low birth weight was “use of drugs” (OR=10.39).
Conclusion: Marital status is a risk factor for adverse birth outcomes particularly preterm birth and low birth
weight. Promoting access to antenatal care targeting unmarried mothers with friendly services and provision
of social support program will help reduce these adverse pregnancy outcomes.

Oral 7 (ID552)
Online Victimization of Adolescents and Relationship to Use of Social Networking Sites (SNS)
Mogana Subramania, Mary J. Marret, M.R.C.P.b, Wan-Yuen Choo, Ph.D.a
a JuliusCentre University of Malaya, University of Malaya, Kuala Lumpur, Malaysia
b Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Background / Objective: Online victimization among adolescents due to their participation in social
networking sites (SNS) is on rise and there has been little academic research in Asia and almost none in
Malaysia to examine the factors associated with online victimization of adolescents. This study aimed to
examine the pattern of SNS usage and the prevalence of online victimization of adolescents in Malaysia and
as well as to explore the correlates on online victimization.

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Method: A cross-sectional survey of 1487 students was conducted in 12 secondary schools in the state of
Negeri Sembilan selected through random sampling. The self-administered questionnaire included items on
socio-demographic details, online behaviors and online victimization and other correlates of online
victimization.
Results: One third of the respondents engaged in at least one of the 5 risky online behaviours that were
assesed and engaged in 3 or more risky online behaviours. 52.2 % youths experienced online victimization
with more online harassment then unwanted sexual solicitation. Youths with 4 or more risky online
behaviour are 7 times more likely to experience online victimization compared to those reporting none of the
risky online behaviours (AOR= 6.6, p< 0.001). After adjusting for socio-demographic, internet use
characteristic and number of risky online behaviour adolescents engaged in, frequent online perpetration
(AOR = 21.8, p< 0.001), offline perpetration (AOR = 2.0, p< 0.001), offline victimization (AOR = 1.8, p<
0.001) and high level of parental conflict (AOR = 2.2, p< 0.001) significantly elevated the odds of online
victimization.
Conclusion: Online victimization on SNS is not uncommon and risky online behaviours significantly elevate
the odds of online victimization. However concerns about privacy risk less alarming compared to harassing
behaviour. Significant association between online victimization and online and offline perpetration, offline
victimization and parental conflict were observed. Interventions to reduce online victimization should focus
on risky online behaviour.

Oral 8 (ID690)
Awareness of Warning Signs and Symptoms of Cancer and Anticipated Delay in Help Seeking
Tin T Su, Hazreen A Majid
Centre for Population Health (CePH), Department of Social and Preventive Medicine
Faculty of Medicine, University of Malaya, Malaysia

Background/Objective: The present study used the quantitative data from a population-based survey to
explore the awareness of warning signs and symptoms of cancer and factors associated with anticipated
delay for health seeking.
Method: A cross sectional survey was carried out in four community housing projects in Kuala Lumpur
during 2012. The majority of residents belong to low income groups. The survey recruited a population-
representative sample using multistage proportionate simple random sampling. Altogether 2360 participants
from 833 households were included in this study. The awareness of cancer symptoms, anticipated delay and
barriers in health seeking were accessed by using the validated Cancer Awareness Measure (CAM)
questionnaire. Multivariate logistic regression was developed to identify factors associated with anticipated
delay in help seeking.
Results: Among respondents, 22.1% had zero knowledge score for warning signs of cancer. About 25% had
anticipated delay in health seeking. Participants who had higher knowledge score of cancer symptoms were
less likely to face anticipated delay (OR = 0.80, CI: 0.77- 0.84). Among emotional, service and practical
barriers, emotional barriers played important role in delayed seeking health care. Participants who had at
least one emotional barrier are more likely to face anticipated delay (OR = 2.20, CI: 1.71- 2.83).
Conclusions:Better knowledge of the signs and symptoms of cancer may help people recognize possible
cancer symptoms and therefore reduce anticipated delay in help seeking. Campaigns to educate the public
about cancer symptoms could reduce help-seeking barriers and promote early diagnosis.

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Oral 9(ID840)
Trends in the Prevalence of Intestinal Parasitic Infections Among Orang Asli (Aborigines)
over the Past Forty Five Years (1967—2013)
Bharathalingam Sinniah, Sabaridah Ismail, Myint Myint Soe, Abdul Karim R. Hassan
Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Perak, Malaysia

Background/objective: Intestinal parasitic infections are considered as a major public health problem in
most developing countries. More than 5 billion people are at risk of soil-transmitted helminthiasis. The aim
of this study is to determine the trends in the prevalence of intestinal parasites among the Orang Asli
(aborigines) communities over the past 45 years in relation to socioeconomic and environmental factors.
Methodology: A cross–sectional study was conducted among Orang Asli (Aborigine) in Kelantan, Malaysia.
Stool samples were collected and examined using the direct smear and formal ether sedimentation technique.
Questionnaires were used to obtain demographic information. Published data on intestinal parasitic
infections inOrang Asli in Malaysia from 1967 to 2013 were researched using various sources like the
websites and Pub Med to compare with the current study and compare the trend in the infection over the past
forty-five years.
Results: Of the 86 Orang Asli children examined 50.0% were positive for intestinal parasitic infection.
Soil-transmitted helminths were the commonest with Ascaris lumbricoides (38.4%) followed by Trichuris
trichiura (34.9%) and hookworm (8.1%). The intestinal protozoa detected was Giardia intestinalis (8.1%)
followed by Entamoeba histolytica (1.0%), Entamoeba coli (0.7%) and Blastocystis hominis (0.5%) Since
1967 twenty two studies on STH among Orang Asli show considerable variation in the prevalence ranging
from as high as 90%-100% to as low as 44.3%. The most common parasite detected was Ascaris
lumbricoides (ranging from 4.6% – 86.7%) Trichuris trichiura (2.1% to 98.2%) and hookworm
(0.0%-37.0%). At the same time the prevalence of intestinal parasites has decreased ranging between 50% to
70%. The prevalence of intestinal protozoan parasites fluctuated from 1.0% to 40.0%.
Conclusion: Review of 22 studies on Orang Aslis indicates that intestinal parasitic infections are still highly
prevalent. Poverty, ignorance, lack of education, low socioeconomic status with poor environmental
sanitation are the main factors associated with the continued prevalence of the infection.

Oral 10 (ID939)
Teaching Community Diagnosis and Intervention in the Undergraduate Curriculum Through
A Field Residential Program (FRP) in the Rural Villages, Malaysia
Myint Myint Soe, Osman Ali, Davinder B. Singh, Sandheep Sugathan, Ibrahim Z. Abd Rahman, Sabaridah
Ismail, Ku Yussof E. Ismail
Universiti Kuala Lumpur - Royal College of Medicine Perak, Ipoh, Malaysia

Background/Objective: In an effort to make the undergraduate public health teaching to be more

community based, student centred, enquiry driven, and problem solving, the students are posted to a two
weeks Field Residential Program (FRP) where they are fully engaged with the rural village communities,
conducting Rapid Rural Appraisal (RRA) and community diagnosis, and intervention. The aim of this
presentation is to share our experience of teaching community diagnosis and health promotion intervention,
and the students’ feedback on their learning experience.
Methods: Students use various RRA methods in the community and search for available secondary data to
come up with a community diagnosis. A detailed community survey on the identified health problem
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follows and ends with a health promotion intervention. A feedback and evaluation on their learning
experience was done at the end of posting.
Results: Students’ feedback was very positive. More than 80% of students agreed or strongly agreed that
FRP improved their knowledge and skills in public health, knowledge of health problems and issues among
rural communities, improved their skills to conduct rapid rural appraisal and community diagnosis, plan and
implement a community survey and health promotion intervention. On a scale of 1 to 5, in terms of
usefulness in learning public health, FRP was rated highest with an average rating of 4.4, followed by
practical exercises and field visits. Didactic lectures were the least popular among the teaching and learning
methods with a rating of 3.8.
Conclusion: Engaging medical students in community diagnosis and intervention through FRP improved
students’ learning of public health while it benefits the community and local health care providers.

Oral 11 (ID960)
Chronic pain, impact of pain and pain severity with poor physical function in older people
Noran N. Hairia, c, Robert G. Cummingb, d,e, Fiona M. Blyth,b, d, Vasi Naganathand
a Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
b School of Public Health, University of Sydney, NSW, Australia

c JCUM, Centre for Clinical Epidemiology and Evidence-Based Medicine, Faculty of Medicine, University of Malaya,

Kuala Lumpur, Malaysia

d Centre for Education and Research on Ageing, University of Sydney, Concord Repatriation General Hospital, NSW,

Australia
e ANZAC Research Institute, Concord Repatriation General Hospital, University of Sydney, NSW, Australia

Objective: To establish if there is any gender difference in associations between chronic pain, impact of pain
and pain severity with poor physical function.
Methods: Data from the New South Wales Older People’s Health Survey (OPHS), a population based survey
of 8881 older people aged 65 years and above were used in the analysis. Chronic pain, pain with interference
and pain severity and outcome variable of poor physical function were all measured and determined by
self-report.
Results: Poor physical function were more frequent in respondents reporting chronic pain, pain that interferes
with activities and pain that was of moderate and strong to severe severity. Chronic pain was significantly
associated with poor physical function among men with adjusted Prevalence Ratio (PR) 1.31 (95% CI 1.19,
1.43) and women with adjusted Prevalence Ratio (PR) 1.34 (95% CI 1.28, 1.42). The relationships between
pain with interference and pain severity with poor physical function were similar in older men and older
women. However, adjustment for psychological distress and self-rated health led to greater reductions in
prevalence ratios for older men than women for all associations.
Conclusion: There is no gender difference in associations between pain and poor physical function among
older people. However, psychological distress accounted for more pain-related poor physical function in men
than in women.

Poster 1 (ID6)
Assessing Knowledge and Practice on Clinical Pathways Among Healthcare Professionals in
Universiti Kebangsaan Malaysia Medical Centre
Haris Cendera Khazaani, Aniza Ismail, Saperi Sulong
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 University Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia

Background / Objective: A cross sectional study was conducted at University Kebangsaan Malaysia
Medical Centre (UKMMC) to study and measure the knowledge and practice of Clinical Pathways among
healthcare workers at University Kebangsaan Malaysia Medical Centre (UKMMC) and the factors that
affecting it.
Method: Universal sampling method based on inclusion and exclusion criteria were used and a total of 127
respondents were involved in this study. A self developed questionnaire by the researcher with the reliability
(reliability) tested was used to collect the data. Data was analyzed using Chi Square and Logistics Regression
with SPSS version 17.0. Variables analyzed include socio-demographic, socio-economic and organizational
factors.
Results: Majority of respondents were female (77.2%), aged between 32 to 45 years (51.2%), working as
nurses (71.7%) and with working experience of six (6) years and above (52%). 52.8% of respondents agreed
that there is a proper implementation of the Clinical Pathways program and agreed that there is full
participation by the organization. Overall, most of the respondents have high level of knowledge (52%) and
(70.1%) of them practiced Clinical Pathways. Results of bivariate analysis found, that there are four (4)
factors that have significant relationships (p value <0.05) with the level of respondents' knowledge about
Clinical Pathways. Meanwhile, three (3) factors are found to have significant relationship (p = <0.05) with
the practice of Clinical Pathways in UKMMC. Multivariate analysis results found that only two (2) factors
that are significant as the predictor of respondent’s knowledge about the Clinical Pathways and one (1) factor
is significant as the predictor in practice of Clinical Pathways in UKMMC.
Conclusion: Overall, most of the respondents have high level of knowledge regarding Clinical Pathways and
practice it in their daily tasks as healthcare workers.

Poster 2(ID76)
A Qualitative Study of Knowledge about Abortion Among Malaysian Women Who
Experienced Voluntary Induced Abortion
Wen Ting Tonga, Wah Yun Lowb, Yut Lin Wongc, Sim Poey Choongd, Ravindran Jegasothye
aMedical Education and Research Development Unit

bDean’s Office, Faculty of Medicine, University of Malaya, Kuala Lumpur

cDepartment of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur,

dKlinik Rakyat, Gelugor, Penang,

eDepartment of Obstetrics & Gynaecology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia

Background: Women who did not have information regarding safe abortion or are unaware of their
reproductive rights may subject themselves to harmful abortifacients or exploited by some practitioners due
to current misconceived clandestine environment surrounding abortion. This study aims to explore abortion
knowledge among Malaysian women who had experienced voluntary induced abortions.
Methods: This study adopted qualitative methods. Women (n=31) who had experienced voluntary induced
abortion were recruited from a private family planning clinic between May to June 2011. In-depth individual
interviews were conducted by study researchers using a semi-structured interview guide developed based on
literature review and expert opinions. Interviews were recorded, transcribed verbatim and analysed
thematically.
Results: Women’s knowledge about abortion methods ranged from unconventional/traditional (and its
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ineffectiveness and harmful effects) to modern methods. The women perceived that abortion side effects
included prolapse of the womb, infection, infertility and even possibility of getting cancer, and giving birth to
an abnormal child. They knew that abortions were available at some private clinics but not in government
hospitals due to its restrictions, and based on their own experience of rejections. Generally, women in this
study were unsure of the abortion law in Malaysia but were of the impression that it was illegal since they
felt that government hospitals do not provide the service. However, some were aware that abortion is allowed
under certain health conditions. Majority of the women received abortion information mainly from relatives,
friends and colleagues at work.
Conclusion: There was a lack of clear knowledge about abortion among women in this study. Information
with regards to abortion in terms of methods, side effects, legality and accessibility must be made known to
women so that they are fully informed when making an abortion decision and be able to access safe and legal
abortion should they need one.
Poster 3 (ID184)
What Improves Quality of Life- Views from Post-stroke Survivors in Kano, Nigeria
A. M. Hamzaa, A. S. Nabillaa, S. Y. Lohb
aCenter
for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of
Malaya, 50603 Kuala Lumpur, Malaysia
bDepartment of Rehabilitation Medicine, Faculty of Medicine Building, University of Malaya, 50603 Kuala

Lumpur, Malaysia

Background: Cerebrovascular Accident or stroke is currently the main cause of neurological disability in
Nigeria. However, the residual physical consequences are not necessarily associated with Quality of Life
(QOL) as some survivors are able to adapt to their disabilities while others are devastated even by a minor
sequelae.
Methods: Using qualitative interviews with 15 informants, this study explore the complexity of factors
influencing the quality of life of post-stroke survivors. Thematic analysis via constant comparative method
and aided by NVivo 9 software was used for the qualitative analysis.
Results: The 19 sub themes emerged from the in-depth interview. These themes influencing stroke
survivor’s quality of life were regrouped into 7 themes. Of these, 4 themes have further related issues whilst
3 were independent issues: adaptive and coping strategies, the impact of the extent of disability (effects of
activities of daily living on functioning, effect on self and identity, effect on religious activities, effect on
occupation and return to work), social relationship and support system (social and instrumental supports,
communication, autonomy, social role adjustments, sexual relationship), resources (medical services and
rehabilitation, spiritual and resources, educational skills and experiences), anxiety and distress due to
(financial resources, perceived change in body image, fear of uncertainties, increased forgetfulness), pains
and stigma.
Conclusion: The finding of this study supports that measures of stroke-related quality of life should be
subjective and multidimensional. Priorities should be focused on socio-cultural activities considered most
essential to an individual’s identity; drawing on existing resources including health services and
rehabilitation, social relationship and support system to address individual’s identity.

Poster 4 (ID219)
Cost Effective Analysis (CEA) of Recall Methods for Cervical Cancer Screening Program in
Selangor - Which is the Best?
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 Rima Marhayu Abdul Rashida, b, Sophia Ramlia, b, Jennifer Johna, b, Maznah Dahluia
aDepartmentof Social and Preventive Medicine, Faculty of Medicine, University, Malaya, Kuala Lumpur
bFamily Health Development Division, Ministry of Health Malaysia, Kuala Lumpur.

Background/Objective: Cervical cancer screening in Malaysia is by opportunistic screening which

contributed to the low uptake. To overcome this, a pilot project called the SIPPS program (translated as
information system of pap smear program) had been introduced whereby women were invited for pap smear
and recall for repeat smears. This study aimed at determining the most cost-effective recall method in getting
women to repeat pap smear.
Methodology: 1000 women who attended pap smear and had normal cytology in the previous year were
randomized into different recall methods to repeat smear. The outcome chosen was the response to recall by
attending pap smear screening. The total cost applied for cost-effectiveness analysis (CEA) includes the cost
of sending first invitation letter, recall methods and cost of twice pap smear screening. CEA of pap smear
uptake by each recall method was performed.
Results: The percentage of women who responded to recall and the pap smear uptake by postal letters,
registered letter, sms and phone call were significantly different (p<0.05). The total cost up to recall for a
woman by each recall method were highest for registered letter and the cheapest for sms. The Cost Effective
Ratio (CER) for the recall method was lowest for phone call compared to other interventions at RM 93.56 +
0.15 per pap smear uptake. ICER showed that it is most cost saving if the usual method of recall by postal
letter be changed to phone call.
Conclusion: The possibility of letter as a recall for repeat pap smear to reach the women is higher compared
to others. However, getting women to do repeat pap smear is better with phone call which allows direct
communication. Despite the high cost of phone call as a recall method for repeat pap smear, it is the most
cost-effective compared to others.

Poster 5 (ID225)
Knowledge and Practice of the use of Prescription Medicines, Complementary and
Alternative Medicines and Food Supplements among Elderly Malay Population in the
Community
Osman Ali
Kuala Lumpur University, Malaysia

Introduction: World population is ageing and by the end of 2020, the age group of 65 yrs and more are
expected to grow by 7% in Malaysia.. Chronic illnesses are more common in elderly and they are major
consumers of drugs in the society2. It has been observed that the elderly population is most often using
alternative medicines and/or herbal products and also nutritional supplements with or without modern
medicines (prescription drugs). Use of herbal or dietary supplements has been increasing by 14% in older
women in 1998 to 27% in 2002 and 49% in 2006.
Objectives: The present study was undertaken:
1. to determine the most prevalent self-reported chronic illnesses among elderly Malay population in the
community.
2. to determine the common prescription drugs taken by this group and the knowledge about these drugs.
3. to determine whether they are taking any complementary alternative medications with or without
prescription drugs and the knowledge on the use of those medications.
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to determine the use of any food supplements and/or vitamins and the reasons for their use.
Methodology: This is a population- based, cross-sectional study conducted using pre-validated
questionnaires among Malay subjects aged 60 years and above in the semi-urban and rural areas in Perak,
Malaysia. The data were collected by trained interviewers on their current health status and practices of
medications.
Results and conclusion: Major chronic illnesses prevalent among the elderly Malays are hypertension,
diabetes and bronchial asthma. Therefore, most of the prescription medications contain different
anti-hypertensive, anti-diabetic and anti-asthma medications. The subjects are well aware of their illnesses
and the medications they are using. Use of one or more alternative medicine/ herbal drug is common among
elderly Malays. These are mostly used as an adjunct to the prescription medicines. Food supplements are
used very commonly among elderly Malays as energizers.

Poster 6 (ID248)
Association of Sitting and Obesity Among Adults in Rural Communities in Malaysia
Daniel W.J. Tana, Pui Mun Liewa, Yogeshwarran Nadesona, Esan Ravi Chandrana,
Noran Naqiah Hairib, Foong Ming Moyb
a Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

b Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of

Malaya, Kuala Lumpur, Malaysia

Background: In recent years, there has been growing interest in the association between sedentary
behaviour (sitting) and health outcomes such as obesity, diabetes mellitus and cardiovascular diseases. Many
studies have shown significant association between the two among adults in the West. However, there was
paucity of such studies in the East especially developing countries like Malaysia. In view of Malaysia’s
upward trend in obesity, this study aimed to study the association of sitting with obesity among rural adults
in the state of Pahang.
Method: This was a cross-sectional study. Data was collected in 2008 from five districts in Pahang. Data
collected included socio-demographic characteristics, weight and height, lifestyle behaviour, physical
activities and sitting time. IPAQ was used to quantify the participants’ physical activities and sitting time.
Descriptive analyses were used to describe the baseline characteristics of the participants while logistic
regression analyses evaluated the association between sitting and obesity, controlling for confounders such
as age groups, gender, race and smoking status.
Results: A total of 2037 participants were recruited. There were slightly more female participants (54.5%)
and majority of them were of Malay ethnicity (73.8%). The prevalence of obesity was 18.8%. The mean
(standard deviation) sitting time was 3.4 (±2.18) hours/day. In the multivariable logistic regression model,
obesity was associated with sitting more than 3 hours/day (OR=1.54, 95% CI: 1.11, 2.14), age group in the
50s (OR=2.63, 95% CI: 1.61, 4.29), female (OR=1.74, 95% CI: 1.14, 2.07) and Malay ethnicity (OR=3.70,
95% CI: 1.32, 10.37).
Conclusion: Longer sitting time was significantly associated with obesity as people who sat more had higher
odds of being obese compared to those who sat less.

Poster 7 (ID272)

287
Pre-sarcopenia and Its Relationship with Physical Disability Among Rural Elderly in Pahang,
Malaysia: A Cross Sectional Study
Wern Sheng Laia, Yit Nian Laia, Azlah M. Azhara, Kiahs S. Shaika, CRP Muar 2 2013a, Noran N. Hairib,
Foong Ming Moyb
a Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

b Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of

Malaya, Kuala Lumpur, Malaysia

Background: Aging process is associated with loss of muscle mass and muscle strength. This study aims to
determine the association between presarcopenia (low muscle strength and mass) with physical disability
among rural elderly in Malaysia.
Methods: Using a cross-sectional study design, 547 elderly (aged 60 years and above) from five districts in
Pahang were recruited. Hand grip strength was assessed using Jamar hand-grip dynamometer, while muscle
mass was estimated using a formula by Lee et al. Physical disability was based on self-reported activity of
daily living (ADL) measured using Barthel Index. Descriptive analyses were used to observe baseline
characteristics of the elderly population and the trend of reduction of muscle mass and strength according to
age group. Logistic regression analyses evaluated the association between muscle mass and strength with
physical disability, controlling for confounders such as age, gender and education level.
Results: Mean age (standard deviation) of the elderly was 68(±0.27). Hand-grip strength and skeletal muscle
mass decreased with age. Elderly with physical disability were older, shorter, had lower BMI, more
co-morbidities, lower hand-grip strength and muscle mass. The odds ratio (OR) of physical disability for
muscle strength was 1.69 (95% CI: 0.99-2.86) while the age-adjusted and multivariate-adjusted OR were
1.22 (95% CI: 0.69-2.15) and 1.08(95% CI: 1.03-1.14) respectively. The OR for muscle mass was 1.47(95%
CI: 0.89-2.42) while the age-adjusted and multivariate-adjusted OR were 1.08 (95% CI: 0.63-1.84) and 1.38
(95% CI: 0.57-3.33) respectively.
Conclusion: Low muscle strength compared to low muscle mass has significant association with physical
disability among elderly.

Poster 8 (ID290)
Health Seeking Behavior among T2DM in Primary Care Setting: A Grounded Theory
Approach
LL Lowa, SF Tongb, WY Lowa
a
Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
b
Department of Family Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

Background: Diabetes is a chronic disease that has serious consequences if poorly controlled. Hence,
exploring patient’s health seeking behavior is important in order to facilitate the management of diabetes.
Methods: We adopted grounded theory approach. In-depth interviews were carried out among twelve
patients with Type 2 diabetes mellitus, nine family members of the above patients and five health care
providers. In addition three focus group discussions were also carried out among health care providers from
study centre. Theoretical sampling was used to aid saturating the theoretical framework explaining the health
seeking behaviour of the patients. The in-depth interviews and focus group discussions were audio-taped and
transcribed verbatim, followed by line by line coding and axial coding. Constant comparison method was
used to construct the themes and core category.
288
Results: The health seeking behavior of patients with Type 2 diabetes mellitus is about experimenting with
different modalities of treatment. The experience of how the diagnosis was made, perception towards the
cause of diabetes, experiencing symptoms or diabetes complication and influence of society had affected
their choices of experimenting strategies The experimenting strategies include trials of “modern” treatment,
traditional treatment and self-care. The outcome of these strategies shaped their way of health seeking
behavior, and ultimately utilization of health care system. The stages and development of their health seeking
behaviours are iterative and dynamic, which were dependant on the influences they received during the
experimenting process.
Conclusions: Health seeking behaviors of patients with Type 2 diabetes mellitus are basically experimenting
different treatment modalities by trial and error with the aim of finding an appropriate remedy. This
information is crucial for health care providers and policy makers to develop a diabetes program for the
nation.

Poster 9 (ID295)
Correlates of Lifestyle and Sociodemographic Factors with Prostate Symptoms Among
Elderly Men
Ying Guat Ooi, Teck Cheng Yap, Wan Izzah Wan Jaafar, Nur Liyana Zakaria, Nurul Amira Zaimy,
Muhammad Asyraf Zakaria, Zhun Foo Tan, Siti Zaharah Salim, Ridhayah Aziha Rosli, Jie Xiang Leong, Wan
Yuen Choo, Tin Tin Su
Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Background/objective: Prostate symptoms or Lower Urinary Tract Symptoms (LUTS) are common
conditions among elderly men and may significantly reduce their quality of life. The aim of this study is to
examine the association between socio-demographic and lifestyle factors with prostate symptoms in elderly
men aged 60 and above in Malaysia.
Methods: A cross-sectional household survey was conducted among 319 elderly men in the state of Perak,
Malaysia. A structured interviewer-administered questionnaire and physical examination was conducted.
Information collected included sociodemographic characteristics, medical history and lifestyle factors such
as smoking status, dietary practice and level of physical activity. Prostate symptoms were assessed by using
International Prostate Symptoms Scoring (I-PSS).
Results: A total of 298 (70.8%) elderly men were found to be symptomatic. About 4.4% have severe LUTS.
Preliminary analysis found that age, race, body mass index (BMI), coronary heart disease (CHD), diabetes
mellitus, hypercholesterolemia, smoking, diet and exercise was not associated with LUTS. Higher waist hip
ratio was found to increase the odds for LUTS although the association is not significant (p=0.051).
Hypertension may increase the odds of LUTS among elderly men.
Conclusions: Prostate symptoms are commonly found among elderly men in Malaysia. Waist-hip ratio and
hypertension may increase the risk of LUTS in elderly men. Routine screening and treatment for LUTS
should be provided to elderly men to improve their quality of life.

Poster 10 (ID298)
Prevalence and Factors Associated with Falls Among Community-Dwelling Elderly in
Malaysia

289
 Uen Yea Yeong, Soon Yee Tan, Yashini Mohan, Jun Fai Yap, Mohd Lokman Hakim B. Ghazali, Muhammad
Qahhar B. Md Jasa, Nur Nazilahani Bt. Jailani, Nurul Huda Bt. Mohd Nor, Rathakrishnan A/L Venkatasami,
Siti Norhawa Bt. Mahat, Tin Tin Su, Wan Yuen Choo
Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Background: Injury due to fall is commonly encountered especially among the elderly population.
However, there is limited community based study conducted to investigate the extent of falls among elderly
in Malaysia. The objective of this study is to determine the occurrence of falls and its associated factors with
falls among elderly living in rural community.
Methods: A cross sectional study conducted in randomly selected households from 5 districts in the state of
Perak, Malaysia. A total of 811 respondents aged 60 years and above were interviewed face-to-face using a
structured questionnaire. The questionnaire consists of socio-demographic information, comorbidities,
medications, smoking status, dietary practice and level of physical activity, assessment of independence, and
experience and frequency of falls in the past 12 months. Clinical examinations such as blood pressure, height
and weight, were also carried out.
Results: About 4.4% of the elderly reported experiencing falls in the past 12 months. Socio-demographic
and lifestyle factors such as age, gender, ethnicity, marital status and physical activity were not associated
with experiencing falls. Clinical factors such as having hypertension, heart disease, stroke,
hypercholesterolemia, hearing problem and urinary incontinence showed no association with falls. However,
diabetes mellitus increased the odds of falls among elderly by two fold, although the association was
statistically insignificant (OR=2.05, 95%CI=0.99-4.26; p=0.053). Consumption of hypnotic drugs
significantly increased the odds of falls among elderly (OR=2.7, 95%CI= 1.1-6.5; p=0.024).
Conclusion: The data show that elderly are predisposed to falls. The usage of hypnotic drug is associated
with increased risk of falls among the elderly. Greater caution in the use of these medications is warranted.

Poster 11 (ID313)
The Prevalence of Obesity and Its Associated Factors among Adolescents and Young Adults:
A Cross Sectional Study
Haw Shyan Ng, Muhammad Taufiq Zulkarnain, Nurain Nadiah Mohamad Nor, Mohd Ikwan Aifq Mohd
Husainin, Muhammad Syazwan Md Shalan, Jun Yuan Moh
Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Background/objective: There is considerable evidence that obesity is a major public health risk with at
least 2.8 million adults dying each year as a result of being obese. Our objective is to determine the
prevalence of obesity among adolescent and young adult, and we also aim to determine factors associated
with obesity such as level of physical activity, ethnicity, sex and age.
Methods: A cross-sectional household survey was conducted among 689 respondents in five districts of the
state of Pahang, Malaysia. A structured interview-administered questionnaire and physical examination was
conducted. Information collected included sociodemographic characteristics, weight, height and physical
activity level. The level of physical activity was accessed using International Physical Activity Questionnaires
(IPAQ). Descriptive, bivariate and multiple regression analyses were performed to examine how level of
physical activity, ethnicity, sex and age are associated with obesity (BMI).
Results: From the result obtained (n=636), a population where 7.2% of obese adolescents and young adults
was reflected. Variables such as level of physical activity, ethnicity, gender and age were assessed in this
290
study. Among all variables only physical activity level and age showed significant difference in obesity
prevalence (p <0.05). Increasing age has an odd ratio of 1.180, which indicated age as a leading factor of
obesity. Higher physical activity level is positively associated with higher prevalence of obesity with an odds
ratio of 2.21.
Conclusion: Prevalence of obesity is 7.2% among adolescents and young adults. Obesity prevalence
increases in a higher age group. Physical activity level acts as a predictor of obesity with age as the
confounding factor. Findings in this study suggest that further investigations should be done to study this
topic more comprehensively using study designs that could show temporal relationship such as a cohort
study and including other important variables such as dietary habits.

Poster 12 (ID331)
Environment and Health Landfill
Lai Mei Yee, Hui Yin Teh, Chee Yong Leow
Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Background: Malaysia faces the solid waste management problems along with the progress of
industrialization. There are approximate 7.34 million tons (6659 million kilogram) of solid waste per year
and landfilling is used as a main method of solid waste disposal. There are altogether 291 of landfills in
Malaysia however only 3% are sanitary landfills. Therefore, it is important to evaluate the role of authorities
and public health personnel on controlling pollution and potential infectious diseases caused by landfill
activity.
Method: A case study was conducted in “Simpang Renggam landfill” in Johor, a southern state in Malaysia.
Observation of the process of waste management and surrounding environment were conducted. An in-depth
interview was carried out with the management authority of the landfill.
Result: Simpang Renggam Sanitary Landfill is one of the main landfill in southern Malaysia. It minimizes
the export of waste from the local areas which reduces the cost of waste disposal. This landfill allows the
local governments to enforce a regulation regarding managing waste disposal. One which is practised is the
use of membranes to protect groundwater from dangerous runoff. Currently, there is no existing method to
treat the leachate in this landfill. The safety of the workers is emphasised by instilling regulations to use
personal protective equipment but are not strictly enforced.
Currently, the landfill is undergoing closure and restoration work which includes of soil covering, leachate
collection and treatment as well as landfill gas passive vents. Presently, landfill gas is released into the
atmosphere directly without proper treatment.
Conclusion: With proper designed and well managed waste management by using landfills can provide safe
and cost-effective waste disposal in low and middle income countries. We would also like to suggest that
reclamation of the landfills should be done once exceeded its limit for the benefits of society.

Poster 13 (ID336)
Effects of Progressive Muscle Relaxation to Alleviate Job Stress in the Automotive Assembly
Line- A Worksite Health Promotion Programme (WHPP)
Bala M. Sundram, Maznah Dahlui, Karuthan Chinna, Retneswari Masilamani
Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

291
Background: The aim of this study was to evaluate the effectiveness of individual-focused stress
management training namely Progressive Muscle Relaxation on self-perceived occupational stress among
male automotive assembly-line workers in Malaysia.
Method: A quasi-experimental study was conducted at 2 automotive assembly plants in Malaysia over 11
months. Assembly-line workers from Plant A received the Abbreviated Progressive Muscle Relaxation
training while Plant B acted as a control by receiving pamphlets on stress and its ill-effects. Participation was
voluntary. Intention-to-treat analysis was conducted among the respondents in Plant A (n=468) and Plant B
(n=293). The level of stress was measured using the short form Depression Anxiety Stress Scales-21
(DASS-21) stress subscale.
Results: Significant favourable intervention effects were found in Plant A (Effect size=0.6) as compared to
Plant B (Effect size=0.2) at the end of the study in those receiving Progressive Muscle Relaxation therapy.
Time and group interaction effects were examined using the repeated measure ANOVA test in which there
was a significant group *time interaction effect [F (1, 1) = 272.45, p<0.001].
Conclusion: The improvement in stress levels showed the potential of Progressive Muscle Relaxation
therapy as part of Worksite Health Promotion Programme in the automotive assembly plant. Future studies
should be carried out to assess the long term effects of an on-site relaxation training to provide stronger
evidence for the introduction of Progressive Muscle Relaxation among assembly-line workers as a coping
strategy to alleviate occupational stress.

Poster 14 (ID349)
Evaluation the Effectiveness of A Five Year Workplace Wellness Program in Kuala Lumpur,
Malaysia
Hua Chan Linga, Foong Ming Moyb
aFaculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
bJulius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Introduction: Lifestyle risk factors such as unhealthy diet, physical inactivity and smoking have contributed
to the high prevalence of obesity, diabetes mellitusand cardiovascular diseases in Malaysia. Therefore, we
aimed to study the effectiveness of a five year workplace wellness program conducted in a public university
in Kuala Lumpur in combating risk factors for cardiovascular disease.
Methodology: This was a retrospective cohort study among the university employees aged 35 years above
who attended the workplace wellness programme from year 2008 to 2012. The program included annual
screening on fasting blood glucose, lipid profile, blood pressure, weight, height and etc. Dietary counseling
was conducted by dietitians and medical referralwere carried out if necessary.
Results: Majority of this cohort (n=2424) were Malays (74.2%), followed by Chinese (8.7%), Indians
(10.5%) and others (6.5%). The proportion of female participants was 52.8%. The mean age of the
participants was 49.66 +/- 7.50 years. By using ANOVA repeated measures, LDL cholesterol and total
cholesterol levels were significantly improved (p<0.05) over the 5 years. Their mean (95% CI) total
cholesterol levels over the 5 years were 5.59 (95% CI 5.52 to 5.65), 5.50 (5.44 to 5.55), 5.45 (5.40 to 5.50),
5.41(5.36 to 5.47) and 5.43 (5.38 to 5.48) mmol/l respectively. The mean LDL cholesterol levels were 3.58
(3.53 to 3.63), 3.51 (3.46 to 3.56) and 3.42 (3.37 to 3.45), 3.40(3.35 to 3.44) and 3.41(3.36 to 3.46) mmol/l
respectively. The blood pressure and fasting blood glucose stayed in the normal range over the five years.
The prevalence of smoking was significantly reduced following the program.
Conclusion: Our findings demonstrated that low intensity workplace wellness program was effective in
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improving cardiovascular risk factors, however the effect sizes were small.

Poster 15 (ID381)
Dengue Vector Surveillance in Kuching, Kota Samarahan, Bau and Serian Districts of
Sarawak, Malaysia
Chee Dhang Chena, Koon Weng Laua, Han Lim Leeb, Lucas Low Van Luna, Huey Min Karen-Chiaa, and Mohd
Sofian-Aziruna
a Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia

b Medical Entomology Unit, Institute for Medical Research, Kuala Lumpur, Malaysia

Background/objective: Dengue is endemic in Malaysia and this disease is mainly reported from the urban
and suburban areas in the mainland of Peninsular Malaysia and East Malaysia. The mosquitoes involved in
the transmission of dengue fever and dengue haemorrhagic fever are Aedes aegypti and Aedes albopictus.
Few surveillance on dengue vectors was done in Sarawak. This study was conducted to determine the
distribution and abundance of dengue vectors in 8 residential areas located in 4 districts (Kuching, Kota
Samarahan, Bau and Serian) in Sarawak, Malaysia.
Method: Ovitraps consisting of 300mL plastic containers with an oviposition paddle each and filled with
hay infusion were placed outdoor in 10% of the houses in eight selected areas. All ovitraps were collected
after 5 days. The hatched larvae were identified and recorded.
Results: The ovitrap index obtained from eight study sites ranged from 36.84 – 100.00%. Only Aedes
albopictus was obtained in this study with mean number of larva per ovitrap ranging from 8.67  2.20 to
33.33  6.91. Armigeres sp. was found cobreeding with Aedes in the ovitraps from 4 study sites with mean
number larvae ranging from 1.00  0.00 to 7.00  0.45. There was significant difference between mean
number of Ae. albopictus obtained from 8 study sites (p>0.05) indicating Aedes populations varied between
sites.
Conclusions: The results implied that Aedes albopictus is the dominant dengue vector in Kuching, Kota
Samarahan, Bau and Serian district of Sarawak, Malaysia.

Poster 16 (ID384)
Two New Species of Simulium (Gomphostilbia) (Diptera: Simuliidae) From Peninsular
Malaysia, With Keys to 10 Peninsular Malaysian Species of The Simulium batoense
Species-group
Hiroyuki Takaoka, Chee Dhang Chen, Zubaidah Ya’cob, Mohd Sofian-Azirun
Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia

Background/objective: The black flies (Diptera: Simuliidae) are one of the blood sucking insects of medical
importance. Due to their habit of taking a blood-meal from men and other animals, females of certain species
are known to be the pest causing dermatitis and as a vector of pathogens such as viruses, protozoans, and
filariae. Up to date, a total of 74 species of black flies have been reported occurred in Malaysia.
Method: Streams and rivers are suitable for breeding sites of immature stages of black flies were surveyed.
Adult, pupal exuviae, cocoons and mature larvae preserved in Carnoy solution (Ethanol: Acetic acid, 3:1)
were examined and identified at subgenus, species-group or species level.
Results: Two new black fly species, Simulium (Gomphostilbia) sp.-1and S. (G.) sp.-2, are described based on

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adult female, male, pupal and larval specimens collected from Peninsular Malaysia, and placed in the
parahiyangum subgroup and the duolongum subgroup of the batoense species-group of the subgenus
Gomphostilbia, respectively. Simulium (Gomphostilbia) sp.-1 is characterized in the female by the narrow
frons, and in the male by the broad style and the ventral plate moderately produced ventrally, and S. (G.)
sp.-2 is also remarkable in having the female subcosta that lacks hairs or bears only the reduced number of
hairs ranging from one to five. The pupae of both new species share a similar arrangement of the eight gill
filaments, i.e., stalks of dorsal and middle triplets and ventral pair arising at the same level from the short
common basal stalk, though relative lengths of the ventral paired filaments to the middle triplet filaments are
clearly different between the two new species.
Conclusions: Keys to identify all 10 species (including two new species) of the batoense species-group
recorded from Peninsular Malaysia are given for adult females, males, pupae and mature larvae.

Poster 17 (ID404)
Knowledge Attitude and Practice on Diabetes and Diabetes Care in A Rural Community in
Malaysia
Sandheep Sugathan, Davinder Singh, Myint Myint Soe
Universiti Kuala Lumpur – Royal College of Medicine Perak, Malaysia

Background / Objective: Diabetes is a global public health challenge with high economic burden. Diabetes
is increasing not only in the urban but also in the rural settings. A study was carried out to identify the
prevalence of diabetes, its risk factors and complications, knowledge, attitude and practice on diabetes and
diabetes care among adults above 40 years of age in a village in Kinta district, Perak, Malaysia.
Method: This cross-sectional study was conducted on 194 villagers of Kampung Seri Jaya, who were aged
40 years and above. A written consent was obtained from the participants. Data were collected by
interviewing the participants, using a pre tested structured questionnaire developed in the local language.
Results: The prevalence of reported diabetes with documented evidence was 20.1% (95% CI 15.07 to 26.3)
among the participants. Prevalence among males was 18.66% (95% CI 11.46 to 28.93) and among females
was 21.01 (95% CI 14.65 to 29.18). A positive family history (43%) and unhealthy diet (51%) were the
significant risk factors among diabetics (p <0.05). Other risk factors were – physical exercise for 30 minutes
less than 2 times a week (39%), overweight (42.8%), obesity (36.1%) and smoking (18%). Diabetic
retinopathy was the most prevalent self-perceived complication among the diabetics (33.3%). About 53% of
participants were having good knowledge on diabetes while 86% were having good attitude. About 69% of
the diabetic patients were practising good diabetes care. Those with low income and low education level (p
<0.05) had a significantly lower knowledge on diabetes.
Conclusion: The proportion of those above 40 years of age with diabetes was 20.1%. There need to be more
intensive interventions on lifestyle changes in the rural population to control this alarmingly high occurrence.

Poster 18(ID414)
Employee Assistance Programme: A Workplace Intervention for Psychological Health and
Sickness Absence
Marzuki Isahaka,b, Azlan Darusa,b, Moy F. Mingb
aCentre for Occupational and Environmental Health, University of Malaya, Kuala Lumpur, Malaysia
b Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

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Background / objective: The Employee Assistance Programme (EAP) for stress is an individual approach
worksite-based programme to improve psychological health of the workers. However, the scientific evidence
on effectiveness of EAP is still controversial. The objective of this study was to determine the effectiveness
of EAP in the improvement of workers psychological health status and sickness absence.
Method: This is a randomised-controlled trial conducted among 150 workers in a public university in Kuala
Lumpur. There were 75 participants in both intervention and comparison group respectively. Information on
socio-demographic data and self-perceived depression, anxiety and stress using DASS-21 questionnaire was
administered at baseline. Serum cortisol as a biochemical stress indicator was measured. Sickness absence
data also was obtained from the Human Resource Department. Psychological work exposures were measured
via Job Content Questionnaire (JCQ). EAP interventions given were consisting of stress management
workshop, two sessions of individual counselling and relaxation therapy for the period of six months. As for
the comparison group, only self-help stress management pamphlet was given to them. All the indicators were
repeated in both groups post-intervention.
Results: Both groups were comparable at baseline. After the intervention, there were significant
improvement in self-perceived depression (p <0.001), anxiety (p <0.001) and stress (p <0.001) score among
intervention group as compared to comparison group. Serum cortisol also showed a significant reduction in
intervention group (p<0.05). However, sickness absence indicators did not show significant difference after
the intervention. As for work psychological exposures, EAP managed to significantly reduce participants’
job demand (p<0.01) and increase co-workers support (p<0.05).
Conclusion: EAP for stress has shown to significantly improve self-perceived depression, anxiety and stress
symptoms. Our results proved that EAP is effective in Malaysia especially among university workers.

Poster 19 (ID415)
Incidence of Adverse Transition Among Adolescents of Kinta, Perak
Premila Devi Jeganathana, b, c, Noran N. Hairia, b, Nabilla Al Sadata, d, KaruthanChinnaa, b
a Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Malaysia
b Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Malaysia

c Ministry of Health, Malaysia

d Centre for Population Health, Faculty of Medicine, University of Malaya, Malaysia

Objective: Tobacco control remains a challenge in Malaysia as cigarette smoking accounts for 25% of all
deaths in this country. Prior studies show smoking habituation is mostly due to adolescent experimentation.
Most smoking research among adolescents in Malaysia has been based on cross-sectional research design.
There is a clear lack of longitudinal studies and adverse transition of smoking stages among adolescents has
not been explored completely. This study aims to identify the adverse transitions prospectively from the
early stages till the escalation of the stages after one year.
Method: Data was collected in two waves from a cohort of 2552 adolescents aged 12 to 13 years old
studying in 15 secondary schools based in Kinta, Perak. Multistage sampling method was used to select the
schools. A self-administered structured questionnaire was used to help categorize the participants into
different smoking stages. A five level variable was constructed to operationalize the smoking stages.
Nonsmokers were divided to never smokers and susceptible never smokers. Ever-smokers were categorized
as experimenters, current smokers or ex-smokers. Four groups of adverse transition were examined in this
study.
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Results: Participants consisted of 46.8% Malay, 33.5% Chinese and 17.1% Indian participants. At baseline,
we had 85.3% non-smoker and 14.6% ever smokers. In total adverse transition among all our participants
was 24.1%. Adverse transition was higher among male participants (16.8%). There was an increase in
smoking behaviour with an increase in age. Adolescents who were susceptible to smoking and those who had
already tried to experiment with cigarettes had a higher chance of escalating to a more detrimental smoking
stage.
Conclusions: This study highlights the changes and patterns of adverse transition among adolescents. Efforts
to reduce smoking among adolescents should take into account age, gender as well as identify different
smoking stages to be able to target and carry out effective anti-smoking prevention.

Poster 20(ID460)
Decentralization of Tuberculosis Integrated Programme in A Semi Urban Community: A
Review of the Challenges in Initiating the Programme and Its Limitations on Implementation
Andy TY Koa, SW Nga, Rafi’uddin Radzi Ruslaya, Hafsah Hamida, JS Tana, CM Yeata, Melissa GL Khora, PT
Chooa, Ameerah Alia, Alvernia Neysa Ujata, Raihan Anis Mohd Amira, Hasliana Abdul Latiff Khana, Siti Fatima
Azahraaa, Wan Nur Ain Wan Adnana, SL Loha, Nur Amalina Yusoffa, Revati Pandurengana, TK Wonga,
Hafizuddin Mohd Ghazalia, Amar Abd Jabara, Siti Noor Azira Mohd Jaida, Mohd Khairrudin Mohd Sobria,
Hafizuddin Taufik Ramlia, LK Tana, ST China, JS Loya, WN Tana, KT Onga, LP Wongb
a Medical student, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

b Lecturer, Department of Social Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur,

Malaysia

Background/Objective: Tuberculosis integrated program (TIP) was introduced in Malaysia in 2004 at

primary care centres for better coverage in combating tuberculosis (TB), human- immunodeficiency virus
(HIV) and TB/HIV co-infections. This study aimed at describing the challenges on initiation and its
limitations on implementation of the TIP in the primary care centres.
Method: A qualitative study was conducted through informal conversations with 22 health-care personnels
namely five family medicine specialists (FMS), five medical assistants, five nurses, two pharmacists and two
lab technicians from five government health clinics and three district health officers (DHO) from the District
Health Office in the semi-urban district of Gombak, Selangor. The field experts, Infectious disease
specialists from Sungai Buloh Hospital were consulted regarding the TIP in Malaysia. The data was
interpreted through impressions of our observers.
Results: The challenges on initiation of TIP from the FMS and DHO’s point of view were (1) lack of
manpower e.g. FMS and nurses cross-trained in HIV/TB management, (2) staffs’ resistance to change, (3)
lack of basic facilities e.g. chest X-ray, advanced diagnostic tests e.g. CD4 count, viral load.
The limitations faced during implementation of TIP expressed by the healthcare personnels in the health
clinics were (1) stigma and lack of interest among healthcare providers, (2) inexperienced FMS in managing
complicated cases, (3) patients with poor compliance and language barrier, (3) limited space at the health
clinics, compromising patient's privacy and poor infection control, (4) shortage of HAART and diagnostic
reagents outsourced from hospitals, (5) limited TB/HIV collaborative funding at the district level.
Conclusions: Many challenges were faced during initiation and implementation of the TIP at the primary
care level compromising patients’ care. Policy makers should address the issues by refining policies with
better collaboration at various levels.

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Poster 21(ID508)
Substance Abuse and Psychiatric Morbidity among Urban Low Income Residents in Kuala
Lumpur, Malaysia
Mas Ayu Said a,c,d, Rusdi Abd Rashidb,d, Ahmad Hatim Sulaimanb,d,Mohd Hussain Habilb,d
aDepartment of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur
bDeparment of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur

cJulius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur

dUniversity of Malaya Centre of Addiction Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur

Introduction: Drug abuse and addiction are serious threats and can affect the quality of life and health of the
community. The high prevalence of substance abuse and increasing cases among youth and adult population
is a public health challenge that needs interventions. Many studies have shown a number of risk factors that
make the young population lead to illegal drugs abuse. The risk factors were male, having low self-esteem,
and poor social and coping skills, poor modelling from parents and poverty, and availability of drugs in the
community. This study aims to determine the prevalence of substance abuse and the psychiatric morbidity
among urban low income residents in Kerinchi, Kuala Lumpur, Malaysia.
Methods: A cross-sectional household survey was conducted with a structured questionnaire. A total of
2243 residents aged 18 years and above lived in a low cost housing area in Kerinchi were approached. The
type of substance abuse assessed including tobacco product, alcohol, cannabis, cocaine, amphetamine type
stimulants, inhalants, sedatives or sleeping pills, hallucinogens and opiods. WHO Alcohol, Smoking and
Substance Involvement Screening Test (ASSIST-BI) and Depression, Anxiety and Stress scale (DASS 21)
were used in this study.
Results: A total of 2068 (92.2% response rate) respondents were interviewed. 358 (17.30%) used tobacco
product, 34 (1.60%) took alcoholic beverages, 10 (0.43%) used cannabis, 2 (0.09%) used cocaine, 1 (0.04%)
used opiods. For psychiatric morbidity screening, 19.6% has depression symptoms, 20.3% has anxiety
symptoms and 25.4% reported has stress.
Conclusion: The prevalence of substance abuse among urban low income groups was low except for usage
of tobacco product. However, the present of psychiatric morbidity is high and need further clinical
psychiatric assessment and diagnosis. Treatment is warranted for those with clinical diagnosis of major
depression and generalized anxiety disorder.

Poster 22 (ID515)
The Rural Medical Mobile Mission (RM3) in Cambodia: The University Kuala Lumpur
Royal College of Medicine Perak Experience
Abdul Karim Russ Hassan
Kuala Lumpur University, Malaysia

Introduction: Cervical cancer screening in Malaysia is by opportunistic pap smear which contributed to the
low uptake of cervical screening. To overcome this, a pilot project called the SIPP program (translated as
information system of pap smear program) had been introduced whereby women aged 20 years old were
invited for pap smear and again invited in the following years to repeat the test if the previous cervical
cytology was normal. This study aimed at determining which reminding method or recall that is most
cost-effective in getting women to do repeat pap smear.
Methodology: A randomised control trial had been conducted at the health clinics of a suburban district that
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implement the SIPP program. One thousand women who had attended PAP smear and had normal cytology
in the previous year were given a recall for repeat smear either by registered letter, phone messages, phone
call and the usual postal letter. They were given eight weeks period to do PAP smear, failing which telephone
calls were made by the researchers to find out why they did not respond to the reminders. The outcome
chosen were whether the reminder had reached the women and whether they had responded to the reminder
by attending for PAP smear screening. The total cost applied for cost-effectiveness analysis includes the cost
of sending letter for first invitation, recall method and cost of twice PAP smear screening. Cost-effectiveness
analysis (CEA) of pap smear uptake by each recall method was performed.
Results: The percentage of women who responded to recall by postal letters, registered letter, sms and phone
call were significantly different; 78.8%, 86.8%, 65.6% and 67.6%, respectively (p<0.05). The uptake of PAP
smear by postal letter; registered letters, sms and phone calls were 18.8%, 20.0%, 21.6% and 34.4%,
respectively (p<0.05). The total cost of cervical screening for a woman by each recall method were RM
51.01+0.03, RM 49.31+0.02, RM 49.13+0.05 and RM 48.81+0.03, for registered letter, postal letter, phone
call and sms, respectively. The CER for the recall method was lowest for phone call compared to other
interventions; RM 142.82+0.15 compared to RM 225.97+0.14, RM 255.05+0.15 and RM 262.29+0.11 for
sms, registered letter and letter, respectively. ICER showed that it is most cost saving if the usual method of
recall by postal letter be changed to recall by phone call.
Conclusion: The possibility of letter as a reminder for repeat PAP smear to reach the women is higher
compared to sending sms or making phone call. However, getting women to do repeat pap smear is better
with phone call which allows direct communication. Despite the high cost of phone call as a recall method to
remind patient for repeat pap smear, it is the most cost-effective recall method compared to others.

Poster 23 (ID641)
Socioeconomic Inequalities in the Choice of Healthcare Provider in Malaysia: Underlying
Determinants
Nithiah Thangiaha, Susila Munisamyb
a Centrefor Population Health, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
b Faculty of Economics and Administration, University of Malaya, Kuala Lumpur, Malaysia

Background: This paper investigates the interplay of socioeconomic inequalities and its’ underlying
determinants of healthcare utilization in Malaysia.
Method: Using novel cross-national data from the National Health and Morbidity Survey (NHMS III), the
study exploits logistic regression methods incorporating the complex design of the survey data to illustrate
how individual socioeconomic status determine healthcare utilization in public healthcare facilities for both
outpatient and inpatient treatment.
Results: The study found that lower income per household member, lower education and occupation level of
household head and rural dwellers were significantly associated with public healthcare use for outpatient
treatment. Those with less than RM 400 income per household member were five times more likely to use
public healthcare compared to those with income more than RM 2000. Household heads with primary
education are twice as likely as household heads with tertiary education to be public healthcare consumers.
Farmers were found to be 1.5 times as likely as professionals to use public healthcare. The odds ratio of
public healthcare use among those from rural areas is 2.004 (95 % CI : 1.629, 2.465) indicating a higher use
as compared to urban dwellers. As for inpatient treatment, all income categories were found to be
significantly associated to the utilization of public healthcare. Odds ratios increased from 2.893 to 26.392
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showing that the lowest income group used public inpatient care 26 times more than those from highest
income quintiles.
Conclusions: The determinants of inequalities show that the choice in the type of healthcare provider is
strongly related to ones’ socioeconomic position. The higher use of public healthcare with decreasing
socioeconomic status is a good sign that the pattern of healthcare utilization in Malaysia follows that of a
pro-poor country that strongly favors the least advantaged thus ensuring a healthcare system that is equitable
and fair for all.

Poster 24 (ID652)
Rota Viral Infection: A Significant Disease Burden to Libya
Salem Alkoshia, Mohamed Smeob, c, Maznah Dahluia
a Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Malaysia
b Department of community medicine, Faculty of Medicine, University of Tripoli, Libya

c National Centre for Disease Control, Tripoli, Libya

Background/objective: Rotavirus is a major reason of acute gastroenteritis among young children, causing
approximately 40% of all gastroenteritis cases < 5 years of age each year worldwide. The mean incidence
rate of rotavirus was estimated 419 per 100000 children < 5 years of age in the period (2007 - 2009) in
Libya. The surveillance data has been suspended after the revolution in 2011. The study aims to determine
the incidence of rotavirus gastroenteritis in Libya in the study period.
Methods: Cross sectional study in 2 randomly districts selected of 60 districts in Libya. Three public
hospitals were included in the study where the people of the 2 districts search treatments. The incidence rate
of rotavirus infection in the 2 areas was projected for the 10 months of study period to the population aged <
5 years in Libya.
Results: In the period of 10 months of specimens collected, a total of 545 stool samples from diarrhea
children aged below 5 years of age were collected for rotavirus detection. The proportion of rotavirus was
57% of all gastroenteritis patients < 5 years of age. A peak rate of rotavirus was identified in winter months.
The rotavirus rate among inpatients was 58% of all admitted cases, while 53% in outpatients. Most rotavirus
gastroenteritis patients (86%) were detected in children below the second years of age, with no difference
between male and female cases. Rotavirus patients with severe and moderate dehydration represented 31% &
66% of all rotavirus children respectively. The national incidence estimation of rotavirus gastroenteritis was
728 ranged (665 - 787) per 100000 children < 5 years old. Rotavirus deaths were not shown during
conducting the study.
Conclusions: The study introduces important results that the rotavirus gastroenteritis is a significant burden
among children; thus, evidence could be presented to the general public on the importance of rotavirus
vaccination.

Poster 25 (ID713)
Effectiveness of A 6-month Community-based Healthy Lifestyle Intervention Program Among
Adults at High Risk of Type 2 Diabetes in Malaysia
Norliza Ibrahima, Foong Ming Moyb, Intan Attikah Nur Awalludinc, Zainudin Alid, Ikram Shahe
aDepartment of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia

bJulius Centre University of Malaya, Department of Social and Preventive Medicine, University of Malaya, Kuala

Lumpur, Malaysia
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 cDiabetes Association, Petaling Jaya, Selangor, Malaysia

dStateHealth Department of Negeri Sembilan, Seremban, Negeri Sembilan, Malaysia

eDepartment of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia

Background/ objective: Community-based interventions promoting healthy lifestyle have become an

important strategy for prevention of type 2 diabetes in Malaysia. Therefore, we aimed to assess the effects of
a 6 month community-based healthy lifestyle program (Co-HELP) in reducing the modifiable risk factors of
type 2 diabetes at the community level.
Methods: A quasi-experimental study was carried out in two semi-urban localities in a state in Malaysia
among high-risk adults with prediabetes. The strategy of intervention was group-based approach,
collaborative efforts between academia, Non Governmental Organizations (NGOs) and community
volunteers. Participants in the intervention group participated in Co-HELP sessions for 6 months. The
Co-HELP program included health education, exercise, diet, health monitoring and counseling. The main
outcome measures were changes in the fasting blood glucose, 2-hour plasma glucose and HbA1C. The
assessments were conducted at baseline, 3rd and 6th month of intervention.
Results: A total of 123 and 146 people participated in the Co-HELP intervention and usual care groups
respectively. Compared with the usual care participants, Co-HELP intervention participants showed
significantly greater decreased in FBS (-0.63±0.74 mmol/l vs 0.08±0.91 mmol/l; p<0.001), 2HPP
(-0.53±1.78 mmol/l vs 0.28±1.24 mmol/l; p<0.001) and HbA1C (-0.04±0.25% vs 0.05±0.35 %; p=0.015).
Further analysis using Cohen’s d reported that the effect size for FBS value was 0.85 indicating large effect
size observed. Whereas, the 2HPP and HbA1C values were 0.528 and 0.296 respectively indicating medium
and small effect size.
Conclusions: The results demonstrate that a community-based lifestyle intervention administered through
partnership with the existing local NGOs or volunteers may become a promising strategy for widespread
dissemination of interventions for high risk adults at community level.

Poster 26 (ID717)
Men's Involvement in Unintended Pregnancy, Contraception, and Legal Safe Abortion:
Challenges to MDG 5B Universal Access to Reproductive Health
Yut-Lin Wong
Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Background/objective: The 2010 Malaysia MDG Report and 2009 ICPD15 Monitoring Report revealed
low/stagnated contraceptive prevalence, 25% unmet need for contraception and rising unintended
pregnancies among young unmarried women. Male responsibility and involvement in these issues, though
vital, has often been omitted in the strategy of achieving MDG 5B - universal access to sexual reproductive
health by 2015.
This paper assesses men's involvement in unintended pregnancy, contraception, and legal safe abortion.
Method: On-line Focus Group Discussion (OFGD) and face-to-face in-depth interviews (IDI) were
conducted with multi-ethnic young men in Kuala Lumpur and Petaling Jaya. OFGD utilized the internet to
collect data via text-based group discussion where participants were invited to post responses to the FGD
guide asynchronously (not in real time). Research ethics approval was granted by the University of Malaya
Medical Centre (Ref No: 956.45). Informed consent was duly obtained from respondents. All IDI were
digitally recorded, transcribed verbatim and checked by independent checkers. IDI and OFGD data were
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managed and analyzed using NVIVO Version 8.
Results: The 30 respondents comprised of university undergraduates and vulnerable youth from institutions,
shelter/homes and low income communities. Average age was 19.7 years and age ranged from 15-24 years.
One third were sexually active but none reported they ever had impregnated their partners. Yet, all feared
unintended pregnancy might occur. Sexually active men agreed they should be responsible in preventing
unintended pregnancy. However, majority neither practised contraception readily nor effectively. Majority
perceived abortion as sinful/prohibited and yet they did not view marriage as a solution/option should
unintended pregnancy occur.
Conclusion: These findings pose grave challenges to women’s sexual reproductive health and rights. They
confirm the urgent need to upscale approaches that consciously engage men in resolving unintended
pregnancy, low/stagnated contraception practice, and women’s access to legal safe abortion towards
achieving MDG 5B.

Poster 27 (ID727)
What Sexuality Means to Malaysian Young Women: Results from A Qualitative Research
Zahra Fazli Khalaf a, Wah Yun Low a, Behzad Ghorbani b, Effat Merghati Khoei c
a Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

b Avicenna Research Institute, ACECR, Tehran, Iran

c School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Background/objective: Sexuality is considered as an important element of women’s health. Malaysian

women, as a multiethnic and multicultural community, vary in terms of religious beliefs, life styles and
practices. Sexuality understanding and practices of these women are strongly affected by Asian discourse
which is determined by strict perceptions of gender roles and sexual behaviors. This study explores the
meaning of sexuality among young women in Malaysia.
Methods: Interviews and focus group discussions with 34 female university students aged 20-30 years old
were conducted by using a semi-structured interview guideline. Thematic analysis aided by Nvivo qualitative
software was adopted to analyze the data.
Results: Research themes were generated in three levels: Intra-psychic level, Interpersonal level and
Socio-cultural level. In Intra-psychic level, young women understood sexuality as vaginal penetration, a
forbidden action, an uncomfortable matter, a complicated feeling, a physical action, and a basic
physiological need. In Interpersonal level, they believed that sexuality is a way of sharing emotions and love,
satisfying the male partner, feeling loved and cared, preserving virginity for marriage, as a token for husband
and feeling of responsibility. In Scio-cultural level, sexuality was seen as a private action, serving for God
(through procreation), unspoken matter, element of honor and social reputation, and a practice acceptable
under the conventional relationship (marriage). Religion was an important factor influencing sexuality
understanding of these young women. Muslim and catholic women shared more negative beliefs about
sexuality.
Conclusion: Recognition of women’s self-understanding of sexuality will facilitate to determine the
personal, interpersonal and socio- cultural challenges facing their sexual life, and will help to develop a
conceptual framework for healthcare system and health providers in providing more culturally-based
healthcare.

Poster 28 (ID818)
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 Ethnic Difference in Vitamin D Status and Its Associated Factors Among Teachers in A
Tropical Country, Malaysia
Foong Ming Moya, Victor Hoe Chee Waia, Noran Naqiah Hairia, Shireene Ratna a/p DB Vethakkanb,
Awang Bulgiba Awang Mahmudc
a Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of

Malaya, Kuala Lumpur, Malaysia

b Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

c Cansellory, University of Malaya, Kuala Lumpur, Malaysia

Background: Vitamin D level is associated with bone health, cardiovascular disease and certain types of
cancers. The main source of vitamin D for the population in tropical countries is thought to be from sunlight
exposure. However, evidences showed that population residing in the Tropics are also facing vitamin D
insufficiency. Therefore, we aim to study the vitamin D status and its associated factors among multiethnic
teachers within a state in Malaysia.
Method: This was an analytical cross sectional study. School teachers were sampled randomly and their
vitamins D status (25-hydroxyvitamin D), fasting blood glucose, full lipid profile were assessed using
venous blood. Systolic and diastolic blood pressure, weight, height and waist circumference were measured
following standard protocols. Socio-demographic data, sun exposure and sun avoiding practices were
collected. Vitamin D insufficiency was difined as 25-hydroxyvitamin D less than 20ng/dl.
Results: Out of 738 participants, 92% were females with Malays being the majority (76.2%), followed by
Chinese (15.6%) and Indians (8.3%). Their mean age (SD) was 40.29 (8.79) years. Only 24.3% of Chinese
had vitamin D insufficiency compared to Malays (76.5%) and Indians (86.3%) (p<0.001). Males
(25.6+7.9ng/dl) also had significantly higher vitamin D levels (p<0.001) then females (17.1+6.8ng/dl).
Ethnicity, sex, sun avoiding practices, age, BMI, waist circumference, calcium and para thyroid hormones
were significantly associated with vitamin D levels univariately. However, in the multivariate logistic
model, Malays (OR: 10.1; 95%CI: 5.3, 19.2) and Indians (13.6; 5.7, 32.5) had higher odds for vitamin D
insufficiency compared to Chinese. Females had 6.6 (95% CI: 3.2, 13.6) times odds for vitamin D
insufficiency, while increase of calcium level was protective of vitamin D insufficiency (OR: 0.03; 95%CI:
0.01, 0.23).
Conclusion: Our participants especially the Malays and Indians had poor vitamin D status. Ethnicity, sex
and calcium level were the main factors associated with vitamin D insufficiency.

Poster 29 (ID822)
Awareness and Acceptance of Dengue Self-test Kit Among Households of Community with
Various Levels of Previous Exposure to Dengue
Li Ping Wonga,b, AbuBakar Sazalyc,d, Karuthan Chinnaa,b
a Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
bJulius Centre University of Malaya (JCUM)

cDepartment of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia

dTropical Infectious Diseases Research and Educational Centre (TIDREC)

Background: Dengue home self-test kit, though not yet available, may positively contribute towards
improvement in dengue treatment seeking behaviour and dengue prevention effort. The objective of the study
was to investigate the awareness and acceptance of dengue home self-test kit were it to be available among

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community withvarious levels of previous exposure to dengue virus infection.
Method: A cross-sectional computer-assisted telephone surveys were conducted on households in a 3km
radius of the schools where dengue serological tests on the student population have been determined.. They
were asked about their awareness and acceptability of a dengue home self-test kit. The results were then
associated with the prevalence rate of dengue in the community marked by dengue IgG seropositivity of
students attending schools in the community. Telephone interviewing (CATI) was used to reach the
households.
Results: A total of 1,400 complete responses were obtained. In total, 71 persons (5.1%) claimed have heard
of a possible dengue home self-test kit. A total of 4.8% of household in community with absent of dengue
IgG seropositivity claimed have heard of dengue home self-test kit compared to 5.5% of community with
present of IgG seropositivity (P>0.05). In multivariate analysis, those who claimed having heard of the
dengue home test kit (OR 2.48, 95%CI 1.47-4.17 vs. never heard) and had dengue experience (OR 1.55, 95%
CI 1.04-2.39 vs. no dengue experience) are the two strongest predictors of likely acceptance of dengue home
test kit. Three main factors that influence acceptance of a possible dengue home self-test kit were i)
recommendation by healthcare providers (40.0%), ii) price of the test kit (28.0%), and iii) accuracy of the
test (11.0%).
Conclusions: Home self-test kit for dengue though currently not available is a possible approach towards
early detection of dengue. Households in community which had high previous exposure to dengue are more
likely to accept use of the test. Publicity of the dengue home self-test kit once it becomes available, however,
is warranted and should be targeted among community with low dengue prevalence. Acceptance by
healthcare providers however, is critical as household acceptance of the dengue home self-test relies on their
recommendation.

Poster 30 (ID830)
Domestic Waste Management in Kuala Lumpur: Current Strategies and Knowledge, Attitude
and Practice of Recycling or Waste Separation by Residents
Lee Qin Zhia, Ong Rui Minga, Ruhana Abdul Rahmana, Lam Ri Huia, Tan Yi Xianga, Sofinaz Al-Hadara, Iznor
Haslizaa, Saimy Ismailb, Tin Tin Sub
a Faculty of Medicine, University of Malaya, Malaysia

b Centre for Population Health (CePH), Dept. of Social and Preventive Medicine, Faculty of Medicine, University of

Malaya, Malaysia

Background: The high rate of urbanization, rising standards of living and rapid development accompanied
by population growth has resulted in increased generation of solid waste in urban areas. A sustainable waste
management programme is essential to protect the environment and promote health. This study aims to
evaluate current waste management strategies in Kuala Lumpur (KL) and to assess the knowledge, attitude
and practice of recycling and waste separation by its residents.
Materials and methods: This study comprised both qualitative and quantitative aspects. The qualitative
research involved key informants interviews with officers from the Urban Cleansing Unit of KL City Hall
and Konsortium Alam Flora. The quantitative research was conducted through a survey via convenience
sampling of residents in KL in June 2013. A self-formulated questionnaire was administered to residents
living in KL for at least 6 months and in landed property, which yielded 298 completed questionnaires.
Results:
Qualitative: Kuala Lumpur city generates 2500-3000 tons of solid waste each day, of which only 3% are
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recycled. There are no existing landfills, waste processing centers or incineration facilities in KL. Collected
domestic waste is gathered at a transfer station before being transported for disposal at a landfill 74km away
in a neighboring state. Policies for waste reduction and recycling are currently put on hold in favor of
upgrading services of concession companies.
Quantitative: Most of the respondents (93.29%) have heard or read about recycling or domestic waste
separation with moderate (39.9%) to good (40.9%) knowledge. While 96% of respondents viewed separating
household waste to be important, less than half (44.3%) of the respondents practiced waste separation.
Conclusion: Good knowledge and attitude towards recycling and waste separation did not translate to actual
practice. Good practice can be achieved with support from relevant authorities by providing more recycling
bins and implementing efficient collection services.

Poster 31 (ID878)
Sources of Information on Sexual and Reproductive Health Among Adolescents
Rafdzah Zakia, Ahmad H Samsudinb, Nurnazimah Yusofb, Maznah Dahluib, Tin T Suc, Marzuki Isahakd
a Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of
Malaya, Kuala Lumpur, Malaysia
b Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

c Centre for Population Health, Department of Social & Preventive Medicine, Faculty of Medicine, University of

Malaya, Kuala Lumpur, Malaysia

d Centre for Occupational and Environmental Health, Department of Social & Preventive Medicine, Faculty of

Medicine, University of Malaya, Kuala Lumpur, Malaysia

Background: Implementing sexual and reproductive module in school is a great challenge. However,
modernisation has resulted in increased sexual exposure among adolescents. They have been receiving
information from various resources no matter how reliable and accurate they are. Therefore the purpose of
this study is to identify the most important and most preferred sources of information on sexual and
reproductive health among adolescents.
Methods: A cross sectional study was conducted among adolescents age between 15-17years old attending
schools in Terengganu, Malaysia in January 2013. Ten schools were selected randomly and a total of 100
self-administered dual-language (malay-english) questionnaires were distributed in each school.
Results: A total of 1000 questionnaires were distributed, but only 890 students have responded well to the
questions. 52.5% of the respondents are female (52.5%), majority (99.9%) of the respondents are Malay, and
all of them are Muslim. Majority of the respondents never discussed sex-related matter with their father
(84.8%) and mother (74.2%). Most of information on puberty was obtained from teachers (51.8%) and their
mother (24.2%). Friends (22.2%) and mother (19.4%) has become their second important sources of
knowledge on puberty. However, they preferred to have the knowledge from the internet and friends.
Regarding knowledge on sexual and reproductive system, the most important source of information was
from teachers (68.7%) and second most important source was from friends (21.7%). These are also their
preferred sources of information for sexual and reproductive system. Teachers (31.5%) and friend (18.5%)
are the most and second most important sources of knowledge for relationship. However, they preferred to
have the knowledge from the internet and friends.
Conclusions: Three most preferred sources for sexual and reproductive health knowledge are through
school, internet and peer education. Delivering sexual and reproductive health education through these
approaches might be more effective and acceptable to them.
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Poster 32 (ID885)
Health of Female Foreign Domestic Workers in Malaysia: Stressors, Buffers, & Resilience
Yut-Lin Wonga, Shanthi Thambiahb, Denise Spitzerc, Siti Sa'adiah Hassan Nudind
a JCUM, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

b Faculty of Arts & Social Sciences, University of Malaya, Kuala Lumpur, Malaysia

c Institute of Population Health, University of Ottawa, Ottawa, Canada

d Institute for Health Behavioural Research, Ministry of Health, Malaysia

Background/objective: Malaysia is host to thousands of female foreign domestic workers (FDW) from
Indonesia, Philippines, Vietnam and other low income countries in the region. Although FDW form
significant proportion of the global spread of out-migration, their health and wellbeing has received less
attention. Often confined to the private homes of their employers and subject to the latter's control, FDW
tend to have limited access to health determinants like nutrition, social support, and healthcare. Yet, they are
vulnerable to multiple stressors arising from their migrant status and gender hierarchy at home and
workplace. This paper explores the FDW's health stressors, buffers, and resilience to uncover the
intersections of gender, migration, and health.
Method: Fifty-four FDW (30 Indonesian and 24 Filipino) were purposively sampled. Data on out-migration
process, socioeconomic background, work conditions, and health were collected via survey; while indepth
interviews captured qualitative data on health and illness experiences. Ethics approval was granted.
Results: Stressors included long working hours (76-90 hours/week), lack of separation between work and
leisure, constrains/surveillance due to close proximity to employers, social hierarchy, financial and emotional
stress related to own children and families back home. Thus, they reported health problems like headaches
(the most common), insomnia, gastric pains, menstrual disorders, and hypertension. Social support from
fellow FDW, especially for the Filipina FDW, is the main buffer. Some FDW resorted to recruitment agent
and own employer for social support due to lack of social interaction. With or without buffers, many coped
through selfcare: trying to not think too much, practicing patience, refraining from anger or unpleasant
thoughts, and use of traditional medicine.
Conclusion: Migrant status and gender hierarchy impact on health stressors and buffers of the FDW. Coping
strategies and resilience being borne out of the FDW's vulnerable conditions need to be considered as well
when addressing migrant health.

Poster 33 (ID933)
Modelling Dengue Incidence and Climatic Factors using Poisson and Negative Binomial
Model
Nur Sabrina Che Soha,b,c, Karuthan Chinnaa,b, Jonathan Inbaraj Dossa,b, Mas Norehan Merican Aljunid
Mericand
aJulius Centre University of Malaya, Malaysia

bDepartment of Social and Preventive Medicine, University of Malaya, Malaysia

cDepartment of Biomedical Science, Kuliyyah of Allied Health Sciences, International Islamic University Malaysia,

Malaysia
dSelangor State Health Department, Malaysia

Introduction: Dengue is currently a major public health burden in Malaysia. Several studies have shown

305
that there is an association between temperature, rainfall and dengue incidence. The aim of this study is to
establish a mathematical model to explain the relationship between dengue incidence and climate variables,
namely, temperature and rainfall.
Methodology: The study location is Gombak, a district in the central part of Peninsular Malaysia. The
weekly reported dengue cases for this district from 2006 till 2011, was retrieved from the local health office.
The mean temperature and cumulative rainfall figures for the same area for the same time period were
retrieved from the meteorological department. Data were analyzed using Poisson and Negative Binomial
regression analysis including time trends and lag periods of weather predictors.
Results: The weekly mean temperature was significantly related to the number of dengue cases in Gombak
district. Dengue cases increased at time lag of 1 week for rainfall and 1-3 weeks for temperature.
Conclusion: Weather plays a significant role in dengue incidence in Gombak.

Poster 34 (ID987)
Relevance of Established Risk Factors Associated with the Development of Hypertension
among Selected Communities above the Age of 30 in Pahang: A Cross Sectional Study
Kam Wah Lee, Soon Shan Loh, Kar Jun Lee, Aishah A. M. Khairuddin, Wey Ting Lee, Aimi I. Ibrahim, Ting
Chung Lim, Sook Wah Jenny Lam, Intan S. M. A. Merican, Amanina Z. A. Puaad
Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Background/objective: There is considerable evidence that hypertension is a major public health risk,
however according to the Malaysian Society of Hypertension’s report in 2011, only 35% percent of
hypertensive patients were diagnosed. Our objective is to determine the prevalence of hypertension among
population above the age of 30 in selected rural communities in Pahang. We also aim to determine factors
associated with hypertension such as ethnicity, gender, level of physical activity, body mass index (BMI) and
smoking status.
Methods: A cross-sectional household survey was conducted among 689 respondents in five districts of the
state of Pahang, Malaysia. A structured interview-administered questionnaire and physical examination was
conducted. Information collected included sociodemographic characteristics, weight, height and physical
activity level. Descriptive, bivariate and multiple regression analyses were performed to examine how level
of physical activity, ethnicity, sex and age are associated with hypertension.
Results: Women have a higher prevalence of hypertension and the risk of hypertension was also found to be
higher with increasing age and with family history of hypertension. Our study also showed that the risk of
developing hypertension is higher in respondents who do not exercise. For body mass index (BMIs),
respondents who were in the overweight and obese categories had a much higher prevalence of developing
hypertension while those in the underweight category were protected against hypertension.
Conclusion: With this multitude of factors leading to a significant increase in the risk of developing
hypertension, it is important that necessary steps are taken to increase the awareness among these rural
communities in Pahang regarding this problem. Early detection and intervention of hypertension may help to
reduce the number of complications among hypertensive people and, also, in reducing the morbidity and
mortality rates of cardiovascular diseases associated with it.

Poster 35 (ID989)
Validation of the Teacher Reporting Attitudes Scale (TRAS) for Child Abuse and Neglect
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 Among Malaysian Primary School Teachers
Choo Wan Yuena, Kerryann Walshb, Karuthan Chinnaa, Tey Nai Pengc
a Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, & Julius Centre University

of Malaya, Malaysia
b Faculty of Education, Queensland University of Technology, Australia

c Department of Applied Statistics, Faculty of Economics and Business Administration, University of Malaya, Malaysia

Background/Objective: The Teacher Reporting Attitude Scale (TRAS) is a newly-developed tool to assess
teachers’ attitudes towards reporting child abuse and neglect. This paper examines the factor structure and
psychometric properties of the short-form Malay version of the TRAS.
Methods: A cross-sectional survey was conducted among 667 primary school teachers in 14
randomly-selected schools in the Selangor state, Malaysia. Teachers responded to a self-administered
questionnaire consists of sociodemographic background, training experience, and their attitudes towards
reporting child abuse and neglect. Analyses were conducted based on a three-stage process, using both
confirmatory (stages 1 and 3) and exploratory factor analyses (stage 2) to test, modify, and confirm the
underlying factor structure of the TRAS in a non-Western teacher sample.
Results: The results show that confirmatory factor analysis did not support a 3-factor model previously
reported in the original TRAS study. Exploratory factor analysis revealed an 8-item, 4-factor structure. The
subsequent confirmatory factor analysis demonstrated appropriateness of the 4-factor structure. Reliability
estimates for the four factors, which include commitment, value, concern, and confidence, were moderate.
Conclusion: The modified short form TRAS Malay version can be used as a simple tool for quick
assessment of teachers’ attitudes towards reporting child abuse and neglect. Cross-cultural differences in
attitudes towards reporting may exist and the newly developed instruments should be evaluated in other
populations to determine its transferability and applicability.

Poster 36 (ID990)
The Impact of Men’s Health Project on the health behavior of community in rural Kudat,
Sabah, Malaysia
Fredie Robinsona, Yasmin BH Ooia, Jecelyn Johna, Rina Norganathaia, Suliong China, Bella Puvoka, Atiqah
Chewa, Osman Alib
a School of Medicine, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia

b UniKL Royal College of Medicine, Perak, Malaysia

Background: On average men have lower life expectancy compared to women. This has very much to do
with their riskier health behavior and lifestyle. A health promotion project for the male population was
conducted by PERDESA and UMS School of Medicine in the rural Kudat district of Sabah, Malaysia on the
village community living there between the years 2012 to 2013 with the aim to create awareness of healthy
lifestyle, for a better quality related way of life through promoting of good health habits while at the same
time try to stop or reduce some risky behaviours such as smoking and alcohol.
Method: The project which was funded by the Malaysian Board of Health Promotion (MySihat), was aimed
specifically to the men who are above 30 years of age who would benefit community health promotion.
Several intervention techniques were used which include structured educational health talks on lifestyle
diseases, demonstrations of home exercise that they can do, health checkup either at health clinic or through
visiting the villagers approach, organized events of sports or games competitions and community dialog. Pre
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and post questionnaires was given to all participants through self-filled or interviewed to obtain the data on
the habits and practices of the subjects in terms of health behavior before and after the men’s health project,
in order the study the effectiveness of the project.
Results: There were altogether 186 subjects who participated in the project from the beginning of the total
14 months duration. The mean age was 51.25 (sd. 11.07) from age 28 to 80 years old with majority being
main occupation as farmers. Pre and post questionnaire showed improvement in terms of healthy
behaviours and at the same time reduction in unhealthy or risky behavior. The health seeking behavior
such as having own health checks at clinics improved in terms of the frequency of visits. The smoking
prevalence among the participants dropped from 47.4% to 39.0%. The alcohol drinking habits also reduced
in prevalence from 73.4% to 64.5%, while among those who drink the frequency was also reduced to be
more of the ‘seldom drink’ category. Frequency of doing exercises also increased, and from the total, those
who exercise at least once a week became from 64.12% to 86.6%.
Conclusion: The Men’s health project through health promotion intervention showed promising evidence on
health behavior changes towards a healthier lifestyle for the community of rural Kudat.

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Nepal（尼泊尔）

309
Poster (ID148)
Knowledge and Risk Perceptions about HIV/AIDS among Nepalese Migrants in Gulf
Countries: A Cross-sectional Study
Sharma Narayana, Joshi Sureshb
a Little
Buddha College of Health Science, Kathmandu, Nepal
b Alfred Deakin Research Institute (ADRI), Deakin University, Australia

Background/objective: Migration is considered as one of the major risk factor for HIV/AIDS transmission.
Inadequate knowledge and misconceptions about HIV/AIDS transmission are still the major challenges in
developing countries. This study aimed to explore the knowledge and risk perceptions about HIV/AIDS
among a sample of Nepalese migrants working in three Gulf countries.
Method: A cross–sectional study was performed among a sample of 408 adult Nepalese migrants who had a
work experience of at least six months in one of the three Gulf countries, (Qatar, Saudi Arabia and United
Arab Emirates). An interview-based questionnaire was used to obtain the information from these migrant
workers.
Results: The respondents in this study were from different parts of Nepal and the majorities were adult
males, most frequently of age 26-35. More than half of the respondents were involved in construction related
works. The majority of the respondents were aware that HIV virus is transmitted through sexual intercourse
without using condoms and having sex with many people. The most prevalent misconceptions about
HIV/AIDS transmission was that a person can get HIV/AIDS from a mosquito bite. More than a quarter of
the respondents perceived that they were not at risk of being infected with HIV/AIDS due to their sexual
activities.
Conclusions: There is still a lack of adequate awareness and risk perceptions about HIV/AIDS among some
of the Nepalese migrants. We can suggest to government of Nepal and employers to provide proper
preventive health information regarding HIV/AIDS to migrant workers in both home and destination
countries.

Poster 1(ID146)
Assessing Health Status of Rural Village Development Committee of Nuwakot District of
Nepal
Janak Kumar Thapa
Little Buddha College of Health Sciences, Nepal

Background: Assessing health status is crucial to understand the level of health in the community. Maternal
health, child health and behavioral practice on diseases are key issues to assess health status of a community
in Nepal. Preliminary analysis and literature review shows the health status of Nepalese community was
lower than national averages. Thus, the aim of this study was to assess general health status of Khanigaun
VDC of Nepal.
Methods: A descriptive cross-sectional study was undertaken using semi-structure questionnaire, interview
and observation. Simple random sampling was done to conduct household survey, where 346 (33%)
household were taken for sample population. Key informants were taken purposively.
Results: General Fertility Rate (GFR) of the VDC was found to be 69.15/1000 Women. Regarding
socio-economic status, literacy rate of the VDC was 71.14% and 74.92% of household depends on

310
agriculture. Toilet coverage was 88% and only 80% of household manage their waste by making compost
manure. More than 60% of respondents have Knowledge, Attitude and Practice on diarrhea, TB, worm
infestation and Leprosy. Contraceptive prevalence rate was 72% and majority of women have home delivery.
It was found that 69% of newborn have weight more than 2.5 kg and immunization coverage was high in the
community. Need of the community was addressed through Micro Health Projects conducted on hygiene and
sanitation, safe motherhood, adolescent health through exhibition, mini-lecture, group discussion and school
health program.
Conclusions: Overall health status of the community could be further enhanced through youth mobilization
and community participation.

Poster 2(ID164)
Reasons behind Women Having Abortion and Consequences of Abortion: A Study among
Aborted Women in Charikot, Nepal
Pritha Manandhar, Janak Thapa
Little Buddha College of Health Sciences, Kathmandu, Nepal

Introduction: Abortion is the termination of pregnancy from whatever cause before the fetus is capable of
extra uterine life (WHO-1994). The main aims of the study were to assess health related and socio-economic
factors and physical and social consequences of abortion.
Methodology: Descriptive cross sectional study was carried out among 51 aborted women selected
purposively. The data was collected by interview using structured and semi-structured questionnaire and
analyzed using Statistical Package for Social Sciences (SPSS).
Results: Health related factors for abortion included unintended pregnancy due to no use of contraceptive
(60.8%) or failure of contraceptive (39.2%) and to stop child bearing (47.1%). Very few showed economic
reasons for abortion i.e. 11.8% didn’t want to leave their job and 5.9% said it was due to food insecurity.
Nearly one third (31.4%) said they aborted as they wanted son and 9.8% did so because of pregnancy before
marriage.
General health condition of 29.4% of respondents was degraded. Among them, the commonest physical
consequences were lower abdominal pain (80.0%) and back pain (53.3%). Few of them were involved in
smoking and alcoholism i.e. 9.8% and 5.9% respectively due to abortion. The families of 72.5% of
respondents were happy and 96.1% said that their society was unaffected with their decision to abort.
Abortion had brought positive affects in the daily work of 84.3% respondents.
Conclusion: The results showed that very few were having physical and social consequences after abortion.
But the information on Family Planning methods and their proper use were lacking leading to unintended
pregnancy resulting abortion. So, Health education on Family Planning and its importance must be provided
to couples. The study can also be helpful to improve the Post Abortion Care (PAC) services and to instigate
the development of further programs related to abortion issues thus helping to improve women’s health.

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312
Philippines(菲律宾)

313
Oral 1 (ID571)
Emergence of Global Health Education in the Asia-Pacific Region
Don Eliseo Lucero-Prisno III
Faculty of Management and Development Studies, University of the Philippines
Department of Public Health and Policy, School of Medicine, University of Liverpool, UK

Background/objective: Education and training in global health and international health have become
popular in many universities in Europe and North America. The Asia-Pacific region has caught up with this
trend resulting into new offerings of similar programs. This paper analyses the emergence of global health
education in the region.
Method: A survey questionnaire was sent to schools of public health in the region. The questionnaire asked
for programs offered, rationale and vision, history, student profile, research, etc. A 25% return rate was
observed. In-depth interviews with course coordinators and instructors were conducted in China, the
Philippines, Singapore, Vietnam, Hong Kong, Bangladesh and Singapore. Websites and annual reports of
various public health education institutions were also analyzed.
Results: Many universities in the Asia-Pacific region have started to offer various courses such as master,
short courses and PhD in international health. The demand for these courses has been the major driver in the
increase of the opening of such degrees. Others are interested in offering in the near future. MPH is
considered the backbone of the program. This trend finds a role in the changing economic climate of the
region with countries shifting from being donor-recipient to development aid providers necessitating training
of global health experts. An emerging classification of a wide range of work characterized as ‘global health’
has become attractive resulting in more demand in the course. This includes jobs with international
organizations and non-profits. Institutions look at the program as a new science and practice that would
address health issues on a regional level through research and training.
Conclusions: The increasing popularity of international health education program in the region establishes
international health as an emerging science within public health with an emerging identity, role and concepts.
It advances the research on health at a global and international scale.

Poster (ID617)
Analysis of the maintenance and depreciation costs and requirements of Selected government
hospitals in the Philippines
Eduardo Banzona, Ma. Gerry Lyn Alcantarab, Lorra Angelia Saysonc, Maria Alyana Diez c
a Independent Consultant, NCR, Philippines

b Asian Institute of Management, NCR, Philippines

c Philippine Institute for Development Studies, NCR, Philippines

Background/ Objective: The Aquino Health Agenda for Universal Health Care aims to provide Filipinos,
especially the poorest, access to quality health services. Thus, the poor were enrolled into the National
Health Insurance Program (NHIP); while funds were infused to enhance health facilities. However, service
delivery gaps still exist.
The study explored financial and resource management practices in health facilities, specifically government
hospitals, and sought to determine the root causes of complaints about insufficient health services and goods
provided by public hospitals. Are these due to low government budgetary allocation, inefficient and poor
management of resources in government hospitals, or both?
314
Method: The ideal budget practices and hospital costing requirements in relation to maintenance and
depreciation of hospital equipment and facilities were reviewed. Focus Group Discussions (FGD) and Key
Informant Interviews (KII) were conducted. An Excel-based hospital survey was administered to extract data
necessary to compute the hospital capital budget, maintenance, and depreciation costs. Recommendations
were made based on comparing the standards with the actual hospital budget practices and costs.
Results: Government hospitals had varying financial and management capacities with most hospitals
employing budget practices that deviate from the ideal and standard practices. There is poor monitoring of
the budget practices by the oversight agencies. Moreover, inadequate understanding of the maintenance
and depreciation costs of hospital equipment and facilities has contributed to the non-inclusion of these costs
in the design and costing of the benefits of the NHIP.
Conclusion: Moving towards Universal Health Coverage requires a reliable service delivery arm. Health
facilities/public hospitals must become more efficient in managing limited resources and properly tracking
maintenance and depreciation costs in order to abide to quality assurance and cost containment designs of the
NHIP. There should be robust government financial management standards with strict monitoring of the
compliance with these standards by government hospitals.

Poster 1(ID185)
Knowledge on HIV and Sexually Transmitted Diseases, Self-Efficacy and Communication
Skills on Condom Use of Selected College Students: Basis for Development of Health
Education and Promotion Materials
Prof. Myra Oruga, MPH
Self University of the Philippines-Manila College of Public Health, Manila Philippines
Philippine Council for Health Research and Development, Advance Science and Technology Research and
Development Program (PCHRD-ASTRDP) Department of Science and Technology (DOST), Manila Philippines,
Lyceum of the Philippines University- Laguna, Manila Philippines
AECOM, Philippines, Manila Philippines

Background and Objectives: Knowledge on HIV and Sexually transmitted Diseases, Self-Efficacy and
Communication Skills on condom use of selected college students on HIV/AIDS and sexually transmitted
diseases were explored in this cross sectional study. The profiles of the respondents were correlated to
dependent variables knowledge on HIV and sexually transmitted diseases, self- efficacy and communication
skills on condom use.
Method: There were 263 respondents. Sampling used was cluster sampling. Mean, frequency and
percentage and regression analysis were used.
Results: There were more female than male respondents. Majority of them belong to age 16-21 years old,
most of them were Filipino, they came from private high school, belong to middle income family and were
catholic. They have adequate knowledge on HIV and Sexually transmitted disease however the mean
self-efficacy and communication skills on condom use were moderately low. The level of knowledge of the
respondents on HIV and sexually transmitted diseases resulted to weak positive relationship when correlated
to age and type of high school; however it has significant relationship to age and gender. Self- efficacy on
condom used when correlated to gender and daily allowance resulted to weak negative relationship
compared to age having a weak positive relationship. Self- efficacy has significant relationship to daily
allowance. Gender and age has weak negative relationship to communication skills but it shows significant
relationship to the same. Self-efficacy and communication skills have weak positive relationship to
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knowledge however there is no significant relationship to the same.
Conclusions: Majority of the students have adequate knowledge on HIV and sexually transmitted diseases,
the moderately low self-efficacy and communication skills on condom use should be given a highlight in the
conceptualization of health education and promotion materials. The relationship of other independent
variables should be considered such as religious affiliation, income and nationality.

Poster 2 (ID572)
Changes and Challenges of the Hospital Sector in the Philippines
Don Eliseo Lucero-Prisno III
Faculty of Management and Development Studies, University of the Philippines
Department of Public Health and Policy, School of Medicine, University of Liverpool, UK

Background/objective: The hospital sector of the Philippines has been undergoing various changes in the
past decades due to changing health policies and economic regimes. These changes impacted on access to
health care and provision of medical services to the population. This paper discusses the drivers of change
and its consequences.
Method: Document analysis of various policy papers, reports, research studies and other relevant papers was
done. Papers used were reviewed, categorized and analysed. In-depth interviews were conducted with
government health officials, civil society groups and academic researchers.
Results: Policy regimes had different perspectives in changing the hospital sector using concepts like
decentralization, fiscal autonomy, competition, efficiency, privatization and access. Changes are led by policy,
business and management frameworks instead of health and demographic determinants. The outcomes made
the Philippine hospital system more complex due to the emergence of many players with differing
characteristics and persuasions. Hospitals are characterized into many categories such as primary, secondary
and tertiary, private, public and charity, etc. The changing economic climate paved the way for a hospital
sector that has become a lucrative industry for the private sector. The government continues to support many
hospitals that cater to a big percentage of the population including the poor. The hospital sector needs to
work with the country’s health financing scheme. To achieve universal healthcare, a more comprehensive
approach needs to be in place that includes the hospital sector to achieve a more equitable and universal
healthcare.
Conclusions: Hospital development is a result of the changing health needs of the population, demographic
changes, economic climate and government policy. These changes add to a more nuanced national health
care system that does not address the goal of universal health care. This results into a more complex health
system undermining the health goals of the country.

Poster 3(ID573)
An Assessment of Medicine Entitlement Programs and their role in Universal Health
Coverage in the Philippines
Beverly Lorraine Ho
Asian Development Bank, Philippines

Introduction: Household out of pocket (OOP) spending pays for for 52.7% of total health spending with
medicines as the main out of pocket health expense accounting for 65.7% of all household health spending.
Overall, medicines account for 42% of total health spending with 90% paid out of pocket . In response, the
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Philippines began to pursue Universal Health Coverage (UHC) by increasing budgetary allocations for health,
promotion of public-private partnerships, and expanding social health insurance. This resulted in several
Medicine Entitlement Programs (MEPs) that were expected to address high OOP for medicines by providing
free, subsidized or discounted medicines.
Objectives: The study aimed to map and document all existing MEPs, examined current policy and program
constraints, and explored opportunities that would improve synergy and efficiency in the implementation of
the MEPs. It also determined the contribution of the MEPs in attaining the country’s UHC goals of
expanding access to necessary health services and reducing health-related financial hardship.
Methods: Review of literature and available documents was conducted followed by key informant
interviews and focused group discussions.
Results and Discussion: A total of 18 MEPs were reviewed covering a range of out-patient and inpatient
medications. There was no overall strategy in selecting and prioritizing which medicines to cover, with
existing laws for expanding medicine access not fully integrated in the design. Private drug companies
collaborated in the MEPs, seeing value in lower price-higher volume deals, but there was minimal synergy
among MEPs with each program having their unique information dissemination, availment and reporting
mechanisms resulting to patient difficulty in accessing MEPs and minimizing their contribution in attaining
UHC goals.

Poster 4 (ID854)
Public Health Law Review on Six Countries in Western Pacific Region: Republic of Korea,
The Philippines, Samoa, Vanuatu, Kingdom of Cambodia, Lao People’s Democratic Republic
Yuri Lee a, Sjoerd Postma b, Myongsei Sohn c, So Yoon Kim d
a Technical Officer (Legal), Health Services Delivery, Western Pacific Regional Office, World Health Organization,
Manila, Philippines
b Team Leader, Health Services Delivery, Western Pacific Regional Office, World Health Organization, Manila,

Philippines
c Dean, Graduate School of Public Health, Yonsei University; Director, Asian Institute for Bioethics & Health Law,

Yonsei University; Professor, Department of Preventative Medicine, Yonsei University College of Medicine, Seoul,
Republic of Korea
d Associate Professor, Department of Medical Law & Ethics, Yonsei University College of Medicine, Seoul, Republic

of Korea

Background: Public health law is one of the important tools for improving public health. Public health law
provides a legal and administrative means that assure social conditions in which people can be healthy.
Despite such significance of public health laws and legislations, many countries still lack adequate public
health legislation or have legislation that is outdated which fails to address people in contemporary health
issues of their people. Also, there is currently no substantial regulatory framework to monitoring domestic
public health law. So, the purpose of this study is trying to review public health law situation in six countries
in Western Pacific Region.
Methods: Local researchers were conducted desk review for gathering most of data on public health law
from library, archives of the Ministry of Health, and also from the website for the latest posting. Then desk
review results were supplemented with consultation meeting with WHO country office technical staffs,
government officers in central and local government, and health law specialists. Standardized report forms

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including government structure, basic code and other laws, legal system, list of health legislation, legal
typology, public health law coverage by International Digest of Health Legislation (IDHL) and some topics
such as Health System based on Primary Health Care (PHC) values, International Health Regulation(IHR),
and Framework Convention on Tobacco Control (FCTC) were used. Comparative analysis among six
countries was conductive after gathering data.
Results: Three countries were civil law system and the Samoa and Vanuatu answered their countries are
closed to common law system. Government structures in six countries were various. All five countries had
constitutional provision relating to health. In primary legislation which is enacted by the main law-making
body of the government, 34 in Republic of Korea, 28 in the Philippines, 42 in Samoa, 39 in Vanuatu, 22 in
Kingdom of Cambodia, and 16 in Lao PDR were found. Also, secondary legislations promulgated by
executive bodies was also found 10 in Republic of Korea and the Philippines, 5 in Samoa, 126 in Kingdom
of Cambodia, 17 in Lao PDR. Cross country comparisons were conducted based on horizontal as well as
vertical comparison perspectives. With respects to health law coverage, Republic of Korea answered all 40
questions covered by current primary and secondary legislation. Six in the Philippines (15% gaps), nine in
Samoa (22% gaps), nineteen in Vanuatu (47% gaps), fourteen in Kingdom of Cambodia (35% gaps), and
nine in Lao PDR (22% gaps) out of forty questions were not addressed directly by existing public health
laws in countries. Major gaps comparing with international standards or other countries were raised in each
country.
Conclusion: The analysis framework may show that generate interaction between countries which increases
the necessity of the study on comparison of the public health law, regulation, and legislative process among
countries. The reasons why similarities and difficulties of the law were analysed are for improving law in six
countries.

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Singapore (新加坡)

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Oral 1 (ID190)
Occupational Risk Factors for Low Back Pain among Drivers of Three-Wheelers in Sri Lanka
Misa Nodaa, Rahul Malhotraa, Vijitha DeSilvab,c, Pasindu Sapukotanad, Asela DeSilvad, Jacob Kirkorowiczc,
John Allene, Truls Østbyea,c
a Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore

b Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka

c duke Global Health Institute, Duke University, United States of America

d Faculty of medicine, University of Ruhuna, Sri Lanka

e Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore

Background: Large numbers of workers in low and middle income countries work in the informal sector
where health and social protection is often lacking. Three-wheel drivers are one large such occupational
group in many Asian countries including Sri Lanka. Being exposed to long hours of sitting and vibration,
they are particularly at risk for low back pain (LBP); in this study, we aim to characterize LBP among these
drivers, and to test the hypothesis that an increase in self-reported weekly work hours is associated with an
increase in 4-week prevalence of LBP, independent of confounders.
Methods: A questionnaire was administered by an interviewer as part of a cross-sectional study of 200 full
time three-wheel drivers in Galle district, Sri Lanka, from January to February 2013. Data collected included
work hours, presence of LBP in the past 4 weeks, as well as occupational, psychological, socio-demographic,
lifestyle and anthropometric information.
Results: LBP was the most common musculoskeletal pain reported (N=31, 15.5%). In univariate analysis,
self-reported weekly work hours, engine type, pressure to compete with other drivers and PSS score were
significantly (p<0.05) associated with 4-week prevalence of LBP. In multivariate analysis, the significant
association with weekly work hours (odds of LBP : 1.51 [0.33-6.86], 2.40 [0.57-10.01] and 5.31 [1.28-22.10]
times greater for those in the 1st [<71 hours], 3rd [82-91] and 4th [>91] quartiles versus those in the 2 nd
quartile [71-81]) and engine type (odds of LBP: 2.85 [1.18-6.93] times for 2-stroke engine versus 4-stroke
engine) was maintained.
Conclusions: Increasing work hours and driving a three-wheeler with a 2-stroke engine were found to be
associated with an increase in the prevalence of LBP among three-wheel drivers. We suggest regulating
work hours and a shift towards four-stroke engines as ways to prevent LBP among three-wheel drivers.

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Sri Lanka(斯里兰卡)

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Guest Lecture (from APACPH)
The APACPH Global Public Health Education Model in the Asia-Pacific Region
Indika Karunathilake
Faculty of Medicine, University of Colombo, Sri Lanka

In a globalizing world, national boundaries are porous and conditions impacting on health easily cross
borders. Events such as pandemics, disasters, economic crises, ethnic violence, wars and migration, further
demonstrates that health of populations are linked and co-dependent. In this emerging conceptual shift,
health needs to be viewed fundamentally as a human asset beyond borders, a global asset. Validating this
global perspective, a large multi–disciplinary body of experts composed of academics, health care providers
and policy makers convened by APACPH have determined that the Global Health Specialist as
representatives of the emerging health professional of the future, needs to have the core competencies
essential to the profession embodying the basic quantitative and qualitative skills as well as the global health
competencies including integrative transforming skills attributed to the public health professional in The
APACPH Global Health Model Jakarta 2012.
The future public health graduate - the global health specialist “GHS”- needs to be a ‘super generalist’ able
to integrate and address problems across disciplines and help develop solutions, policies etc rather than a
‘super specialist’ only dedicated to a particular discipline or procedure. The GHS should be able to draw
upon other disciplines to address complex problems like Obesity or AIDS or rapidly changing dynamics in
health for example in urbanization - poor urban slums in economically developed and as well as in poorer
countries. The GHS should be able to identify experts and work across disciplines in an integrated problem
solving approach. With this strategic framework, it is expected that all institutions of Public Health will
prepare practitioners who have a prevention orientation and are able to identify and assess needs of diverse
populations; plan, implement and evaluate programs more cohesively efficiently and effectively to address
identified needs; and otherwise assure conditions that protect and promote the health of populations within
country or global context. The GHS like the Primary Care Physician, The GP and others in the health care
field needs to bring a long term view to health problems with global - cross cultural, cross national -
perspective to reinforce, and support partners as well as take the lead to coordinate and manage. The
leadership role for the GPS is therefore significant.

Guest Lecture
Experience of Provision of Basic Occupational Health Care in Non-formal Workplace Though
Primary Health Care (PHC)
Rohini DA Seneviratnea, Kantha Lankatilekea, Novil Wijesekarab
aFaculty of Medicine, University of Colombo, Sri Lanka

b Ministry of Health, Sri Lanka

Background: In Sri Lanka two thirds of working population is employed in non-formal and small and
medium scale industries, mainly unregulated, unregistered, lacking in attention to safety. Primary health care
(PHC) system covering entire island with trained Medical Officers of Health (MOH) and Public Health
Inspectors (PHI), designated to implement occupational and environmental health activities are able to
improve health and safety of such workplaces. Objectives of this study were to assess health problems, work
environment, exposures and carry out health promotion in small and medium scale industries in an MOH
area and recommend improvements to work environment to promote healthy work setting using.
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Methods: A walk-through workplace survey, inspection of machinery for safety, compliance to safety
standard, recording accidents as prescribed in Factories Ordinance and assessment of physical environment
and a survey of workers and health examination were carried out.
Results: Walk-through survey identified problems related to machine, fire and electrical safety.
Housekeeping and welfare measures needed improvement. Recommended mechanisms for reporting
workplace accidents were not in place. After completion, findings of walk-through survey were conveyed to
occupier on spot, highlighting existing deficiencies, recommending action for improvement and referring to
experts for further support to implement changes. Good practices were highlighted. Findings of health survey
were conveyed to workers and referrals were made as appropriate. Health and safety education of was
carried out. Workers were invited to attend lifestyle clinic held to prevent non communicable disease and
promote mental wellbeing.
Conclusions: We recommend that a PHC approach be utilized in developing countries to identify and
address health related work hazards, of non-formal small scale industries and as a feasible setting for health
promotion in the work place.

Oral 1 (from APACPH)

Initiation, Maintenance and Quitting of Betel Quid Chewing in Estate Populations in Sri
Lanka
E. A. Prasad D. Amaratunga, R. D. Jayasinghe, A. A. A. K. Wimalarathna
Faculty of Dental Science, University of Peradeniya, Sri Lanka

Introduction: Betel Nut/Quid Chewing (BNC) is an age-old social habit in the Indian subcontinent. Oral
Cancer and its link to chewing of betel nuts together with other ingredients such as tobacco, lime and betel
leaves (betel quid) has been established beyond doubt. Oral Cancer research is vast and ever growing.
However, behavioral and Socio-Cultural factors in the initiation, maintenance, addiction and quitting of BNC
have been less rigorously studied.
Aims: Principal Aim of this study is therefore to find out the behavioral and socio-environmental factors that
influence initiation, maintenance and quitting of BNC.
Materials and Methods: Data collected by means of a questionnaire and a structured interview from betel
nut chewers (Chewers) and from individuals who have quit the habit of Betel nut chewing (Ex-Chewers).
Results: Data collected from a total number of 132 individuals; 115 (87%) Chewers and 17 (13%)
Ex-Chewers. More than two third (64.3%) were Indian Tamils whereas Moors and Sinhalese accounted for
18.1% and 17.4% respectively. A large majority (80%) of Chewers were female whereas only 35% of
Ex-Chewers were females. Both Chewers and Ex-Chewers come from a poor educational background and
73% of Chewers and 87% Ex-Chewers had either not gone to school at all or gone only up to elementary
level. Social influence from friends and the enjoyment of chewing were considered the most important
reasons for chewing.
Conclusions: Large majority of Chewers and Ex-Chewers come from uneducated Low Socio-economical
background. Practice of BNC seems to start in young adulthood and the principal driving force is the
influence from the immediate social group; friends and family. Duration of practice of BNC does not seem to
have an effect on desire and the ability to quit. Majority of Chewers are aware of ill effects of BNC but
continued to Chew.

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Oral 2(from APACPH)
Addressing Human Resources in Health (HRH) Issues in An Island Nation - the Maldivian
Experience
Indika Karunathilake
Faculty of Medicine, University of Colombo, Sri Lanka

Background: The Republic of Maldives has achieved remarkable health gains over the past few decades.
Being a small island nation, Maldives is highly vulnerable to effects of globalization as well as
epidemiological, socio economic, cultural and political changes. The Human Resources in Health (HRH)
situation of the country is determined by a complex interplay of these factors as well as internal factors
governing HRH such as health financing, policy, management and training.
Method: A HRH situation analysis was conducted in the republic of Maldives.
Results: The main HRH issues faced by Maldives include, overdependence on expatriate health
professionals, variability in the quality of pre-service and postgraduate training, difficulties in legally binding
staff to service/training bonds, inequitable distribution of health workforce between Male’ and the Atolls,
shortages of HRH in the Atolls, difficulties in retaining health workers in the Atolls and islands, leading to a
high turnover and lack of coordination in HRM management
Conclusion: In order to address these complex issues in HRH, a well-thought and holistic plan is needed. A
systematic approach in HRH policy, management, leadership, education and training, and promotion of
partnerships as well as financial components should be used in combination to improve HRH situation of the
country.

Oral 3 (from APACPH)

Three Wheeler and Tuk-Tuk Accidents: An Emerging Burden in Motor Vehicle Deaths and
Injuries in Sri Lanka
Chiranthi Liyanage, Indika Karunathilake
Faculty of Medicine, University of Colombo, Sri Lanka

Motor traffic accidents are a growing concern across the globe. In Sri Lanka with the recent development of
the road network and new highways and the massive influx of vehicles, the number of road traffic accidents
have shot up exponentially compared to the last decade. Sri Lanka’s road traffic accident surveillance
records indicate that 38.4% involve motorcycles and three-wheelers (Tuk-Tuks) with over 16,400
motorcycle accidents in the year 2010. Moreover, approximately 27,000 people have been injured and 2,700
fatalities have been reported from motor traffic accidents during this year. The true burden of this problem is
evident in the number of grievous and non-grievous injuries caused to humans and the damage caused to
public and private property. Sri Lanka has battled with this rising number of road traffic accidents for years
by implementing new road safety rules and regulations, strict implementation of existing legislations and
public awareness programmes. Like in many other Asian countries “The Helmet Law” has been
implemented with the objective of minimizing the casualties from motorcycle accidents. However despite
the high helmet usage in adults, the majority of children appear not to wear helmets, making them vulnerable
to even severe injuries. Furthermore, multiple pillion riders on motorcycles poses greater difficulties to
authorities to streamline and implement such legislations.

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Oral 4(from APACPH)
Reframing Rural Health: Health Beyond the Health Sector
Chrishantha Weerasinghe
Faculty of Medicine, University of Colombo, Sri Lanka

Traditionally the focus of rural health is to explore the access to healthcare in rural settings. Hence,
interventions to improve rural health are centered on developing health services, i.e. hospital services and
health manpower, in rural areas. However, it is seen that isolated development of health infrastructure per
say does not improve the health status of rural population. Hence, a holistic approach is needed for success.
In Sri Lankan context, physical access to health care is seen to be generally high. Studies show that on
average a government health facility is within five kilometres of a residence. Although there is
maldistribution of health manpower, the current status is much better than the comparable economies in
Asia-Pacific region. Hence, there is a need to revisit rural health in a broader context. This paper focuses
on the availability of “water” as a key determinant of health in rural population.
Providing water for agriculture as well as for human consumption is a challenge in any setting. In the Sri
Lanka, providing adequate water for dry zone agriculture and safe drinking water for human consumption is
becoming a major issue with the epidemic of chronic renal disease of unknown origin. CKDU has become
the main health issue in the rural dry zone where water is implicated as the key factor. Entire development of
the health sector in the rural dry zone during a last 4 decades is threatened and the gains in rural heath are
taken back. The value placed on “water” in a rural setting is different to most other settings. This paper
provides empirical evidence from the field on the relevance of “water” as a key determinant of rural health
and concludes emphasizing the need for reframing “rural health”.

Oral (from APACPH)

Medical Students in Health Assistance in Areas of Conflict
Dr. Indika Karunathilake MD M Med
Director, Medical Research and Development Centre, Faculty of Medicine, University of Colombo

Oral 5(ID580)
Climate Factors and Dengue Fever in Selected Areas of Sri Lanka
Rohini De-Alwis A Seneviratne
Faculty of Medicine, University of Colombo, Sri Lanka

Background: Global warming and associated climate change affects ecological systems, and enhance the
range, breeding sites, reproductive and biting habits of mosquito species. Thus mosquito borne diseases are
sensitive to effects of climate. In addition, Urbanization, population expansion and movement, and
increasing population density with human behavior changes have resulted in favorable conditions for
breeding of aedes species, the vector of dengue fever (DF).
Objective of this study was to describe relationship between climatic factors and incidence of dengue fever,
in selected urban, semi urban and rural areas in Sri Lanka.
Methods: A retrospective study in five urban, rural, and urban-rural mixed areas in Sri Lanka was carried out
using weekly DF notification data from 1996- 2010 and weekly temperature and rainfall for same areas for
the period. Using time series analysis descriptive monthly time series graphs were obtained and ARIMAX

325
models were developed on weekly data.
Results: Dengue rate in the previous week (lag 1) was the most significant predictor of DF in the current
week for all five study areas. Rainfall, up to a lag period of 6-7 weeks was significant in predicting DF case
rates in a high rainfall urban area. The significant positive correlation between dengue case rate and average
temperature with a lag varying between 10-16 weeks was observed for three areas.
Conclusion: Occurrence of DF is related to rainfall and previous week’s case load. Rainfall occurring 6-7
weeks earlier was related to DF in the current week, implicating the role of vector density in transmission.
Although vector of DF plays a crucial intermediary role in the complex dynamics of DF transmission and
climate factors, entomological surveillance data were not available for analysis. Setting up an entomological
surveillance system is a need.

Oral 6 (ID627)
Sri Lanka: Advocating for SRH/HIV Integration Through Partnerships and Networking
Using Provincial Structures as A Platform
Thilothama. V. Munasinghe, Madusha S. Dissanayake
Family Planning Association, Colombo, Sri Lanka

Background: Sexual and Reproductive Health (SRH) and HIV integrations are strategic to containing the
HIV pandemic and achieving the Millennium Development Goals 4, 5b and 6 in 2015. In Sri Lanka,
adopting rights based approaches to scale up current SRH HIV integrations to achieve HIV testing coverage
among criminalized and stigmatized populations (female sex workers, men who have sex with men, drug
users including injecting users, beach boys), and antenatal women, will enable realising the national goals of
maintaining the current low HIV epidemic status and eliminating parent- to- child- transmission of HIV.
Method: The Sri Lanka SRH HIV Integration Project advocated the Country Coordinating Mechanism of
the Global Fund on TB, AIDS and Malaria to support proposals seeking donor investment to strengthen
integrated service delivery, national and provincial health sector officials to expand current integrations, and
strengthened provincial Civil Society Organizations (CSOs) to advocate media, key populations and youth
on the benefits of supporting rights based SRH HIV integrated service delivery to achieve national goals.
Results: Sensitized stakeholders and partners established one network (40 CSOs) advocating on SRH HIV
integration in the tourism driven Southern province, three youth networks lobbying for youth friendly SRH
HIV integrated services in the Southern, Eastern (post–conflict and tsunami) and Central (underserved tea
plantation sector) provinces, and did integration focused radio broadcasts and newspaper articles in Sinhala,
Tamil and English in the Southern and Uva (underserved) provinces. Measures of satisfaction included
letters from listeners and readers, award of free airtime for an additional broadcast on integration, and media
personnel recommendations to extend capacity building strategies to other provinces.
Conclusion: The advocacy related outcomes highlighted the importance of political engagement, and
provincial media and civil society strategies to increase awareness of benefits of integrated approaches, and
promote tolerance of key populations among key stakeholders, partners and the public.

Oral 7(ID977)
Psychosocial Well Being & Its Influence on School Performance of Children from Institutions
and Children Live with Parents
Thadshajini sivalingam, Priyanthy Swarnaraj

326
 Faculty of Medicine, University of Jaffna, Sri Lanka

Background: Number of children institutionalized is increasing nowadays. In Sri Lanka the poverty is the
most common cause of institutionalization of children. Internal war in country for last few decades also
increased the number of children getting institutionalized. The emotional needs and some fundamental rights
of children are rarely met in institutional settings. So the psychosocial well being of children will be affected
by institutionalization.
Methodology: This is a comparative study conducted among institutionalized children (aged 11-16 years)
and age and sex matched children live with parents from same class to compare the state of psychosocial
well being. 170 institutionalized children (males =73) and 170 controls living with parents were compared
using validated Strength and Difficulties Questionnaire (SDQ) self report, SLIPSS-C (Sri Lankan Index of
Psycho Social Scale for Children) and self administered questionnaire to assess school based activities.
Results: This study found that Institutionalized children have higher level of risk for developing clinically
significant emotional and behavioral problems (OR=3.96, CI=2.33-6.71) and they showed the higher level of
distress (t test value=7.925, p=0.05). Educational performance of institutionalized children also was
significantly lower than that of children living with parents. But institutionalized children showed better
extracurricular activities than children living with parents.
Conclusion: Findings of this research suggest that the psychosocial well being of children was significantly
affected due to institutionalization. Educational performance of institutionalized children is also lower than
that of family reared children. Children living with parents had lower level of extracurricular performance
than institutionalized children.

Poster 1 (ID106)
Adaptation and Validation of Effort-Rewards-Imbalance Model Among Administrators:
Evidence from Sri Lanka
Anuji U. Gamagea, Rohini De. A. Seneviratneb
aNutrition Division, Ministry of Health, Colombo, Sri Lanka
b Department of Community Medicine, University of Colombo, Sri Lanka

Introduction: Growing evidence over the last few decades indicate that negative psychological factors have
an adverse impact on employee health and wellbeing which eventually affect work place productivity.
Objective: Objective was to translate the 23 item effort rewards imbalance model (ERI) in to Sinhala
language and validate it among administrators of government administration offices in a District of Sri
Lanka.
Methodology: The ERI model was translated into Sinhala using the forward backward translation
methodology. Modified-Delphi process assessed consensual validity. A descriptive survey assessed the
construct validity among 242 randomly selected administrative officers from 14 government administration
offices. Both exploratory and confirmatory factor analysis were performed. Cronbach’s alpha and test re-test
reliability assessed internal consistency.
Results: Judgmental validity was established. Construct validity was assessed with data derived from the
cross sectional survey. Six factors were derived from Principal factor analysis with Varimax rotation,
Bartlett’s test for sphericity was significant(X2=3445.737, df 378, p < 0.001) and Keiser-Mayer-Olkin
measure was 0.763 which confirmed the factorability of data. Satisfactory test retest reliability (0.80; n= 25)
and internal consistency (Cronbach’s alpha coefficients for efforts, rewards and over commitment were 0.80,
327
0.84 and 0.60 respectively) were obtained. After confirming that data met the statistical assumptions
required, confirmatory factor analysis was performed. Five competitive models were explored and best fit
indices were achieved with the original model (Model V- Chi-square= 131.9, df= 203, p= 0.99; Goodness of
Fit indices= 0.79; Non Normal Fit Indices=0.99; Root Mean Square Error =0.11; Standardized Root Mean
Square Residual = 0.09).
Conclusions: The Sinhala ERI model is an acceptable, reliable, valid self-reporting method of assessing
occupational stress among senior officials and managerial assistants of government administration offices in
Sri Lanka. Importantly in the context of the current labour market in which lack of reciprocity between
efforts and rewards at work is associated with ill health.

Poster 2 (ID168)
Health Promotion in Workplaces as A strategy for Modification of Risk Factors for NCDs:
A Practical Example from Sri Lanka
Amila Chandrasiria, Arosha Dissanayakeb
aPost Graduate Institute of Medicine, University of Colombo, Sri Lanka
b Department of Clinical Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka

Background/Objective: Non communicable diseases (NCDs) are emerging as a major public health concern
worldwide. NCDs are the leading cause of mortality in Sri Lanka accounting for 70% of deaths, most of
which are premature. Economic burden from NCDs, on a health system already maximally stretched, is
enormous. Risk factors for NCDs are closely related to unhealthy lifestyles. Health promotion strategies
aimed at lifestyle modification are helpful in modifying risk factors for NCDs resulting in lower morbidity
and mortality. Objective of this program was to transform a workplace to a health promotion setting where
lifestyle changes in workers led to a modification of risk factors for NCDs.
Method: A health promotion program was conducted in a divisional administrative office, in a semi urban
area Sri Lanka. An office health promotion committee was established and an action plan prepared with
participation of the workers. An interviewer administrated questionnaire was used to assess for risk factors
for NCDs .Workers were then screened for NCDs. Behavioral change and communication (BCC) programs
were conducted to improve physical activity and dietary modifications. Health policies were laid down
targeting identified risk factors.
Results: Workers actively participated realizing the ownership of their health. 74 males and 89 females
(mean age of 35.5 years) were assessed. 14.1% were overweight. 26% reported physical inactivity. 13.5% of
males were smokers. Hypertension and dyslipidaemia were present in 9.8% and 20.9% respectively. 3%
were having high fasting blood glucose values. The programme resulted in identifying 16 new patients with
NCDs.
Conclusions: Programmes targeting office settings with workers as owners is a new strategy for reduction of
NCDs in Sri Lanka. This was an attempt to translate evidence into practice. True benefit of risk factor
modification through BCC programs will become apparent in longitudinal assessments.

Poster 3 (ID278)
Salt Consumption Estimated by 24 Hour Urinary Sodium Excretion Among Employees of
Government Administration Officers in Sri Lanka
Anuji U. Gamage a, Rohini De. A. Seneviratneb

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 a Nutrition Division, Ministry of Health, Colombo, Sri Lanka

b Department of Community Medicine, University of Colombo, Sri Lanka

Introduction: High level of sodium (Na) intake is associated with many health risks. Measurement of 24
hour urinary Na excretion is considered the ‘gold standard’ method of estimating Na intake in population
surveys.
Objective: To estimate and compare the 24-hour urinary sodium excretion and estimate salt consumption
among senior officials (SOs) and managerial assistants (MAs) in government administration in a district of
Sri Lanka.
Methodology: A comparative cross sectional survey was conducted to assess Na intake by 24 hour urinary
Na excretion among 164 randomly selected SOs and MAs. Sample size was calculated to estimate and
compare the parameters among the two categories of workers and a 24 hour urinary collection for sodium
excretion was conducted from selected participants. Consumption of salt per day was computed using the
formula: 17mmol of sodium = 1gram of sodium chloride (salt).
Results: Mean ages were 44.1(SD ± 9.0) and 42.1(SD ±8.7) years for SOs and MAs respectively. Mean
excretion of Na,K and Na/K molar ratio over 24 hours among SOs was 184.4(SD±83.17), 63.8 (SD±28.8)
mmol and 3.1 respectively and among MAs it was 192.7 (SD±93.52), 60.8(SD±28.8) mmol and
3.2 respectively. Male SOs had a higher 24 hour urinary Na excretion compared to females (201.4 vs 172.9
mmol) (p>0.05). Female MAs had a higher 24 hour urinary Na excretion compared to male MAs
(195.2vs178.2mmol)(p>0.05).
The mean salt intake among SOs and MAs were 10.84(SD±4.9) and 11.33(SD±5.5) g per day respectively
(p>0.05). 24 hour urinary sodium excretion was significantly higher (p<0.05) among hypertensives
compared to non hypertensives in both study populations.
Conclusions: Salt intake among senior officials and managerial assistants of government administration
officers in Sri Lanka was much higher than the recommended intake of ≤ 5g per day. The findings also
support the hypothesis that blood pressure within a population is related to dietary sodium intake.

Poster 4 (ID321)
Delirium: A Cause for Concern
Chathurie Suraweerab, Varuni de Silvaa, Raveen Hanwellaa, Wajantha Kotalawalab,
Chaya Kapugamab, Manisha Dalpathadub, Vipula Wijesirib
a
Professor of Psychological Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
b
Registrar in Psychiatry, Post Graduate Institute of Medicine, Colombo, Sri Lanka

Background: Delirium is a frequent form of psychopathology in hospitalized patients; particularly in the

elderly. The consequences of delirium include high morbidity and mortality. There is a delay in recognizing
delirium as most patients present with psychiatric symptoms. The aim was to describe the demographical
factors, aetiology and phenomenology of the patients who are diagnosed of delirium
Method: A descriptive study was conducted on patients referred to the Psychological Medicine Unit with
altered behaviour. Out of 44 patients referred, 29 were diagnosed of Delirium with the Confusion
Assessment Method (CAM). Phenomenology was assessed using the Delirium Rating Scale – Revised-98
(DRS-R98).
Results: None of the 29 subjects were diagnosed of delirium at the time of referral. 20 in the study group
were men and the mean age was 57.9yrs. 22 subjects were more than 50 years. 16 subjects were from
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surgical wards while 11 were from medical. 17 patients had diagnosed medical or psychiatric illness prior to
admission, with 2 having a history of forgetfulness. A mean of 2.62 diagnostic categories were noted per
subject as the cause for delirium with systemic infection being the most common contributing cause (62%).
The patients had a mean DRS-R98 total score of 32.17 with a mean severity score of 27. Inattention,
disorientation, visuospatial and impairment of short term memory were present in all 29 subjects. Psychotic
symptoms were present in 28 subjects. There was a significant positive correlation between thought process
and language abnormalities (r=0.75, p=0.01). A delay of mean 3.7 days was seen between alteration of
behaviour and psychiatry referral after which delirium was diagnosed.
Conclusion: Delirium is often not diagnosed in medical and surgical settings which results in a delay in
delivering optimal care for the patients. Often there are multiple contributory causes for delirium and the
phenomenology is complex which may contribute to late diagnosis.

Poster 5 (ID322)
Impact of Media on Child Mental Health
Hemamali Pereraa, Chathurie Suraweerab, Chaya Kapugama b, Nilmini Illandarac
aProfessor of Psychological Medicine, Faculty of Medicine, University of Colombo, Sri Lanka

bRegistrar in Psychiatry, Post Graduate Institute of Medicine, Colombo, Sri Lanka

cMedicalOfficer, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka

Background: Children and adolescents are known to spend more time with media than they do in any other
activity except for sleeping; an average of 7 hours/day. More than 50 years of media research attests to the
significant influence of media on child and adolescent mental health.
Aim: To assess for impact and relationship of media on attention, behaviour and educational performance in
school children 6-12 yrs.
Method: 56 children attending the child guidance clinic as sample group and 53 children at the outpatient
department of Lady Ridgeway hospital with no history of psychiatric comorbidities as control group were
assessed.
Results: The commonest media used was television (95.4%) with newspapers (1.9%) being the least
popular. The mean time spent on media was 4.1hrs with an average of 3hrs spent on television. Boys spent a
mean time of 2.7hrs on the television while girls spent 3.4hrs. Only 29.3% children spent less than 2hrs on
media per day. A significant difference (p=0.013) was found between mean times spent on television
between clinical (2.5hrs) and control (3.5hrs) groups. There was a significant difference in time spent on
media and academic activities (p=0.003). The average time spent on reading was 0.6hrs and they spent an
average of 1.5hrs on sports. 63.3% of children consumed food while using media while 41.2% used this time
to be with family members. Contrary to earlier evidence, no significant difference was found between
television use and ADHD. 62.3% of parents thought that children use media for fun.
Conclusion: 70.3% of children exceeded the daily recommended level of media use of 2hrs. There was a
correlation between the time spent by children on media, particularly television with the time spent on
academic activities. The significant difference in use of television between clinical and control groups may
be due to treatment factors.

Poster 6 (ID401)
The Impact of the Absence of the Biological Father on the Well Being of 11-16 Year Children

330
 in the Western Province of Sri Lanka
Rangani W.P.T.a, Goonewardena C.S.Eb
a Health Education Bureau, Sri Lanka

b University of Sri Jayewardenepura, Sri Lanka

Background: How important father is to his children has not been evaluated in our context as in other
countries, induced us to carry out this study.
Methodology: A comparative cross sectional study was done. Father absent was confined to father migration
and death. Father absent children were compared with father present children in the comparison group I and
II matched by their age, sex, social class and by living index. The interviewer administered questionnaire
which was developed after focus group discussions with the children were used with the Strength and
Difficulty Questionnaire (SDQ).
Results: The educational attainments of the father absent and present groups were compared. There was a
significant difference between the position by merit in the last school examination in father present group
and father absent group but the marks for the mathematics subject had no such difference. The attitudes
towards studies of the bereaved group of children had a significant change after father absent than when
father present but this was not seen in the migrant group. Children were classified as children with mental
health problems and without mental health problems according to the validated cut off values of the SDQ.
Mental health problems were seen among 27.5% children in migrant group and 34.1%children in bereaved
group and these proportions were significantly higher than there comparison groups. Further these children
with fathers had less emotional problems, less conduct problems, less hyperactivity problems and less peer
relationship problems and poor pro-social behaviors than the children without fathers. Also the children
without fathers were poorly attached to mothers than the father present children.
Conclusion: Children had psychological problems, poor educational attainments and poor relationship with
their mothers after father’s absence which implies that fathers are not only a financial source to children.

Poster (ID484)
Health Promotion Tool to Reduce The Tobacco Consumption in Men Through Their Children
in Low Socio-Economic Groups In Kandy District, Sri Lanka
Chamil P. Senevirathnea, Nayana D. Dhanapalab, Shalika Thennakoon a, Prasad Katulanda a, Manoj Fernandoc,
Shanika Malalgodad
a Diabetes Research Unit, Faculty of Medicine, Colombo, Sri Lanka.

b Regional Director of Health Services, Kandy District, Sri Lanka.

c Health Promotion Unit, University of Rajarata, Sri Lanka.

d Child Protection Unit, Plan Sri Lanka, Kandy, Sri Lanka.

Introduction - Tobacco smoking is one of leading causes of premature death and disability in worldwide,
and over 80% of the world's smokers live in low- or middle-income countries. It is estimated that annual
mortality from tobacco-related illness is about 20, 000 deaths.
Objectives - To determine the effectiveness of a health promotion tool in reducing cigarettes consumption
among men through children’s participation, in low socio economic communities.
Methods – This community based intervention was conducted through assigning two children’s groups as
“intervention” (n=76) and “control” (n=69) in four divisions including two tea estates, Kandy district.
Socio economic characteristics were similar in both groups. Intervention group was given health promotion

331
tool to facilitate the reduction of tobacco consumption among smokers. Smokers were encouraged by their
children, to reduce “one cigarette” out of their daily consumption and save that money for utilizing on
children’s necessaries. Children were given a training to use the tool through role play model. Regular
follow-ups were carried out strength the programme.
Results- After six months, 85% of Intervention group (n=65) and 79% of children (n=55) in control group
have successfully completed the study. There was no significant difference (p = 0.081) for the mean number
of cigarettes consumed by both groups before intervention; cigarettes per day by intervention and control
were 9.22 (SD =3.61) and 9.07 (SD=3.69) respectively. After the intervention, interventional group was able
to reduce their daily cigarettes consumption (mean – 7.12 cigarettes) with compared to control group (mean-
8.36 cigarettes). Independent samples t-test showed that the health promotional tool was an effective method
to lower the tobacco use among smokers in low socio economic groups (p=0.025).
Conclusion- Children based interventions through health promotional approach and proposed tool can be
used to reduce the tobacco consumption among smokers in low socio-economic communities.

Poster 7(ID438)
Health Promotion Approach to Improve the PA Level Among Women Who Live Low
Socio-economic Group in Sri Lanka
Chamil P. Senevirathnea, Manoj Fernandob, Prasad Katulandaa
a Diabetes research Unit, faculty of Medicine, Colombo

b Health Promotion Unit, Faculty of Applies Sciences, University of Rajarata, Sri Lanka

Introduction: Physical activity (PA) is a major component in the scope of health. Regular physical activity
can improve women’s' health and help prevent many of the diseases and conditions that are major causes of
death and disability for women around the world.
Aim: was to improve the PA level in women (age 25-49), in low socio- economics community in Sri Lanka.
Method: This community based intervention study collected all quantitative data through the International
Physical Activity Questionnaire long form (IPAQ) among target population in the “intervention” (n=29) and
“control” groups. Demographic factors were similar in both areas. Data on walking, Moderate-intensity and
Vigorous-intensity activities were collected. Intervention group was given a lifestyle intervention through
health promotion approach to improve PA level in active transport domain, Household and gardening
domain, working domain and leisure domain. Qualitative assessment done through Focus Group Discussion
(FGDs).
Results: MET- minutes for moderate, vigorous intensity activities were increased among subjects in the
intervention group (< 0.005), while control showed slight improvement which wasn’t significant. Among
those who were overweight and obese, 14 women (53 %) in the intervention group reduced their weight by 1
- 5 Kg. study showed a significant change in moderate PA (from 49%-89.7%) compared to control area
(from 46% - 55.5%). Qualitative assessment revealed that majority of the subjects participated with leisure
time PA sessions (volleyball, Elle, Cricket) who preferred the sedentary lifestyle before the intervention.
Most of them have become more active and some of them experienced cost benefits with saving money
that were spent for transport purposed (taxi and motorbike), also they commented that they felt comfortable
with house hold work than ever before.
Conclusion: Lifestyle intervention programme through health promotion approach can be effectively used to
reduce low level PA among women in low-socio economic groups.

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Poster 8 (ID500)
Knowledge of Cervical Cancer and Its Preventive Strategies Among Nursing Students in A
Developing Country
Balasubramaniam Branavan, Malik Samarasinghe, Chamila Lakmal, Narmada V Ekanayake, Shashikala
Mathotaarachchi
Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

Background/ objectives: Cervical cancer is the second commonest malignancy among women in Sri Lanka.
The incidence of mortality has been substantially decreased following the effective screening programme in
western countries. But, it remains a challenge in South Asian region including Sri Lanka. This study
investigated the knowledge about cervical cancer and its preventive strategies among female nursing
students.
Method: This descriptive cross sectional study was conducted among 272 female nursing students at the
leading school of nursing in Sri Lanka. Students with the clinical exposure were invited to this study and a
self-administered questionnaire was used to collect information. Data were analysed with SPSS 21 software.
Results: All the participants have heard about cervical cancer. 85.3% of participants agreed that HPV is a
major causative organism for developing cervical cancer. 97.1% of participants believed that family history
of cervical cancer is a risk factor. Only 80.1%, 70.6% and 91.9% believed that post coital bleeding,
inter-menstrual bleeding and blood stained vaginal discharge are the symptoms of cervical cancer
respectively. Only 19.2% of participants were aware that HPV vaccine is available in Sri Lanka while 45.2%
knew that HPV vaccination minimizes the risk of cervical cancer. 97.4% of participants have heard about
(Pap test), while only 21.32% have agreed that it is performed to detect precancerous status. 41.9%% of
participants said it should be performed annually, while 22.1% and 11.4% preferred it should be performed
once in three years and once in five years respectively.
Conclusions: Knowledge about the risk factors and symptoms of cervical cancer was reasonable. However
the awareness of HPV vaccination and the knowledge about the Pap test need to be improved. By this,
knowledge will disseminate among general public effectively.

Poster 9 (ID544)
Obstetric Risks and Adverse Birth Outcomes in Teenage Pregnancies: Experience of A
Tertiary Care Centre in Sri Lanka
Harshani Sisinuwani Liyanarachchi a, Praveenya Kalpani Liyanawadugea, Sumedha Madusanka a, Poojitha
Wickramasingheb
aFaculty of Medicine, University of Colombo, Sri Lanka

bDepartment of Paediatrics, Faculty of Medicine, University of Colombo, Sri Lanka

Background/Objective: Teenage (14-19 years) pregnancy is known to be associated with adverse antenatal
and birth outcomes. The objective of this study is to assess the pregnancy outcomes among teenage
pregnancies and compare them with pregnancies of 20-35 year olds females, in a tertiary care setting in Sri
Lanka.
Method: A cross sectional study involving 120 primi singleton mothers in all post natal wards of De Soyza
Maternity Teaching Hospital for women, Sri Lanka was carried out during the month of August, 2011. 40

333
Teenage mothers and 80, 20-35 year mothers of the same ward, were recruited (for each teenage delivery,
next two deliveries of older age group).
Results: Teenage mothers had a low maternal weight gain than the other group (t=2.944; p=0.004). However
there was no significant difference between the incidence of antenatal complications (anaemia, gestational
diabetes mellitus, pregnancy induced hypertension), adverse birth outcomes (prematurity, birth asphyxia, low
birth weight, birth length, meconium aspiration, neonatal sepsis) and mode of delivery (normal vaginal
delivery, emergency or elective caesarian section) between the two groups (p >0,05).
Conclusions: The absence of a significant difference in outcomes, except the maternal weight gain, between
the two groups could be due to effective provision of antenatal and perinatal care irrespective of the age.

Poster 10 (ID581)
Climatic Factors and Occurrence of Dysentery in Sri Lanka
Rohini De-Alwis A Seneviratnea, Arunasalam Pathmeswaranb, Kantha Lankatilekea, Paba Palihawadanac,
Panduka Karunanayakea
aFaculty of Medicine, University of Colombo, Sri Lanka

bFaculty of Medicine, University of Kelaniya, Sri Lanka

cChief Epidemiologist, Ministry of Health, Sri Lanka

Background/ Objective: Climate change results from emission of greenhouse gases from burning of fossil
fuel. Heavy rain, drought, high temperature and poor sanitation are known to be related to diarrheal diseases.
Diarrheal diseases in developing countries are a major public health problem. Objective of this study was to
describe relationship between climatic factors and occurrence of dysentery.
Methods: A retrospective study in five urban, rural, and urban-rural mixed areas was carried out using
weekly dysentery notification data from 1996- 2010 and weekly temperature and rainfall for same areas for
the period. Using time series analysis descriptive monthly time series graphs were obtained and ARIMAX
models were developed on weekly data.
Results: Case rate of dysentery has shown a declining trend and more in major municipal areas. In these
areas with high population density and a mix of high and low income settlements, usual peak of dysentery
during South-West monsoon rains was not observed. In dry zone, decline in dysentery was not so marked.
One area showed peaks during North-East monsoon rains. There was a positive autocorrelation of case rates
with case rates in previous 1-2 weeks in dry zone areas.
Conclusions: Decline in reported dysentery in municipal areas even during monsoonal rains can be
attributed to improvement of sanitation and other public health programs. In dry zone during monsoons
reporting of dysentery is higher. These areas do not have consistent safe water supply unlike in municipal
areas, which may account for differences in reported dysentery. Consistent finding of presence of significant
autocorrelation with lagged terms of dysentery rate in preceding 1-2 weeks supports importance of safe
drinking water for preventing spread of dysentery during times of high precipitation and floods. A consistent
positive relationship of case rate with rainfall was observed.

Poster 11 (ID584)
Prevalence and Correlates of Noise Induced Hearing Loss Among Traffic Policemen in the
City of Colombo
Nandika S. Nagodawithanaa, Arunasalam Pathmeswaran b, Ananda S. Pannilac, Nalini Sathiakumard, Rajitha
Wickramasingheb
334
 a Ministry of Health, Colombo, Sri Lanka

b Department of Public Health, Faculty of Medicine, University of Kelaniya, Sri Lanka

c Industrial Technology Institute, Colombo, Sri Lanka

d Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, USA

Background and objective: Noise induced hearing loss (NIHL) is a high frequency sensory-neural hearing
loss in subjects who are exposed to environmental noise, but this diagnosis is made only after excluding
other reasons for the hearing. Traffic policemen are exposed to environmental noise due to the nature of their
duty and are susceptible to develop NIHL.
The objective of this study was to determine the prevalence and correlates of NIHL among traffic policemen
in the city of Colombo.
Methods: A cross sectional study was carried out among traffic policemen in the city of Colombo. 350
participants were selected by cluster sampling. Pure-tone audiometry test was performed to assess the level
of NIHL. Hearing levels of participants were classified using a classification obtained by modifying the
Clark’s classification. Correlates of NIHL were assessed using an Interviewer Administered Questionnair
(IAQ).
Results: High frequency hearing of, 169 (total 287) participants (58.9%) was normal. Seventy nine
participants (27.5%) had minor NIHL and 39 participants (13.6%) had major NIHL.
In bivariate analysis 23 variables showed statistically significant association with mild and major NIHL
while multi-variate analysis showed only age had statistically significant association with major NIHL with
odds-ratio(OR) of 1.088 and only “duration of work as a policeman” had statistically significant association
with any NIHL (major or minor) with OR of 1.007.
Conclusions: Prevalence of NIHL among traffic policemen working in the city of Colombo was 41.1%(95%
CI=35.5%–46.9%). A third of those having NIHL had major NIHL.
Traffic policemen should undergo periodic hearing assessment. The police department should explore the
feasibility of reducing the number of hours per day spent on the road by traffic policemen. Traffic policemen
with NIHL must be transferred to a different division immediately.

Poster 12 (ID725)
Development of a tool (NULMSDQ) to assess neck and upper limb musculoskeletal disorders
among female garment workers in a free trade zone in Sri-Lanka
Nirmalie C Amarasinghe
National Institute of Occupational Safety and Health, Ministry of Labour, Sri Lanka

Background: Garment industry with 1,060 garment factories has become Sri Lanka’s largest export,
providing more than 330,000 employment. O workers 87% are females. Musculoskeletal disorders (MSDs)
among these workers is a major health problem and adversely effects productivity. Assessment of MSDs in
them has been hampered by lack of a validated tool in Sri Lankan context. The objective of this study was to
develop and validate a tool to assess MSDs of neck and upper limb.
Method: Study comprised three components; item selection, item reduction through a pilot studies with
principal component analysis, and validation. A pool of symptoms of neck and upper limb MSDs were
generated through literature review. An operational definition was developed based on symptoms derived and
content validity assessed by a panel of experts. A preliminary questionnaire was developed, translated to
Sinhalese and pre-tested among ten female garment workers. A pilot study and principal component analysis
335
(PCA) was carried out among 350 female workers. Content and criterion validity, and reliability were
assessed.
Results: Symptoms loaded to four domains; neck, shoulder, elbow and wrist in PCA. Content and criterion
validity of the tool was assessed. Physical examination by a rheumatologist was considered the “gold
standard” for criterion validity. Separate ROC curves for each region, neck, shoulder, elbow and wrist were
drawn and cutoffs were identified. Based on this sensitivity and specificity of tool were: for neck-83.1%,
71.7%; shoulder-97.6%, 91.9%; elbow-98.2%, 87.2%; and wrist-97.6%, 94.9% respectively. Cronbach’s
Alpha and correlation coefficient of each subsection was above 0.7
Conclusion: The tool, Neck and Upper Limb Musculoskeletal Disorder Questionnaire is valid and reliable
for assessment of MSDs in neck and upper limb of garment workers.

Poster 13 (ID749)
Prevalence Of Neck And Upper Limb Msds Among Female Apparel Workers In An Export
Processing Zone In Sri Lanka
Champika Amarasinghe
National Institute of Occupational Safety and Health, Ministry of Labour, Sri Lanka

Background: Garment industry is Sri Lanka’s largest export industry. A majority of workers in this industry
are females and musculoskeletal disorders (MSD) among them is a recognized health problem.
The objective of this study was to assess the prevalence of MSDs in female apparel workers in an export
processing zone.
Methods: A descriptive cross sectional study was conducted among 1089 females of 18-45 years selected
randomly from apparel industry using validated self-administrated NULMSDQ and a health information
questionnaire after obtaining written informed consent. Sensitivity and specificity of NULMSDQ to assess
MSDs in neck shoulder and upper limb were: neck (83.1%, 71.7%), shoulder (97.6%, 91.9%), elbow (98.2%,
87.2%), and wrist (97.6%, 94.9%). Cronbach’s Alpha and correlation coefficient of each subsection were 0.7.
Data were collected at lunch break by trained pre- intern doctors.
Results: Prevalence of having any work related neck and upper limb MSDs was 54.9%. In neck region
work-related neck MSDs, and thoracic outlet syndrome prevalence rates were, 33.1% and 30.2% respectively.
Work-related shoulder MSDs, rotator cuff syndrome and tension neck syndrome prevalence rates were
36.9%, 30.6% and 27.9% respectively. Frequency of elbow MSDs (21.5%), epicondilitis(10.6%), wrist
MSDs(14.7%), of De Quervain disease(7%) and carpel tunnel syndrome(5.8%) were less common. More
than one disorder was observed among workers and prevalence of having one, two, three disease conditions
and all four disease conditions at the same time were 18.7%, 23.5%, 11.0% and 1.8% respectively.
Conclusion: Almost half female apparel industry female workers had MSDs. Work-related MSD prevalence
was highest in neck, followed by elbow, and was least in the wrist. More than one area was affected in over
one fourth of workers

Poster 14 (ID765)
Correlates of the Three Domains of Burnout Among Nursing Officers Working in
Government Teaching Hospitals in Colombo

336
 Dulani Samaranayake, Rohini De A. Seneviratne
Faculty of Medicine, University of Colombo, Sri Lanka

Background: Burnout, which is a negative outcome of chronic occupational stress, comprises a syndrome of
emotional exhaustion (EE), depersonalization (DP) and a sense of low personal accomplishment (PA). It
leads to decreased job performance, low career satisfaction and suboptimal patient care.
Objetive: The objective was to describe the correlates of the three domains of burnout – EE, DP and PA-
among nursing officers employed in government teaching hospitals in Colombo
Methods: A descriptive cross sectional study was conducted in six teachings hospitals in Colombo district
among a stratified cluster sample of 1500 nursing officers. A self-administered questionnaire consisting of
the validated Sinhala translation of Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and a
questionnaire to assess personal, family and work life correlates was used. Presence of EE, DP and PA was
determined using validated cut off values for the subscale scores of MBI-HSS and univariate and
multivariate analysis was performed to identify their correlates.
Results: Response rate was 90.4% (n=1356). Correlates of EE were younger age (OR=4.4, 95%CI1.6-11.7),
more night shifts (OR=2.8, 95%CI1.25-6.25), perceived difficulty with shift work (OR=2.8, 95%CI1.4-5.7),
time pressure (OR=2.03, 95%CI1.2-3.5), frequent work-family conflict (OR=4.5 95%CI1.4-13.9) and poor
supervisory support (OR=2.7, 95%CI1.4-5.2). Correlates of DP were lesser work experience (OR=6.5,
95%CI2.2-18.6), poor planning in working unit (OR=5.8, 95%CI1.2-27.7), perceived difficulty with shift
work (OR=4.1, 95%CI1.7-9.8), frequent work-family conflict (OR=4.5, 95%CI1.2-16.4), Task significance
(OR=2.3, 95%CI1.2-4.3) and higher job satisfaction (OR=2.8, 95%CI1.4-5.7). Correlates of PA were
younger age (OR-3.2,95%CI1.5-6.9) poor cleanliness of working unit (OR=3.2, 95%CI1.6-6.3), poor resting
facilities at working unit (OR=7.5, 95%CI1.3-43.5), more night shifts (OR=2.4, 95%CI1.1-5.2), perceived
difficulty with shift work (OR=2.7, 95%CI1.3-5.4), lack of cooperation among workers (OR=2.02,
95%CI1.3-3.2), task significance (OR=3.3, 95%CI1.2-9.4) and poor supervisor support (OR=4.6,
95%CI1.3-15.7).
Conclusions: Several factors in the nursing officers’ work life contribute to emotional exhaustion,
depersonalization and reduced personal accomplishment and minimizing these could be an important
strategy in prevention.

Poster 15 (ID789)
Prevalence of perceived stress & its influencing factors among staff of the urban area Banks
in Northern Srilanka
Ramasamy Gajenthirava, Vijayaratnam Jeyarajaa, Pethirupillai A D Coonghea, Sampasivamoorthy Sivayoganb,
Nadaraja Sivarajaha
a Faculty of Medicine, University of Jaffna, SriLanka

b Teaching Hospital Jaffna, Sri Lanka

Background: Nowadays with the fast moving life, rapid moving economy, the competition has also
increased. Everyone is trying to fight and lead the competition. These have caused stress.
Methodology: This study was carried out to describe the prevalence of perceived stress and its influencing
factors among staff of the banks in Jaffna municipal area in Northern Srilanka. This is a descriptive cross
sectional study and be carried out in banks (both state & private) during March 2013 to June 2013.
Self-administered questionnaire with Perceived Stress Scale (PSS) was used in the study. 145 bank
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employees were participated.
Results: Mean age of study participants were 31.5 years. Male female ratio was 0.7:1. Working for more
than 8 hours per day was 82%. More than 14% of staff was consuming alcohol and 7% had smoking habit.
Mean perceived stress score was 17.26 (SD 4.19). According to PSS 70% of staff had high level of stress and
only 10% had low stress level. Around 80% staffs perceive that they have to work for more than allocated
time and 63% reported bullying & harassments at work place. But 80% staff satisfied with their works.
Perceived stress level had significant negative correlation with family income (r=-0.219,p=0.038). But it
didn’t show significant correlation with age (r=-0.028,p=0.741), years of service (r=-0.032,p=0.707), duty
hours per day (r=0.016,p=0.848) & number of dependent (r=0.081, p=0.386). And Low educational status
also (75%) statistically significant with perceived stress level (p=0.015). Sex, marital status and post at bank
showed no statistically significant association with perceived stress.
Conclusion: The present study shows high prevalence of high level of stress in the study population. There
is an urgent need to educate coping strategies for stress and to conduct program about stress management for
staff of the banks in Jaffna municipal area.

Poster 16 (ID791)
Prevalence of Obstructive Sleep apnea Risk and Related Factors in Public Transport Bus
Drivers in Jaffna, Sri Lanka
Balachandran Gajalaksana, Sundaralingam Lijaa, Pethirupillai A D Coonghea, B Thirumaranb, Nadaraja
Sivarajaha
a Faculty of Medicine, University of Jaffna Sri Lanka

b Teaching Hospital Jaffna, Sri Lanka

Back ground/ Objective: Obstructive sleep apnea Syndrome (OSAS) is a common disease associated with
daytime sleepiness. OSAS is characterized by instability of the upper airway during sleep, which results in
markedly reduced (hypopnea) or absence of (apnea) airflow at the nose and or mouth with accompanying
desaturation of oxy hemoglobin. The objective of this study is to describe the prevalence of obstructive sleep
apnea syndrome (OSAS) risk and related factors in public transport bus drivers in Jaffna district Sri Lanka.
Method: Descriptive cross sectional study was done among Public transport bus drivers (n=267) of both
state and private sector. Stratified random sampling method used. Interviewer administered questionnaire
and a check list were used to collect data. The prevalence of OSAS risk was estimated using the Berlin
questionnaire.
Results: Mean age of study participants was 40.2 years. Mean BMI was 24.8. The prevalence of
Obstructive sleep apnea risk was 11.6% and the prevalence of self-reported snoring was 28.5%. Reported
falling asleep while driving was 24.7%. The following variables were found to be statistically significant
association with OSAS: Smoking (40.4%, p=0.034), alcoholism (38.2%, p=0.010) and obesity measures like
neck circumference (4.5%, p=0.000) & waist circumference (36.7%, p=0.031). The risk of OSAS had
statistically significant positive correlation with systolic blood pressure (r=0.5, p<0.001) and diastolic blood
pressure(r=0.416,p<0.001) . Age of the drivers and betel chewing were not statistically significant associated
with OSAS risk
Conclusion: A significant proportion of the public driver population is at high risk for OSAS and day time
sleepiness. So it is important to increase the awareness on OSAS among the risk groups and their
administrators. And it need further community based studies.

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Poster 17 (ID815)
Influence of Pre-pregnant BMI and Gestational Weight Gain on Pregnancy Outcomes in A
Teaching Hospital of Northern Sri Lanka
Sonthararajan Visagan, Selvaratnam A Joseph, Pethirupillai A D Coonghe, Kobalasuntharam Mugunthan
Faculty of Medicine, University of Jaffna, Sri Lanka

Background/Objective: Pre-pregnancy BMI & Gestational weight gain (GWG) are one of the major
determinants of pregnancy outcome. This study aimed to describe the influence of pre-pregnant BMI and
gestational weight on pregnancy outcomes among pregnant mothers
Methodology: 264 pregnant mothers admitted for delivery in teaching hospital, Jaffna, Sri Lanka were
recruited for the study. Data collected by Interviewer administered questionnaire.
Results: Among those pregnant mothers 58.3%, 22%, 15.2% and 4.5% of the mothers were having normal
BMI, low BMI, over weight and obesity respectively. 137(51.9%) women gained less and 51(19.3%) more
weight, than it is recommended by the institute of medicine (IOM). Low BMI common in teenage group and
High BMI was (BMI > 25) common in elder mothers. (p=0.03). There is a significant association of
incidence of PIH (p=0.002), GDM (p=0.006) with increase on BMI. And no significant association of
incidence of UTI (p=0.297), anemia (p=0.715), PROM (p=0.578), PPH (p=0.198). Increase in pre-pregnant
BMI significantly influences in mode of delivery (p=0.005), length of hospital stay (p=0.012), induction of
labor (p=0.033), small for gestational age (p=0.037), large for gestational age (p=0.009). GWG was
influenced by parity (p=0.022), maternal education (p=0.001), monthly family income (p=0.025). High
GWG was common in nulliparous mothers & low GWG common among non-primi mothers.). Development
of GDM was significantly associated with increase in BMI (p=0.033). But development of PIH (p=0.243),
UTI (p=0.919) or Anemia (p=0.447) wasn’t associate with the level of GWG. Length of hospital stay, &
incidences of caesarean section (p=0.049) were increase with GWG. In neonatal outcomes birth weight
(p=0.031) & large for gestational age (p=0.004) were significantly influenced by GWG.
Conclusion: Pre-pregnant BMI & GWG have influence in several important pregnancy outcomes. So proper
attention should be paid on maintaining normal pre pregnant BMI and normal GWG.

Poster 18 (ID862)
Ensuring school water safety by minimizing wastage: a successful story at a school in a
developing country in South Asia
Chamila lakmala, Aravinda Madushanka b, Thilanka Madushanic
aFaculty of Medicine, University of Colombo, Sri Lanka

bFaculty of Engineering, University of Moratuwa, Sri Lanka

cFaculty of Medical Sciences, University of Sri Jayawardenapura, Sri Lanka

Background: Water wastage is a burning issue in most institutes and it impairs the water safety by reducing
the available safe water. Majority of schools in Sri Lanka use underground water and water insufficiency is a
major challenge. However, the water wastage at school setting was not properly assessed.
Methods: A preliminary observational survey was done to quantify the water wastage at a local school. The
school premises was divided into 16 areas and water taps were mapped. The volume of water leakage was
calculated and action plan was implemented. Follow up study was done after one year.
Results: School populace was 3200 and there were classes from Grade 06 to 13. There were 338 water taps

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in the school. Out of that 65(19.2%) were leaking. 21(32%) of the leaking taps were not in use but were not
permanently closed. The calculated average volume of water pumped (four times a day) to the college tank
was 12000dm3 per day. The average wastage of water per day was 3041.44dm3(25.3% of the water
consumption).Most of the taps for the students were single taps which were stood 2 to 3 feet height. Action
plan was made and all the leaking taps were repaired. Unnecessary tapes were permanently closed.
Education programme was carried out among the children with the theme of “Save water-save the drop”.
Short height taps were replaced with proper height (3-4.5 feet) taps. After one year, total of 342 taps and
only 13(3.8%) ware leaking. The school tank was pumped only three times a day now (9000 dm3). The
wastage per day was 930.96 dm3 (1.1%). Average saved volume by simple interventions per day was
2109.48 dm3.
Conclusions: Major cause of water wastage at institutes is unattended leaking taps including “one drop per
minute” taps. Water wastage can be minimized effectively by proper simple interventions and educational
programmes.

Poster 19 (ID886)
Knowledge on Menopausal Related Health Problem and Factors Influencing on It Among
Female Nursing Staff in Teaching Hospital Jaffna
Dilanee Sivagnanasundarampillai
Jaffna University, Sri Lanka

Background: Menopause is a critical life-cycle transition for women, and is associated with many short term
and long term health problems. Nurses play a vital role in caring for patients, preventing illness. It is
important for nurses to have a good knowledge on menopause for the advancement of health status of the
country.
Objectives: To assess the knowledge on menopausal related health problems and factors influencing on it
among female nursing staff in Teaching hospital Jaffna.
Methodology: An institutional based descriptive cross sectional study was done using self administered
questionnaire. It addressed information about work experience, current working position, socio cultural
factors and overall knowledge on menopausal related health problems in nursing staff.
Results: The mean age of the participants was 36.02 ±10.06. Majority of the participants had poor
knowledge 91(47.4%) regarding menopausal problems. Majority of the participants had basic knowledge in
menopause. They had lack of knowledge in prevention and treatment of menopausal health problems. There
is significant association between knowledge on menopause and sharing menopausal related experiences (P
value=0.00), working period (P value=0.46) and working grade (P value=0.017).
Conclusion: The knowledge on menopausal related health problems among nursing staff is poor and it is
influenced by working experience and sharing menopausal related knowledge with others.

Poster 21 (ID941) Commented [何宁4]: 此文上面原有 ID905，需删除

Trend and Influencing Factors on Reproductive Health Knowledge and Family Planning
Usage Among Teenage Pregnant Mothers at A Tertiary Care Center in Northern Sri Lanka
T Serujanana, S Rajeevanb, R Surenthirakumaranc, K Guruparand
a Faculty of Medicine, University of Jaffna, Sri Lanka

b Faculty of Medicine, University of Jaffna, Sri Lanka

c Faculty of Medicine, University of Jaffna, Sri Lanka

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 d Teaching Hospital, Jaffna, Sri Lanka

Introduction: Teenage pregnancy is defined as a teenage girl, usually within the ages of 13-19, becoming
pregnant. The risk of death due to pregnancy-related causes is double among women aged 15-19 compared
to women in their twenties.
Objective: The objective is to describe the trend of teenage pregnancy and influence of media and available
health services on knowledge of reproductive health and usage of family planning among teenage pregnant
mothers admitted to Teaching hospital, Jaffna (THJ) in Northern part of Sri Lanka.
Methedology and materials: The delivery registers of Obstetric wards and admission registers of
gynaecology ward and interviewer administered questionnaire to interview 100 teenage mothers admitted to
obstetric units at THJ were used. Collected data were analysed by using Statistical Package for Social
Sciences. Those with the p value < 0.05 were considered statistically significant.
Results: Number of the admissions of teenage pregnancies was higher in 2010 (329) than previous years
(293 in 2008 and 284 in 2009). Level of reproductive health knowledge of teenage mothers was well below
average. Although 31% had poor knowledge on practicing contraceptive methods, 82% of participants did
not practise any contraceptive methods. Only 29% of them had taken pre-conceptional folic acid. Most of
teenage mothers (63%) accepted that both her and her partner’s decisions are important to practice
contraceptive methods. Influence of media and registration with health services in promoting the
reproductive health knowledge of teenage mothers was not significant at p value 0.05 levels.
Conclusions: There was an increased trend in admission of teenage mothers admitted to THJ and
contraceptive knowledge and usage was not adequate. But study failed show the influence of media and
provision of health services on knowledge of contraceptive usage. Studies are needed to explore factors
further.

Poster 22 (ID959)
Ante-natal Iron Supplementation in Sri Lanka: Compliance and Factors Affecting
Narmada V. Ekanayakea, Shakya S. Ekanayakeb, Niroshini N. Ekneligodac, Manuj Weerasinghed
a Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

b Department of Psychological Medicine, Faculty of Medicine, University of Colombo, Sri Lanka

c Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

d Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka

Background: Iron deficiency is the most common nutritional disorder worldwide. Extra-dietary iron
supplements are vital in preventing maternal anaemia, thus improving pregnancy outcome. Despite the
existing national programme and its extensive coverage, maternal anaemia is still prevalent. It is evident that
poor compliance to iron supplementation is a major contributor to the reduced efficacy of this programme.
Therefore assessing the current level of compliance to ante-natal iron supplementation and identifying
factors contributing towards poor compliance is a timely issue to be addressed.
Methods: An analytical cross sectional study was conducted involving 150 pregnant mothers who have not
completed term and in their subsequent ante natal clinic visit at De Soysa Maternity Hospital, Colombo, Sri
Lanka. An interviewer-administered questionnaire was used to assess compliance based on dose, frequency,
time, continuity and relation to meals.
Results: Only 2.7% of the study population was completely compliant, while 96.0% and 1.3% were
categorized as partial and nil respectively. On sub analysis of drug compliance 44.7% was completely
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compliant with 55.3% being both partial and nil. There was an association between the level of compliance
and the pattern of ante natal care services utilized [ X2 =9.0207; df =2; p<0.05 ]. No other factor showed any
significant association with the level of compliance.
Conclusions: Non-compliance to iron supplementation among pregnant mothers is high with a significant
proportion being partially compliant. Side-effects are not a cause for poor compliance. Many are partially
compliant due to their poor dietary practices associated with supplementation. Recommendations include
assessing compliance to ante-natal iron supplementation in a wider scale using a multi-center approach,
further analysis of the completely compliant group in order to identify special features pertaining to them and
studies focused on assessing reasons for lack of knowledge in this aspect.

Poster 23 (ID1071)
A Study of Association between Sedentary Life Style and Childhood Obesity in Urban Sri
Lanka
Priyadarshani Premarathnea, Amarasiri de Silvaa, Pujitha Wickramasingheb
a Department of Sociology, University of Peradeniya, Sri Lanka

bDepartment of Paediatrics, University of Colombo, Sri Lanka

Background/Objective: Childhood obesity is a global public health epidemic. Nearly 5% of 5-17 aged
children living in the Asia-Pacific region are overweight/obese (Lobstein et al 2004) and the prevalence
among 5-15 aged urban Sri Lankan children is about 13% (Wickramasinghe et al, 2013). The objective of the
study is to examine the relationship between sedentary activities and development of overweight/obesity
among Sri Lankan children.
Method: A qualitative descriptive study has been conducted at the Paediatric obesity clinic, Lady Ridgeway
Hospital (LRH), Colombo from April to December 2012. The first 100 overweight/obese children aged
5-12years, who attended the clinic from Colombo district were recruited prospectively. A pretested
interviewer-administered-questionnaire and focus group discussions were used for data. Quantitative data
was analyzed using SPSS. Thematic analysis was performed on qualitative data. Ethical approval was
obtained from the Ethical Review Committees of the Faculty of Medicine, University of Colombo and LRH.
Results: The study sample (n=100) comprises 64 boys; median aged was 10 years (1.9 SD); 74% ( 27 girls
and 47 boys) were obese with a mean BMI of 23.89kg/m-2. The majority belonged to the upper middle class.
Mean TV viewing (16.6 hours/week) and Video games (2.65 hours/week) were significantly associated with
obesity. A significant relationship was seen between the grade five scholarship examinations and the
development of obesity. Attending after-school classes (mean 6.60 hours/week) and spending time on
academic home activities (mean 9.03 hours/week) are higher due to the parents’ influence. Physical inactivity
(mean 4.1% hours/week) is high among the obese. Overweight children also had a similar distribution in
these risk factors and did not show a significant difference when compared with obese children.
Conclusions: A positive association between overweight/obesity and sedentary life-style including less
physical activity was seen. Provisions of community/home based participatory preventive actions are
recommended for prevention of overweight/obesity.

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Sudan (苏丹)

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Poster (ID518)
Job Stress and Work Ability among White Collar Employees of Khartoum Ministry of Health,
Sudan
Einas Abd ElAziz Ibrahim Khalila, Orawan Kaewboonchoob, Tassanee Rawiworrakulb
a Ministry of Health, Khartoum State, Sudan

b Faculty of Public Health, Mahidol University, Bangkok, Thailand

Background: Job stress for prolonged period of time has negative effects on the employees’ health and work
ability. The work ability is explained by an individual’s perception of the work environment and their ability
to cope with them. There is no study on work ability in white collar employees in Sudan. This study aimed to
examine the relationship between job stress and work ability among the white collar employees of Khartoum
Ministry of Health in Sudan.
Methods: A cross-sectional study was conducted. The subjects consisted of 201 white collar employees
which age ranged between 23-59 years. They were asked to complete questionnaire, which included
socio-demographic, an Arabic version of Work Ability Index (WAI) and Job Content Questionnaire (JCQ).
The correlation between the WAI and JCQ was determined by Pearson Product Moment Correlation
Coefficient.
Results: The results showed that most of employees had excellent and good work ability (61.7%). The
significantly associated factors with work ability were age (r=-0.52), work experience (r=-0.51), job control
(r=0.21) and social support at work (r=0.20).
Conclusion: This finding suggested that the increasing of job control and social support at work is required
to enhance the work ability among white collar employees.

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Thailand(泰国)

345
Oral 1(from APACPH)
The Thai Vision: Practice to Policy Public Health Education Program Accreditation
Assoc. Prof. Jarueyporn Suparp, MD
Faculty of Public Health, Mahidol University, Thailand

Background: The increasing number of new public health education programs, rapid changes in Global
Health and emerging challenges to the health system, make it necessary to implement Accreditation.
Objective: To describe the Accreditation Process applicable to Mahidol.
Firstly, Mahidol University Faculty of Public Health and APACPH leadership concurred with the Lancet
Commission Report on Global Health challenges – the framework and global vision of education reform.
The three generations of education reforms described have particular relevance to Asia-Pacific Region
(APR). Secondly, APACPH set up a process to develop a Global Health Model with relevant competencies
for Thailand and APR. Thirdly, implementation strategy for Public Health Education (PHE) Accreditation
policy is initial implementation and demonstration through lead institutions in each country.
Methods: Review literature of PHE Models; Review of written standard guidelines, surveys, reports and
minutes of meetings and conferences.
Results: In Thailand, Public Health Education, international programs are provided by different universities
located all over the country. The programs are conducted at 3 levels: 1 bachelor, 6 masters, and 6 doctoral
degree programs. Quality assurance systems in Thai Higher Education are curriculum standards, a Thai
quality framework, institutional or discipline accreditation and continuous internal and external quality
assurance evaluation. The Lancet Commission, 2010 recommends the competency-based curricula, creative
use of information technology, transformative learning, and inter-professional teamwork as well as a systems
approach to institutional reform. Since 2009, the APACPH Accreditation system has been initiated. The
Master of Public Health curriculum survey revealed that the core competency and crosscutting competencies
in Public Health have been used to design curriculum across Public Health Education programs among
participating APACPH member institutions. The APACPH model of Global Health competencies has been
adopted as the framework for Public Health Education.
Conclusions: Public Health Education among APACPH member countries including Thailand will be
accredited to assure the programs have met accepted standards established by and with the Public Health
profession. The Public Health graduate will be a global health specialist who is able to promote the health of
populations within a local and global context.

Oral 2 (ID155)
Dental Caries Status and Oral Hygiene Habits among Secondary School Children Aged 12-13
Years Old in Yangon Region, Myanmar
Aung Z. Z. Phyo, Natkamol Chansatitporn, Kulaya Narksawat
Faculty of Public Health, Mahidol University, Bangkok, Thailand

Background / objective: Dental caries is still a major oral health problem in most industrialized countries,
affecting 60-90% of school children. It has become the most prevalent oral disease in several Asian countries
and the trend of dental caries in Myanmar is gradually increasing. This cross-sectional survey research aimed
to assess the dental caries status and oral hygiene habits among secondary schoolchildren aged 12-13 years
old in Yangon Region, Myanmar.

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Method: The study population comprised 220 schoolchildren and a simple random sampling technique was
used to select 110 school children from 3 classes in each urban and rural school. Data collection was
performed by means of an oral health examination with DMFT index and self-administrated questionnaires.
Results: The overall mean DMFT was 1.71 ± 2.07teeth per person and the mean DMFT of urban
schoolchildren was 2.19 ± 2.23 teeth per person which was higher than 1.23 ± 1.78 teeth per person of rural
schoolchildren. The urban schoolchildren were 2.24 times (adjusted OR=2.24, 95%CI: 1.01 – 4.94) more
likely to have dental caries than those from the rural schools. Significant differences of mean DMFT were
found by the geographical position of school, the education level of the parents, occupation status of the
father and the level of attitude toward dental caries.
Conclusion: The result of this study suggested that dental public health care services are essential needs to
reduce the high level of DMFT and to improve the oral health status of Myanmar schoolchildren.

Oral 3 (ID213)
Pesticide Use Practices and Its Related Factors Among Farmers in Pyin OO Lwin Township,
Myanmar
May Thet Khine
Mahidol University, Bangkok, Thailand

Background/objective: This cross-sectional study is aimed at identifying pesticide use practices and their
related factors among farmers in Pyin Oo Lwin Township, Myanmar.
Method: The data were randomly selected from eight villages by using the multi-stage sampling method
from January to February 2013. A sample of 219 farmers who grew flowers and vegetables were interviewed
with structured questionnaires. Data analysis was conducted using the mean and percentage. The correlation
of factors was performed by using Pearson Chi-square at α level of 0.05.
Results: Based on the total mean score, 43 percent of respondents had higher practicing scores. It was
revealed that their pesticide practices were significantly and positively correlated with gender, monthly
income, and education at p-value < 0.05. In addition, knowledge on pesticide danger and its usage,
perception about pesticide uses, accessibility to protective equipment and information, and social support had
positive correlations with pesticide use practices at r=0.423, p-value <0.001; r=0.396, p-value <0.001; r=0.69,
p-value <0.001; r=0.44, p-value <0.001; and r=0.48, p-value <0.001 respectively. However, age, marital
status, years of pesticide use, number of children and training programs had no correlation with pesticide use
practices. In this study, 47 percent had good knowledge, 16.9 percent had good perception, and most
respondents had moderate accessibility to protective equipment but low accessibility to information, low
availability to training programs, and low social support.
Conclusions: The findings suggest that in order to increase the practices of using pesticides safely,
agriculturists and village health volunteers should educate farmers more regularly with precise information to
proper pesticide uses during preparation, spraying, and on days when farmers are not using pesticides.

Oral 4 (ID431)
The Relationship Between Mother’s Work and Infant Mortality in Thailand
Tiwarat Tor.jarerna,b, Yothin Sawangdeea, Aroonsri Mongkolchatic, Rossarin Graya, Guang Guod
aInstitute for Population and Social Research, Mahidol University, Thailand

bSarapee Community Hospital, Sarapee district, Chiang Mai, Thailand

cASEAN Institute for Health Development, Mahidol University, Thailand

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 dDepartment of Sociology, University of North Carolina at Chapel Hill, NC, USA

Background/objective: Mother is the key caretaker of children in early life. The relationship between
mother and infant seem to have an important impact on infant health and mortality. Proportion of working
mothers during pregnancy tends to increase among Thai women. Hence, it is necessary to know the
relationship between the mother’s occupations during late pregnancy and infant mortality, and their survival
probability at a given time.
Method: This study was a prospective cohort study of Thai children (PCTC). A total of 4245 mother-infant
cohort data were followed through the first year of age during 2000-2002.
Results: The Fisher’s exact analysis or Chi-square results did not find any association between mother’s
employment, occupation, or working status with infant mortality. However, comparing of the Kaplan
Meier’s survival curves of mother who worked in agricultural sector and construction labours, and those
who worked in industrial sector and clerks showed that pregnant mothers working as agricultural workers
and the laborers had higher infant survival rate in the late- and post-neonatal period(Log-rank chi2 (1) test =
3.21, p-value =0.073). In addition, attendance of Ante-Natal care (ANC) services, preterm birth, low birth
weight, and perinatal hospitalized infant morbidity had an independent relationship with infant mortality.
Conclusions: Therefore, occupation of pregnant mothers in agriculture or labor work had a significant
relationship with post-neonatal mortality in this study. This evidence can support the intensified roles of the state
to enhance health care services for both pre-and post neonatal care to working pregnant women

Oral 5(ID592)
Achievement as Evidence: Strategic Action for Sustainable Financing of Health Promotion
Naowarut Charoencaa, Stephen L. Hamannb, Prakit Vathesatogkitc
a Mahidol University, Faculty of Public Health, Bangkok, Thailand

bTobacco Control Research and Knowledge Management Center, Bangkok, Thailand

c Action on Smoking and Health Foundation, Bangkok, Thailand

Background/objective: Health policy authorities in low and middle income countries (LMIC) face both the
present dominance of non-communicable disease (NCD) risk factors causing more than 60% of deaths
worldwide, and the vital necessity to prevent NCDs rather than counting on expensive curative means to
address them. This has resulted in a new health promotion emphasis exemplified by prioritizing actions
like tobacco control and salt reduction. However, despite knowing what to do, gaining resources and
guidance on how to develop health promotion (HP) mechanisms is often difficult.
Method: Lessons which address useful approaches to funding for risk factors important in HP and NCD
prevention are summarized using content and case analysis from the work of Thai health policy planners,
researchers and innovators.
Results: Analysis of medical, public health and health system researchers’ approaches show that actions for
sustainable funding developed from frustrations with existing vertical program funding which prevented
investment in innovative approaches to emerging areas of need like tobacco and alcohol control. Early
emphasis was placed on legislation to provide new, more autonomous statutory agencies through ‘surcharge’
funding from businesses like the tobacco and alcohol industries who already were taxed for contributing to
health problems and public expenditures. The most successful options for framing legislation depending on
national health data and strategic considerations is discussed using a case study of one advisor’s
recommendations on injury prevention funding as part of a health promotion package.
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Conclusion: With global expectations for increasing action to reduce the growing toll from NCDs, findings
from successful health promotion funding and implementation in the Asian context provides valuable
lessons. Establishing and managing a HP approach addressing upstream realities makes downstream
achievements more probable. Harvesting human knowledge from several masters of strategic thinking brings
the means of ‘how and now’ thinking to inform this global task.

Oral 6(ID667)
Clogging the airways: Smoking in airports in Asia
NipapunKungskulnitia, NaowarutCharoencaa, JintanaPeesing, SongwutTrangwatana b, Stephen L.
Hamannb
aFaculty of Public Health, Mahidol University, Bangkok, Thailand

bTobacco Control Research and Knowledge Management Center, Mahidol University, Bangkok, Thailand

Background/Objective: While smoking on airlines has been prohibited worldwide since 2000, many of the
largest and highest-rated airports in Asia still allow smoking in restaurants, lounges or designated smoking
rooms (DSR). This is providing an indoor air environment that can be dangerous to nonsmokers and smokers
alike. Given the extension of smoke-free (SF) laws worldwide to include most other indoor locations, an
investigation into the reasons Asian international airports have not gone SF was made.
Methods: Environmental results of measurements of exposure to cigarette smoke in airports in two
countries, one middle and one high income country, were reviewed. Findings from internal tobacco industry
documents about industry efforts to support smoking in airports were examined to inform and address
concerns that policy makers may have about establishing SF airports.
Results: Public and policymaker knowledge and perspectives were examined by askingif the public realizes
that air pollution from secondhand smoke (SHS) is unhealthy and can become dangerous, and if they prefer
SF airports? Regarding airport management we asked if the advantages and disadvantages of SF airports
were known and if the public’s view of airports that allow smoking indoors was known? The public had
limited knowledge of airport smoke-free policy, but preferred a smoke-free airport. Management had little
awareness of the advantages of SF policies as a business or consumer practice. There was also internal
document evidence that the tobacco industry had long known of the dangers of SHS exposure in airports,
butpurposely lobbied and supported ‘accommodating’ smoking?
Conclusion: Because of unconcern bythe public and airport management of tobacco smoke dangers, more
needs to be done to counter tobacco industry misinformation so unhealthy SHS exposures are eliminated
through SF policies and facilities in international airports in Asia.

Oral 7(ID810)
Factors Affecting the Neuropsychological Effects of Rice Farmers Exposed to Chlorpyrifos in
Thailand
PornpimolKongtipa, SirikarnPidkanpaia, AdulBandhukulb
a Faculty of Public Health, Mahidol University, Bangkok, Thailand
bOccupational and Environmental Medicine Center, NopparatRajathanee Hospital, Thailand

Background/objective: Chlorpyrifos have been used for a long time in rice farmers. The factors affecting
the long term chlorpyrifos exposure on rice farmers in Chai Nat province, Thailand was investigated.
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Method: A cross sectional study collected information from 87 rice farmers using questionnaires, consisting
of characteristics of farmers, chlorpyrifos exposure, working behavior, PPE used, signs and symptoms.
Morning urine samples were collected the next day after spraying chlorpyrifos and measured for 3, 5,
6-trichloro-2- pyridinol (TCP) using gas chromatography mass spectrometer (GC-MS). Blood cholinesterase
of farmers was measured using reactive paper. The farmers were tested with the neuropsychological test
using Montreal Cognitive Assessment (MoCA-Thai version).
Results: Three groups of rice farmers were chlorpyrifos spraying farmers (G1), occasional chlorpyrifos
spraying farmers (G2), and not spraying chlorpyrifos for more than 5 years (G3). The G1 farmers had longest
working experience, highest amount of chlorpyrifos used per month among the three groups. The urinary
TCP of farmers were compared between G1 vs G2 and G2 vs G3; the significant difference were found at
p=0.023 and<0.001, respectively. The MoCA results were compared, G1 vs G3 and G2 vs G3; the significant
differences were found at p=0.006 and 0.006, respectively. A significant difference was also found between
G1 farmers wearing a balaclava, drinking alcohol while spraying, and cleaning their skin after spraying
chlorpyrifos, and those who did not at p-values = 0.025, 0.021, and 0.011, respectively. The significant
correlations between visuospartial, attention, language, orientation, total score of MoCA, working experience
of farmers and the urinary TCP were p= 0.002, 0.001, 0.048, 0.019 and 0.003. The total MoCA score was
significantly correlated with urinary TCP of farmers with correlation coefficient of -0.257at p=0.016.
Conclusion: The factors affecting the neuropsychological effects of rice farmers exposed to chlorpyrifos
were working experience and urinary TCP of farmers.

Oral 8(ID895)
Factors Toward Gingivitis and Oral Hygiene Among 7-to 9-year-old Children in Thailand
Rachanon Nguanjairaka, Rujira Duangsongb, Piyachat Patcharanuchatc, Niramon Muangsomb, Malinee
Laopaiboonb
a Graduate School, Khon Kaen University, Thailand

b Public Health, Khon Kaen University, Thailand

c Dentistry, Khon Kaen University, Thailand

Background/Objective: Gingival inflammation becomes a negative impact to oral health of oversea young
people. Limited evidence of the prevalence of gingivitis and oral hygiene in young Thai children is available.
This study was aimed to assess the prevalence of gingivitis and oral hygiene and identify its associated
factors in schoolchildren.
Methods: A cross-sectional study was carried out among 415 schoolchildren aged 7 to 9 years in rural
primary schools of Khon Kaen province. Data of socioeconomic and demographic, oral health habits and
receiving of tooth-brushing guidance were collected by a structured questionnaire. Oral examination was
conducted to assess gingival status and visible of dental plaque for the gingivitis and oral hygiene with using
gingival index and plaque index, respectively. Descriptive statistics were used to explain characteristic data
and logistic regression analyses were used to assess associated factors of gingivitis and oral hygiene.
Results: The prevalence of gingivitis was 45.1% and visible of dental plaque was 77.8%. In the adjusted
analysis, the gingivitis was significantly associated with 1-3 times/week of sweet consumption (OR 2.36;
95%CI 1.18-4.72), tooth-brushing guidance from teachers (OR 0.27; 95%CI 0.17-0.43), peers (OR 0.19;
95%CI 0.08-0.44) and dental practitioners (OR 0.58; 95%CI 0.35-0.96). The visible of dental plaque was
significantly associated with 1-3 times/week of snack consumption (OR 2.43; 95%CI 1.01-5.85), twice daily
of tooth brushing (OR 0.45; 95%CI 0.21-0.95), tooth-brushing guidance from teachers (OR 0.34; 95%CI
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0.17-0.67), peers (OR 0.06; 95%CI 0.02-0.14) and dental practitioners (OR 0.27; 95%CI 0.14-0.53).
Meanwhile, parent did not significant associate with the two outcomes.
Conclusions: Our study showed the risk effect of bad diet habits on gingivitis and oral hygiene. The benefit
effects were showed for the twice daily of tooth brushing and tooth-brushing guidance from teachers, peers
and dental practitioners on gingivitis and oral hygiene in schoolchildren.

Poster 1(ID59)
Behavior change among the patients after the detection of coronary heart disease of
Kathmandu valley
Suvesh K. Shresthaa, ChanuantongTanasugarnb, ChaweewonBoonshuyarb, Bharat Rawatc
aSELF Mahidol University, Bangkok, Thailand

bMahidolUniveristy, Bangkok, Thailand

cNorvic International Hospital, Kathamndu, Nepal

Background/objective: The identification of stage of behavior change and the factors affecting the behavior
change, can direct more effective behavior change intervention against coronary heart disease progression.
This paper identifies the stages of change of adherent behaviors among patients with CHD, identifying
demographic, predisposing, and social factors for the behavior change.
Method: It was a cross sectional study with 98 respondents living in Kathmandu, Nepal. Data was collected
using constructed questionnaire and analyzed by using percentage and Chi square using level of significance
at 0.05. The patients were categorized into “practiced adherent behavior” (action and maintenance) or “not
practiced adherent behavior” (pre-contemplation, contemplation, preparation)
Results: The study population comprised CHD patients from age 36-80. Among them, 78.6% were male and
95.9% were still married. It was seen that there was 92.9%, 87.3%, 67.7%, 65.5%and 57.6% increase in the
transition of the patients to practice alcohol moderation, avoiding unhealthy diet, smoking cessation, eating
healthy diet, and physical inactivity respectively after angiography. All of the patients were compiled on
taking medication regularly. 57.1% of the patients had a good knowledge on CHD, 46.9% had a positive
attitude towards behavior change and only 34.7% patients had high level of family support. There was
significant association between the control of blood pressure and blood cholesterol with detection of CHD
(p=0.001). The association was seen between physical activity with gender, education level, family history of
CHD, knowledge on coronary heart disease and perception on behavior change (p< 0.005). Association was
seen between eating healthy diet and education level, family history of CHD, knowledge on CHD. Smoking
was also associated with perception on behavior change.
Conclusion: Encouraging results with regard to alcohol moderation and avoiding unhealthy diet was seen as
the most practiced adherent behaviors. Similarly, physical activity was the least practiced adherent behavior.

Poster 2(ID145)
Adolescent Depression Screening Among International School Students in Bangkok, Thailand
Sabina Wagle, Naruemon Auemaneekul, Pakpimol Mahannop
Faculty of Public Health, Mahidol University, Bangkok, Thailand

Background: Depression has several impacts in adolescent shown as from various symptoms. Nevertheless,
depression in adolescents is more often neglected than in adults. In international school, students come from
different background and different culture with different skills where there is tendency to have more
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competition compared to general schools. These dissimilarities, differences and many other factors might
possibly make adolescents develop depressive symptoms. The main objective of the research was to analyze
the factors related to adolescent depressive symptoms in international schools in Bangkok.
Method: A cross sectional study was done among 125 adolescents of 2 international schools in Bangkok.
Consent was taken from both the guardian and the respondents. Ecological model were used as the
theoretical framework for this study. The research instruments used were self-administered questionnaires.
The questionnaires were tried out with 40 adolescents at international school and Cronbach Alpha
Coefficient was used for reliability test. Pearson Product Moment Correlation Coefficient was used as the
data analysis.
Results: The significant association factors found with adolescent’s depressive symptoms were personal
allowance (r= -0.233, p-value=0.009), stress (r= 0.661, p-value=0.000) and self-esteem ( r= 0.680,
p-value=0.000), mother care (r= -0.304, p-value=0.001), father care (r= -0.255, p-value=0.004), father
control (r= -0.255, p-value=0.022) and peer victimization (r= 0.224, p-value=0.012).
Conclusion: The responsible department in the school that should deliver mental health services in school
setting for those with high risk factor and design easy access and student friendly intervention. The mental
guidance services should include the individual inventory, information, counseling, placement and evaluation
services. Health personnel’s in the school should pay more attention in establishing a very good rapport on
fostering the very good parent-child relationships, relationships with teacher and peers relationships.

Poster 3(ID171)
Health Impacts of Klong-Luang Dam Construction to Local Community in Khoa-Chan
District, Cholburi Province, Thailand
Suthep Silapanuntakula, Phongsak Yenonb
a Mahidol University, Bangkok, Thailand

b En and Earth Consultant, Co.,Ltd., Bangkok, Thailand

Background/objective: Flooding and drought have long been the problems in Khoa-Chan District in
Cholburi Province, Thailand. The Royal Irrigation Department, Ministry of Agriculture and Cooperatives has
proposed the construction of Klong-Luang Dam project (initiated by the King Bhumipol) with the capacity
of 98.0 million m3 to solve this problem in 2009. Health impact assessment was conducted to investigate
possible health impacts in communities relevant to the construction.
Method: Impacts of communities on health dimensions; physical, mental, social, and spiritual health were
investigated. Data were collected by using the structured questionnaires and the focus group method.
Results: Several significant health impacts were observed. Firstly, the diseases brought by the illegal
workers (malarial and water-borne diseases) would occur and had impact to communities during construction
period. Secondly, the nearby community did worry about fugitive dust, noise and vibration from transporting
the construction materials and equipment. Construction related activities including the solid waste,
wastewater, excreta from the workers at the site during the dam construction would lead to the increase of
respiratory diseases, water-borne disease, insect vector-borne diseases and the annoyance for their daily
normal living. Thirdly, the evacuation of villagers located at the construction site to the new place was
mainly worrisome for them. Additionally, at the operation period, the exposure to pesticide use, the
hemorrhagic fever encephalitis due to the Aedes and Culex mosquito, and the liver fluke infection would be
the major impact for the surrounding communities. However, the nutritional status of community would be
improved due to the increase of earning income and good nutrition. Finally, it was found that this project
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encouraged people to more involvement and attachment to their community in terms of environmental values
and benefits.
Conclusions: The health impacts of the project to community will certainly occur. The appropriate health
mitigation plan for the negative impacts should be implemented. The establishment of health surveillance
team in their community is also needed for monitoring the community health impacts during the operation
period.

Poster 4(ID174)
Removal Efficiency of Arsenic (III) by Coconut Shell Char and Rice Husk Ash Adsorbent
Third Muangplub, Suthep Silapanuntakul, Tanasri Srihabut, Pisit Vatanasomboon, Wongduen Pandii
Mahidol University, Bangkok, Thailand

Background/objective: In Thailand, the arsenic contamination in groundwater has been the significant
environmental and health problems in many areas. The well-known case of black fever was occurred in
Aumper Ron Phibun, Nakhon Si Thammarat province. Arsenic contamination in media can cause adverse
health effect to people who exposed to it in long term. The objective of this study was carried out to
investigate to the removal efficiency of arsenic (III) by using the coconut shell char (CSC) and rice husk ash
(RHA) adsorbent in the laboratory.
Method: A completely randomized block design was used in the experiment. The pH of synthetic arsenic
solution, dose of adsorbent, contact time and initial arsenic (III) concentration were tested for the optimum
conditions of arsenic (III) treatment.
Results: The result demonstrated that the optimum condition for arsenic (III) removal by CSC was at pH 7,
the CSC dose of 0.6 g, the contact time of 60 min and the initial arsenic (III) concentration of 2.78 mg/L.
While, the optimum condition for arsenic (III) removal by RHA was at pH 7, the RHA dose of 1.8 g, the
contact time of 45 min and the initial arsenic (III) concentration of 3.4 mg/L. By comparing the removal
efficiency, it was found that the removal efficiency of RHA adsorbent for the arsenic (III) in synthetic
solution was higher than that of CSC adsorbent. The arsenic removal efficiencies for CSC and RHA
adsorbent were 13.19% and 16.57% respectively.
Conclusions: Results suggest that both RHA and CSC adsorbent can be a method of choice to apply for the
future arsenic (III) removal in the contaminated water.

Poster 5(ID178)
Evaluation of the Integrated Disease Surveillance System in a district of Rajasthan, India
Kesorn Thaewnongiewa, Ramesh Bikramb, Intan Pandu Pertiwic, Aakash Shrivastavad
a Office of Disease Prevention and Control Region 6, Khon Kaen Province, Thailand

b Ministry of Health and Population, Department of Health Services, Nepal

c Ministry of Health, Jakarta, Indonesia

d National Centre for Disease Control, Delhi, India

Background/Objective: Beginning 2004-05, India initiated an integrated electronic disease surveillance

system that weekly captured standardised information on all infectious diseases. However, only a few studies
have evaluated its performance. We evaluated the attributes and capability of this surveillance system to
detect outbreaks in a district of Rajasthan state in western India.
Method: One among 33 districts of Rajasthan was selected and its district hospital along with randomly
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selected two community health centres, two primary health centres and two sub-centres were assessed for
performance of the surveillance system using Centre for Disease Control's published guidelines for
evaluating surveillance systems. Data was collected through structured interviews and field assessments of
surveillance documentation and electronic portal entries for the period April to June 2012.
Results: The system was found satisfactory in terms of human and other resources required to deliver
smooth flow of information. 86% (of 84) forms were available for assessment and of these 46% were complete
for all necessary entries. Of the 760 reporting units in the district 72% were consistent in reporting every week,
though this is below the required benchmark of 80%. 89% of the 57 assessed formats were found to be sent on
time recommended in the plan. During the assessed period this system had never generated any alert on an
impending outbreak through data analysis. Information regarding suspected outbreaks was usually obtained
from treating doctors, community leaders or media.
Conclusions: Results suggested of a fairly well-built surveillance system but the need for a stronger
commitment and monitoring was apparent. Even though the surveillance system performed well on
completeness, timeliness and other attributes, its usefulness in generating early warning signals, one of the
main objectives of any surveillance system, was limited. Empowerment through continuous trainings and
accountability towards data analysis at each sub-district level could address this limitation.

Poster 6 (ID227)
Diclosure of HIV Status to the Intimate Partners Among Plhiv in Monywa Consortium Art
Clinic, Myanmar
Wut Y. Soea, Nawarat Suwannapongb, Nopporn Howteerakulc
a Master
Degree of Public Health Program, Faculty of Public Health, Mahidol University, Bangkok, Thailand
b Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, Thailand

c
Department of Epidemiology, Faculty of Public Health, Mahidol University , Bangkok, Thailand

Background/Objective: As HIV transmission has increased among discordant couples, this cross- sectional
study aimed to estimate the prevalence of HIV status disclosure to intimate partners and its influencing
factors in a Monywa Consortium ART clinic.
Method: Self-administered questionnaires were used for systematic random samples of 227 People Living
with HIV aged 18 and above who registered in 2012 at the Consortium ART clinic.
Results: The prevalence of HIV status disclosure to intimate partners was 66.5%. The study also showed
64.8% of PLHIV had good knowledge, 45.8% had a positive attitude, 57.3% had a low level of perceived
stigma and discrimination, and 42.3% had a high self-efficacy level. Multiple logistic regression analysis
showed that four variables influenced HIV status disclosure to intimate partners: good knowledge (OR=
8.95, 95% CI= 2.6-30.8) , positive attitude (OR= 6.45, 95% CI= 1.6- 25.7), a perception of less stigma and
discrimination (OR=29.7, 95% CI= 4.9- 80.7) and high self-efficacy (OR= 4.49, 95% CI=1.10-18.30).
Conclusions: The findings of the study could help creating HIV status disclosure guidelines and to expand
existing knowledge training, behaviour change communication training and counselling program.

Poster 7(ID236)
Factors Affecting the Public Health Performance Evaluation of Sub-district Health Promoting
Hospital Directors in KhonKaen Province, Thailand
Bouphan Prachak, Apipalakul Chanya

354
 Faculty of Public Health, Khon Kaen University, Khon Kaen and 40002, Thailand

Background: In 2008, Thai government launched public health policy to improve the quality and
effectiveness of national healthcare system. The government set out plans to invest in health care system at
all levels. Healthcare facilities in public sector were promoted and referral network was improved for a better
connection between facilities in public and private sectors. The policy aimed to strengthen Universal
Coverage Scheme by improving both service quality and accessibility. Sub-district Health Promoting
Hospital Development Plan B.E. 2552-2555 was introduced by the Ministry of Public Health in 2009 as one
of the vital policy movements. The core of this plan was to transform all health centers, the smallest
healthcare facilities in Thailand, functioning as Primary Care Unit (PCU) into sub-district health promoting
hospitals within three years (Suphawong et al., 2009).
Method: The aim of this research is to study individual attributes and administrative factors that influencing
on the Public Health Performance Evaluation of sub-district health promoting hospital directors in
KhonKaen province, Thailand. This research is imperative to study due to all sub-district health promoting
hospital directors in this province are required to lead their public health services towards the Sub-district
Health Promoting Hospital Development Plan Project. This cross sectional descriptive research design was
employed and conducted for a duration from year 2011 to 2012. A total of 220 samples drawn from a
population of 350 sub-district health promoting hospital directors by using systematic sampling technique.
Research instrument is a self administered questionnaire which developed by researchers. The questionnaire
contained of four session including seven items on general information, 36 items and 30 items five-rating
Likert scale on administrative resources and public health performance evaluation respectively. In addition,
respondents are required to give problem and suggestion at the last session of the instrument as three open
ended questions.
Results: Findings revealed that the level of administrative resources was high (3.86±0.61). When looking at
each resource, it was found that method possessed the highest mean score (4.05±0.61) while money was at
the lowest mean score (3.73±0.79). The level of public health performance evaluation as a whole was high
(3.91±0.60). The highest mean score was data defining (4.00±0.59) whereas the lowest mean score was
interpreting and reporting (3.79±0.72). Specifically man, money, materials and method had moderate and
positive relationship with the performance evaluation with r value ranged from 0.493 to 0.672 at the
significant level as 0.001. Finally, findings showed that there are three significant predictors which
contributed 60.90 percent of the total variance of the Public Health Performance Evaluation. The three
significant predictors are method, materials and man.
Conclusions: To strengthen performance, some suggestions were proposed. Provincial public health Office
should have effective resource allocation plans to support the lower units in command which eventually help
them in response to problems more effectively. The training in public health administration should be
provided in order to help sub-district health promoting hospital directors to practice their skills. The future
study should involve the participation of other personnel in sub-district health promoting hospitals.

Poster 8(ID238)
The Organizational Commitment Factors Affecting Core Competency of Public Health
Officers at Sub-District Health Promoting Hospitals in Sakon Nakhon Province
Assoc. Prof. Witat Janposri, Pornsak Ruekraisri
Department of Public Health Administration, Faculty of Public Health, Khon Khen University

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Background/Objectives: Sakon Nakhon provincial health office set, they need to encourage staff to develop
performance skills and knowledge development process and has chosen to foster progress fairly. To develop
the knowledge, skills, motivation and values to the organization guidance by the office of the civil service
commission.
This cross sectional descriptive research aimed to study organizational commitment that affects core
competency of public health officers working at sub-district health promoting hospitals in Sakon Nakhon
province.
Method: A simple random sample of 156 public health officers was drawn out of the total of 210 using
estimating population mean. The data was collected through a self-administered questionnaire. Frequency,
percentage, means, standard deviation, Pearson’s correlation coefficient and stepwise linear multiple
regression were performed to analyzed collected data.
Result: The findings showed that, from the total score of five, the mean score of organizational commitment
was 3.99 ±S.D.0.41. Correlation analysis revealed that organizational commitment significantly correlates to
core competency of public health officers (r = 0.538, 95%CI = 0.38-0.63, p-value < 0.001). Two components,
which are willingness to push every effort to bring benefit to organization (Mean diff = 0.333, 95%CI=0.19 –
0.47, p-value < 0.001) and strong intention to remain a member of organization (Mean dif = 0.160,
95%CI=0.04 – 0.28, p-value < 0.001), together could predict core competency of public health officers in
sub-district health promoting hospitals in Sakon Nakhon province at 32.8% (R2adj=0.328).
Conclusion: The results indicated that two factor of organizational commitment, which are willingness to
push every effort to bring benefit to organization and factor of strong intention to remain a member of
organization significantly positive correlates to core competency of public health officers.

Poster 9 (ID262)
Development of High Impact Styrene Tube for the Detection of Cryptosporidium and Giardia
Enteric Protozoa in Water and Food
Mayuna Srisuphanunta, Nantida Vodmongkola, Pimchanok Witayaudoma, Narongsak Boonkhaob, Pranee
Inprakhonc
a Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand

bInstitute of Medical and Public Health Technology,Nonthaburi 11150,Thailand

cFaculty of Science, Mahidol University, Bangkok 10400, Thailand

Background: Cryptosporidium and Giardia are the most frequent enteric protozoa causing gastroenteritis in
humans worldwide and found commonly in environmental waters. Due to the small size and frequently low
number of Cryptosporidium oocysts and Giardia cysts in water and food samples, the detection of these
parasites is difficult and requires the efficient laboratory equipments. Most of these equipments in the
country are imported and it is lopsided for Thailand. As toward upgrading local production of these
equipments to reduce imports and costs, the aim of the present study was to develop the high impact styrene
tube by using local materials for the detection of Cryptosporidium and Giardia enteric protozoa in water and
food.
Method: The high impact styrene tube was developed by using thai local materials. The validation was
evaluated by the recovery efficiency of Cryptosporidium and Giardia oo(cysts) detection in seeded samples
by using thai high impact styrene tube compared to the imported L-tube. The water supplies and shellfish
samples were collected and investigated the prevalence of both enteric parasites by using the incorporated
concentration by Immunomagnetic Separation and Immunofluorescent method.
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Results: The thai high impact styrene tube was successfully developed for Cryptosporidium and Giardia oo
(cysts) detection in water and food. The efficiency comparison of thai high impact styrene tube and the
imported L-tube for oo (cysts) recovery detection in seeding samples was no significant difference (p <
0.01). One or both of these enteric protozoan were found, respectively, in 27.4 % of the water, and 18.5 % of
the shellfish. Cryptosporidium was statistically more often found than Giardia among these samples.
Conclusion: The thai high impact styrene tube was developed to replace imported products with no
difference quality. The presence of Cryptosporidium and Giardia enteric protozoa parasites in water
resources and shellfish provide in epidemiological study and sanitary risk for prevention and control of
parasitic diarrhea.

Poster 10 (ID292)
Fear of Falling and Related Factors in Older Persons Living in the Community
Piyathida Kuhirunyaratn, Prasert Prasomruk
Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand

Background /objectives: Falling in older persons can lead to disability, hospitalizations and premature
death. It also results in a psychological trauma term fear of falling which is effect to quality of life among the
older persons and high risk in recurrent fall. This study aims to examine prevalence of fear of falling and
related factors in older persons living in the community.
Method: A cross-sectional study was conducted. Cluster sampling was used. The sample included 652
elders 60 or more years of age, living in five communities in Khon Kaen Municipality, Northeastern of
Thailand. A structured questionnaire was used to collect the information between May and June 2011. Fear
of falling was measured using fall efficacy scale which was translated, reviewed and tested by experts and
Cronbach’s was 0.83.
Results: Response rate was 95.24%. Most of the participants were female 63.1%. The mean age was
69±10.5 year old. The prevalence of fear of falling was 5.8% (95%CI; 4.41, 8.50). The statistically
significant factors related fear of falling were (a) age 80and over (COR=4.33, 95% CI: 1.73,10.74, p=0.001),
(b) adequate exercise (COR=0.37, 95% CI: 0.18,0.76, p=0.003), (c) perceived health status as needs to be
care (COR=3.44, 95% CI: 1.19,10.21, p=0.023), (d) history of fall in last 6 months (COR=2.06, 95% CI:
1.96,4.39, p=0.042), (e) comorbidities (COR=4.73 95% CI: 1.37,9.61, p=0.005) and (f) functional mobility
(COR=6.69% CI: 1.54, 8.89, p=0.003). A multiple logistic regression indicated co morbidities and functional
mobility were statistically significant related to fear of falling (Adjusted OR 3.48, 95%CI 1.02, 6.86, and
5.07, 95%CI 1.19, 9.75).
Conclusions: This study found around 5% of the older person fear of falling. Prevention on fear of falling is
needed such as improving the older person health status and health promotion to improve functional mobility
of the older.

Poster 11 (ID310)
The Bright and Healthy Thai Kid Project, A Three-year Study to Combat Childhood Obesity
ChutimaSirikulchayanontaa, ParadeeTemcharoena, SupreeyaTansakulb
a Department of Nutrition, Faculty of Public Health, Mahidol University

b Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University

Background and objectives: Obesity has reached epidemic proportions globally, and is a major contributor
357
to the global burden of chronic disease and disability. The project aimed to improve nutrition and activity
among primary school children in Bangkok via targeted activities.
Methods: This was a longitudinal study.A preliminary nutritional survey was carried out involving 5,126
children in 4 public schoolsin Bangkok. Participatory action research involving students, teachers, and parents
was conducted. After a 2-day training course, teachers integrated project concepts into their course curriculum.
Seminars on weight management were given separately to parents and students. Multimedia materials
prepared included a DVD for children (songs, cartoon animation for healthy eating and exercise) and
computer assisted instruction for self-learning.The ongoing and post program evaluation at 2 and 3 years of
obese and normal groups was carried out.
Results: The prevalence of obesity in boys (25.4%) was about two times higher than in girls (12.2%) and
was more prevalent in the 11-12 years group than the 6-10 years group for both sexes. It was reported that
high caloric dietary intake significantly decreased for the obese group (p<0.001), aerobic exercise activity
increased in both groups (p<0.001), and overall prevalence of obesity declined from 19.3% to 16.8 and
18.0% respectively. The high blood cholesterol reduced from 78% to 34%. Parents provided their children
with healthier foods and intake of unhealthy foods significantly decreased (p<0.001). However, fruits and
vegetables remained the least desirable foods.
Conclusion: A long-term, participatory effort to promote healthy diets and physical exercise could be
effective with primary school students, and public policy for a healthy school lunch and environment with
public relations, positive mass media and parental role models can be effective in combating childhood
obesity and future cardiovascular diseases.

Poster 12 (ID314)
Mapping of Groundwater Quality for Drinking Purposes in Khon Kaen City, Thailand
Warangkana Sungsitthisawad, Somsak Pitaksanurat and Chatchawal Kiratiworasakun
Department of Environmental Health Science, Faculty of Public Health, Khon Kaen University, Thailand

Background/objective: Khon Kaen City, the district capital of Khon Kaen province, Northeastern Thailand
with the population of 450,000 which currently makes it the fourth largest Thai city. Its citizens use water
supply from the surface water system by pumping untreated water from the Phong River. The condition of
climate change results in pollution problems and small amounts of water in that water source during the dry
season. In order to provide the quality substitute water sources for the futures, the researchers prepared and
developed a map on quality of groundwater evaluated from the Groundwater Quality Index (GWQI) for
drinking purposes.
Methods: The classification of groundwater quality data input was implemented to ArcGIS 10.1 program,
assessed by GWQI, which was developed from groundwater quality index for water supply production.
There were six key parameters: pH, iron(Fe), nitrate(NO3-), total hardness as CaCO3, chloride(Cl-) and total
dissolved solids(TDS). The GWQI evaluated the complex groundwater quality data into a GWQI score and
classified into five types, from “excellent” to “very poor”, then applied to groundwater samples from 63
groundwater sources in Khon Kaen City, which analyzed samples done by the Division of Groundwater
Quality Analysis, Department of Groundwater Resource, Ministry of Natural Resources and Environment.
Results: This study found that the sum of the excellent quality and the good quality of groundwater samples
were the same as the groundwater quality which met the allowable maximum of Thailand Groundwater
Quality Standard for Drinking Purposes; that was 46.03%. The Fair and poor quality were the same value at
19.05% and very poor quality at 15.87% of the samples.
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Conclusions: The map of groundwater quality can be used as a guideline for planning to provide clean
drinking water in the future.

Poster 13 (ID374)
Computer Assisted Instruction “learning of Nutrition Flag for 5th Grade and 6th Grad Deaf
Students”
Suwat Srisorachatra, Yotsinee Huadongb, Chatrapa Hudthagosola, Suksiri Danthanavanichc,
aFaculty of Public Health, Mahidol University, Bangkok,Thailand

bRachapatSuandusit University, Bangkok Thailand

cRachasudacolledgeMahidol University, Nakornpatom, Thailand

Background/objective: Deaf students are one of under privilege group and there are limited resource of
information related to health including nutrition. The purpose of this research was to create computer
assisted instruction of the “nutrition flag” for 5th and 6th grade deaf students.
Method: The content and pictures for computer assisted instruction came from in the curriculum and then
story boards were developed by staffs, including nutritionists, Thai sign language translators, and deaf
students. After recording the sign language onvideo, this material was merged with the contents and
converted into a computer program. The computer assisted instruction was tested, in first trial was conducted
with three students, the second trial with five students, and the third trial with 15 students. The computer
assisted instruction was revised until it met the standard criteria of 80/80. Pre-test was completed on the first
day, and the students performed self-study and completed the exercises for units 1-3, with 50 minutes spent
on each unit on the day 2-4. The post-test was completed on the last day.
Result: The results showed an effectiveness of 81.85/82.22, which was higher than the standard criteria of
80/80. The post-test average score was higher than the pre-test average score with a statistical significance
level at p < 0.0001.
Conclusion: The suggestion for developing instruction for the deaf were the length of the instruction should
not longer than 30minutes and the sign language should be large because the sight was the way of
communication.

Poster 14 (ID380)
Cytogenetic Biomonitoring of Workers Exposed to Diethylamine Analysis in Peripheral Blood
Lymphocytes
LertchaiCharerntanyarak
Department of Epidemiology, Faculty of Public Health, KhonKaen University, Thailand

Background: Diethylamine is used as a corrosion inhibitor and in the production of pesticides, dyes, rubber,
resins and pharmaceuticals. It is a colorless liquid with a fishy, ammonia-like odor. The legal airborne
permissible exposure limit (PEL) is 25 ppm averaged over an 8-hour work shift (OSHA).
Objective/Method: Chromosome aberrations (CA), sister chromatid exchanges (SCE) and mitotic indices
(MI) were the methods of cytogenetic effect. They were studied in the peripheral lymphocytes of 30 male
workers occupational exposed to diethylamine and examined in the normal cultured human lymphocytes
treated with different concentrations (10, 20, 100, 200 ppm) of diethylamine for 8, 24, 48, 72 hours.
Results: It was observed that an increment of the concentration of diethylamine led to a reduction of the

359
amount of cells and their mitotic activity. At the concentration of diethylamine above 500 ppm showed a
marked 50% reduction of growth and above 1000 ppm of diethylamine, a complete lack of metaphase cells
was observed.
CA, SCE and MI were found in a few cells of workers’ blood when compared with controls (untreated cells).
Stratifying for age of the worker, duration of their work and individual data did not change the substance of
the results. Only one worker had 9% incidence of CA; 7% single chromatid gaps and 2% single chromatid
breaks. The number of micronuclei was 0.94% thus ranging under the average of 1.06% calculated from all
30 blood samples.

Poster 15(ID430)
Diclosure of HIV Status to the Intimate Partners among Plhiv in Monywa Consortium Art
Clinic, Myanmar
Wut Y. Soea, Nawarat Suwannapongb, Nopporn Howteerakulc
a MasterDegree of Public Health Program, Faculty of Public Health, Mahidol University, Bangkok, Thailand
b Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, Thailand

c Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand

Background/Objective: As HIV transmission has increased among discordant couples, this cross- sectional
study aimed to estimate the prevalence of HIV status disclosure to intimate partners and its influencing
factors in a Monywa Consortium ART clinic.
Method: Self-administered questionnaires were used for systematic random samples of 227 People Living
with HIV aged 18 and above who registered in 2012 at the Consortium ART clinic.
Results: The prevalence of HIV status disclosure to intimate partners was 66.5%. The study also showed
64.8% of PLHIV had good knowledge, 45.8% had a positive attitude, 57.3% had a low level of perceived
stigma and discrimination, and 42.3% had a high self-efficacy level. Multiple logistic regression analysis
showed that four variables influenced HIV status disclosure to intimate partners: good knowledge (OR= 8.95,
95% CI= 2.6-30.8) , positive attitude (OR= 6.45, 95% CI= 1.6- 25.7), a perception of less stigma and
discrimination (OR=29.7, 95% CI= 4.9- 80.7) and high self-efficacy (OR= 4.49, 95% CI=1.10-18.30).
Conclusions: The findings of the study could help creating HIV status disclosure guidelines and to expand
existing knowledge training, behaviour change communication training and counselling program.

Poster 16 (ID562)
Using Biomarker and Symptoms for Evaluation of Exposure Toluene Levels Among Road
Sweepers in Bangkok
Srirat Lormphongs
Department of Industrial Hygiene and Safety, Faculty of Public Health, Burapha University, Chonburi Province,
Thailand

Background/Objective: Toluene is classified as one of the demolishing organic solvents that the workers are
risky to sickness from their work from exposing to Toluene. The symptom is more or less depending on the
type and the quantity of the Toluene exposed. When it enters into the body it quickly disperses into the blood
system and passes to central nerves system and liver, etc. The groups of road sweepers exposed to Toluene in

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their work are easily risky to this substance which may get sick and are dangerous to their health. This study
was to evaluate toluene exposure in road sweepers in Bangkok by using biological exposure index and
symptoms.
Method: This study employed questionnaire including the subjective symptoms, personal air sampling (3M
3500) and urine sampling (after the work shift). We sampled 253 persons; 123 cases who worked as road
sweepers and 130 as a controller. Comparison of the concentration of toluene and its metabolites between
study and control groups using independent t- test.
Results: Mean age was 44.4 year old for road sweepers and control group mean age was 34.2 year old.
93.5% of the study group worked at least 8 hours per day. 13.0% of study group always used respiration
protection equipment and used cloth masks to cover their nose. When they finished working, more than 70%
of the study group showed symptoms including body fatigue, fatigue only arms and legs, knee pain and
headache. Results of the study group showed average ± SD measures of Toluene 544.04 ± 318.77 µg/m3.
Average urine hippuric acid level of road sweepers was 255.18± 310.07 mg/g creatinine. The average
comparison of concentration of Tolune and Hippuric acid in urine were significantly different between the
study and control groups at level 0.05 (p= 0.010 and p= 0.035, respectively).
Conclusions: The road sweepers had exposed to Toluene while working and there should be the organized
the training about awareness the hazard and the protection. Furthermore, they should be a recommendation
about the use of the suitable respiration protective equipment.

Poster 17 (ID596)
Health Literacy Level of Patients in Srinagarind Hospital, Khon Kaen Province, Thailand
Bangonsri Jindawong, Sauwanan Bumrerraj, Varisara Luvira, Piyathida Kuhirunyaratn
Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen Province, Thailand

Background/Objectives: With adequate health literacy patients can understand and act upon health
information accordingly. And this lead to better health outcomes and lower health care cost. Therefore,
assessment of health literacy level before educate patients is needed. This study aimed to measure health
literacy level of patients in Srinagarind University hospital, Khon Kaen province, Thailand.
Method: A cross sectional descriptive study was employed. Participants were 367 patients from systematic
random sampling. This study used REALM Thai version to assess reading test and used STOFHLA Thai
version to assess reading comprehension test, Cronbach’s alpha of Reading test was .977 and .901 for
reading comprehension test. The same cut of point from original tools was used. Research was approved by
Khon Kaen University Ethics committee for human research.
Results: Response rate was 85.0 % (367/426). Most of the participants were male 50.1%. Median age was
45 years (IQR: 22). Most of the participants were married 70.3%. Educations of the participants were
primary school, secondary school and Bachelor degree 28.9%, 25.3% and 25.1% respectively. The
participants were farmers and teacher 23.2%, and 11.2% respectively. Most of the participants had adequate
health literacy (87.2%), marginal and low health literacy 10.4% and 2.5% respectively from the reading test:
Health literacy level from reading comprehension test showed adequate health literacy (84.5%), marginal
and inadequate health literacy 9.5% and 6.0% respectively
Conclusions: The majority of the patients in this university hospital had adequate health literacy. However
the health literacy test should also be tested in community setting as well.

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Poster 18 (ID655)
Muscle Pain among Thai Massage Practitioners
Saifon Pudponga, Somporn K. Triamchaisrib, Pramuk Osiric
a MSc. student in Occupational Health and Safety program, Faculty of Public Health, Mahidol University, Thailand

b Associate Professor, Department of Occupational Health and Safety; Major Advisor

c Associate Professor, Department of Occupational Health and Safety Co-advisor

Background & Objective: Muscle pain is a major ergonomic problem that has been linked to performance
in a body mechanics workers worldwide. The most common causes of muscle pain are tension, stress,
overuse and minor injuries. A Thai massage practitioner works with strength performance on pressure points,
musculoskeletal muscles, joints, tendon, and feet via a high tension pressure to a client in an hour to 2 hour
session. Excessive tension physical and mental repetitive stress and poor posture can also cause poor
circulation. Constant body aches may lead to increased fatigue, as the pain occurs not only in one particular
area but almost all over the body. So much so, massage workers might even have trouble sleeping. Sleeping
problems almost go hand in hand with chronic body aches and quality of life.
Methods: A cross sectional survey was used to measure muscle pain dimensions, muscle pain states, and
related work performances. One hundred and four convenience participants were recruited from Arima
Onsen Spa, Bangkok, Thailand. A set of questionnaires was applied to interview a Thai massager
individually. Quantitative statistics and analytical statistics were done.
Results: They were muscle aches 100 %. Majority of muscle pain were shoulder pain (89.4%); neck pain
(77.9%); and fingers pain (72 %). Muscle pain has a negative correlated with pain frequencies significantly
(r=-0.272, P=0.005). Frequency of pain has a positive correlated with age. Weekly exercise was associated
with intensity of pain (p=0.000). Lower exercise was strongly associated with intensity of muscle pain.
Conclusions: Muscle pain levels were negatively correlated with frequencies of pain, further supporting the
role of muscle pain in Thai massages performance. Lower exercise was strongly associated with intensity of
muscle pain with differences in perceived levels of muscle pain. Giving an intervention to reduce muscle
strain it may thus be possible to reduce intensity of pain and improve the Thai massage practitioner quality of
work life.

Poster (ID514)
Teen’s perception on Cigarette plain packaging mock up
Naruemon Auemaneekul
Mahidol University, Thailand

Background: Experts consider packaging to be one of the five key components for successful marketing,
along with product, price, place, and promotion. Plain packaging has significant influence regarding the fear
towards health risk. Plain packaging will reduce deception on the package, while increasing the power of
health warnings. The aim of the study is to explore teen’s perception towards cigarette plain packaging mock
up on health warning messages.
Methods: The focus group technique was used among 6 groups of participants from high school and
vocational school in Bangkok. The focus group discussion was conducted among the teen groups, those who
never smoked, those who smoked and later quit, and those who were current smokers. Data synthesis was
performed using inductive content analysis to aggregate the findings by identifying commonalities across
texts. The themes were sorted into categories as described by the participants.
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Results: The results identified 51 findings that were further divided into 13 categories. Those categories
were analyzed to produce 6 syntheses namely, warning message perception, pictorial fear arousal to health,
color perception to health, influence of taste and smell, health warning advertisement area on packaging, and
miscellaneous recommend for most effective fear arousal to health. Although, non-smoker teens perceived
fear arousal to be more towards warning and pictorial messages, current smokers perception did not have an
effect towards fear arousal to health.
Conclusions: The study recommends policy driven approaches to be taken into consideration and advocates
implementation of plain packaging most appropriately for fear arousal amongst the teen.

Poster 19 (ID656)
Thai Neuro-healing Touch (SKT 8): A Mental Health Care Technique for Children with
Autism
Vanvisa Sresumatchaia,b, Somporm K.Triamchaisric, Tassanee Rawiworrakuld
a Department of Biostatistics, Faculty of Public Health, Mahidol University, Thailand
b PhD Student in Public Health Sciences Program, College of Public Health Sciences, Chulalongkorn University,

Thailand
c Department of Occupational Health, Faculty of Public Health, Mahidol University, Thailand

d Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand

Background/objective: Autistic is one of autism spectrum disorders (ASD) in children who suffered from
impaired understanding of social being. In Thailand, the Ministry of Public Health reveals an approximately
of 180,000 people, aged lower than 18 years old, have autism disorder symptoms. Medication treatment can
relief autistic related symptoms without regularly control the symptoms. The Thai Neuro-healing Touch
(SKT8) is performed by slightly touching fingers on head that affect neurotransmitter function. This
technique can reduce inattention, hyperactivity, and impulsivity in children with autism.
Method: A case study on four children with autism attending the SKT8 session was examined. After the
SKT8 treatment, a focus group discussion with open-ended questionnaire was employed for data collection.
Content analysis was applied to explore children’s perceptions on their common problems.
Results: Sleep pattern improvement was reported. Parents of children with autism reveal that their children
could sleep well, better than before attending the treatment. They also reduced their hyperactive manner. One
reflection from a mother was her 3 years old son could sit in a chair and listen to a conversation without
annoying anyone. Another reflection from a mother of 3.5 years old son was, “My son can sleep better than
before. He can eating more, sitting still, and concentrates.” The third mother told, “I appreciate his sleep
pattern and eating behavior”. The fourth mother was also revealed the better sleep pattern, and decrease
anxiety after her son receiving this technique.
Conclusion: This technique is a complementary treatment innovation, which could relieve unsatisfied sleep
pattern. These findings correspond to other exploratory retrospective studies on other immune parameters, as
melatonin levels associated with sleep, and increase serotonin levels associated with feeling well. Further
study should include more participants to decrease confounding factors for a case control study.

Poster 20 (ID658)
Pre-marital sex among Thai Adolescents, the study from the Reproductive Health Survey
2009
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 Patama Vapattanawong
Institute for Population and Social Research, Mahidol University, Thailand

Background/objective: While the fertility in Thailand has been lowered to be below the replacement level
for nearly 2 decades, the issue about increasing trend of teen delivery is emerged. This issue may relate to the
sexual activities of the youths. So, this study aimed to explore the extent of pre-marital sex and its factor
associations among the Thai adolescents aged 15-24 years old.
Method: The data used in this study were from the Reproductive Health Survey 2009 (RHS 2009) which
was a national representative and conducted by the National Statistical Office of Thailand. All samples aged
15-24 years old in the data set were selected into this study (male 44.8%, female 55.2%). The indicator of
pre-marital sex was generated from multiple questions, i.e. marital status, ever had girl or boy friends, ever
used contraception, age at first sex, and age at first marriage. According to the pre-marital sex indicator, 4
951 samples (41.4% of total) were eligible to the analysis. To explore the factor associations to pre-marital
sex, the logistic regression was modeled under the hypothesis that the younger cohort might be more likely
to have pre-marital sex than the counterpart.
Results: Overall pre-marital sex was 37.6%. Men had higher percentage of pre-marital sex than female
(56.1% vs. 23.1%, χ2=564.1 p<.000). Per cent pre-marital sex found in adolescents aged 15-19 years old was
47.9 while it was 33.6% in aged 20-24 years old (χ2=86.8 p<.000). After controlling for sex, marital status,
education level, wealth index, geographical area, and administrative area, it was still found that the older
adolescents (aged 20-24) were less likely to have pre-marital sex than their counterparts (adjusted odd ratios
= 0.51, 95% confidence interval =0.44-0.59).
Conclusions: These findings support the evidence of high prevalence of pre-marital sex among Thai
adolescents in the year 2009. And the hypothesis of higher prevalence among the younger cohort was
accepted.

Poster 21 (ID678)
Comparison on the Limits of Detection Between Quantitative Realtime RT-PCR and
Conventional RT-PCR for Influenza A and B Viruses
Charnchudhi Chanyasanhaa, Thanutsapa Thanadachakulb, Malinee Chittaganpitchb
a Department of Microbiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
bNational Institute of Health, Department of Medical Science, Ministry of Public Health, Nonthaburi, Thailand

Background/objective: Influenza is a respiratory disease mainly caused by influenza A and B viruses. The
disease is a global public health problem which causes severe morbidity and mortality. Viral genome
detection is one of the popular techniques used for laboratory diagnosis. Our previous study developed the
clone and constructed the standard curve for both viruses used for quantitative realtime RT-PCR assay,
which is used for detecting viral genome pathogens. The purpose of this study was to compare the limits of
detection of quantitative realtime RT-PCR and conventional RT-PCR of influenza A and B viruses.
Method: An experimental study was designed in this research. One strain each of influenza A and B viruses
were selected, and diluted within ten-fold serial dilutions. Each dilution was detected by plaque assay. One
dilution giving 50-100 plaques was selected from each virus, and that dilution was used to re-dilute within
ten-fold serial dilutions. Each dilution had it’s genome furth amplified using the quantitative realtime
RT-PCR and conventiona RT-PCR and then compared to the limits of genome detection for both assay.
Results: The plaque assay which gave 50-100 plaques for influenza A virus was found at dilution 10-5 with

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94 plaques and the influenza B virus was at a dilution of 10 -5 with 88 plaques. At this dilution the plaque
forming units of both viruses were 4.7 X 107 pfu/ml and 4.4 X 107 pfu/ml respectively. Comparison on the
limits of detection by the quantitative realtime RT-PCR and conventional RT-PCR for influenza A virus
were 4.7 X 10-2 pfu/ml versus 4.7 X 101 pfu/ml, while influenza B virus were 4.4 X 10-1 pfu/ml versus 4.4 X
101 pfu/ml respectively.
Conclusions: Quantitative realtime RT-PCR is more sensitive in the detection of influenza A and B viruses
than the conventional RT-PCR.

Poster 22 (ID848)
The Quality of Work Life and Barriers to Work Among People Living with HIV/AIDs;
Effectiveness of SKTs Meditation Exercise
Prakasit Thonchoya, Somporn K. Triamchaisrib, Pramuk Osiric
a MSc. student in Occupational Health and Safety program, Faculty of Public Health, Mahidol University, Thailand
b Associate Professor, Department of Occupational Health and Safety; Major Advisor

c Associate Professor, Department of Occupational Health and Safety Co-advisor

Background & Objective: Quality of work life among HIV employees is promoted as a national policy of
Ministry of Thai labor to improve quality of life among this group of workers.
Aims: This study was to examine quality of work life and barriers to work among persons living with
HIV/AIDS (PLHAs) in a provincial hospital, Thailand.
Methods: SKT1, 3, 7 meditation innovation exercise intervention were trained. A disclosure technique by
using telephone interviewing among 42 PLHAs (female; 64.3%, male; 35.7%) was done and laboratory
markers were measured.
Results: The disclosure interviewed outcomes showed that the PLHAs had good work life abilities before
getting HIV infection and were employed (88.2%). The qualy of work life and ability were changed after
getting diagnosed as HIV infected person. They were decreased employment (31.7%), looked for a new job
(46.3 %) and unemployed and others (23.0 %). They major barriers were unable to work (68.8 %), rejected
from the company’s owner (10.3%), needed more money to buy food (20.9 %), and had a lower salary (<
10,000 Thai baht per month). After practicing the SKTs Meditation exercise for 6 months, they showed an
improvement of the quality of work life (100.0%), improvement of health (92.9%), increased CD4 t cells
level (95.2%), improvement of quality of life and went back to work (66.7 %).
Conclusion: SKTs meditation exercise should be a tool to improve quality of work life among PLHAs.

Poster 23 (ID864)
Fatigue and Factors Related Among Thai Nurses
Patcharida Sangdanga, Somporn K. Triamchaisrib, Pramuk Osiric
a MSc. student in Occupational Health and Safety program, Faculty of Public Health, MahidolUniversity, Thailand

b Associate Professor, Department of Occupational Health and Safety; Major Advisor, Faculty of Public Health,

Mahidol University, Thailand

c Associate Professor, Department of Occupational Health and Safety; Co-advisor, Faculty of Public Health, Mahidol

University, Thailand

Background/objective: Fatigue is a complex and individual occurrence that has been linked to performance
decrements. Specific to nursing, strong evidence links prolonged work hours, rotating shifts, and insufficient
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breaks are closely linked to their health consequences and work life ability. This study aimed to study of
prevalence of fatigue among Nurses. Relationships between dimensions of fatigue and factors were
investigated, as were differences in fatigue across levels of several demographic and work environment
variables.
Method: A cross sectional survey was used to measure fatigue dimensions, muscle pain experience, and
background. Participants were recruited via convenience sampling in cooperation with Amnart Chareon
Hospital; a two page questionnaire was sent to 200 nurses. A total of questionnaires were completed and
returned, for a response rate of 47.5 % (n=95) nurses completed the survey in July 2013.
Results: Perceived moderate fatigue to high fatigue level among Nurses was 82.8 %. Majority area of
perceived fatigue among nurses were both left and right shoulder fatigue (91.7%, n=54; 91.5 %, n=47); waist
fatigue (84.5.%, n= 58; 86.3 %, n=51); and craft fatigue (90.3%, n= 62; 84.0 %, n=50). Fatigue has a
negative correlated with sleeping hour (r=- 0.232, P=0.027); has positive correlated with nightshift (r= 0.307,
P= 0.003) significantly. Sleep enough and working posture were associated with intensity of fatigue
(p=0.001).
Conclusions: Fatigue levels were negatively correlated with sleeping hour and also high frequency of night
shift was correlated with fatigue level. Giving an intervention to reduce fatigue it may thus be possible to
level of fatigue and improve the Thai Nurses quality of work life.

Poster 24 (ID954)
Smoking, Alcohol Drinking and Betel Quid Chewing Among Myanmar Youth Workers in Mae
Sot District of Tak Province, Thailand
Kyaw Htina, Nopporn Howteerakulb, Nawarat Suwannapongc
aMaster Degree of Public Health Program, Faculty of Public Health, Mahidol University, Bangkok, Thailand
b Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand

c Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, Thailand

Background/ Objective: Health risk behaviors among youth are a serious public health problem. This
cross-sectional study aimed to estimate the prevalence of single and concurrent multiple health risk
behaviors i.e., smoking, alcohol drinking, betel quid chewing and to explore how health risk behavior is
associated with general characteristics, job stress and social influences among Myanmar youth workers in the
Mae Sot district of Tak province, Thailand.
Method: Self-administered questionnaires were used for simple random sampling of 300 Myanmar youth
workers, aged 18-24 years.
Results: About 33.6% reported no risk, 24% reported one risk and 41.7% reported two or three risk
behaviors. Multiple logistic regression analysis revealed 6 variables which were significantly associated with
health risk behaviors: being male, having friends who smoke, friends who drink alcohol, friends who chew
betel quid, exposure to family member’s betel quid chewing and having high/moderate custom and
traditional influence.
Conclusions: Prevention and treatment interventions should be multi-focus, rather than restricted to a single
focus with an emphasis on male youth workers, establish friendships and follow peers with good behavior
and a parents-targeted program or parenthood education for preventing their children from those health risk
behaviors.

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Poster 25 (ID976)
Headaches and Factor related among Thai Monks
Pukvipa Wongwana, Somporn K. Triamchaisrib, Pramuk Osiric
a MSc. student in Occupational Health and Safety program, Faculty of Public Health, Mahidol University, Thailand

b Associate Professor, Department of Occupational Health and Safety; Major Advisor

c Associate Professor, Department of Occupational Health and Safety Co-advisor

Background & Objective: Migraines, unknown cause’s headaches, can last from four hours to three days
and usually occur one to four times per month. It has an independent moderately deteriorating effect on the
daily functioning of individuals. This study aimed to study the prevalence of migraine headache among Thai
Monk. Relationships between dimensions of Migraine headache and factors related were investigated, as
were differences in migraine headache across levels of related variables.
Methods: A cross sectional survey was used to measure migraine headache dimensions, headache related
chronic illness, sleep problem, and background. Participants were recruited via convenience sampling in
cooperation with 4 Temples in Bangkok Metropolis; a two page questionnaire was sent to 164 monks. A
total of questionnaires were completed and returned, for a response rate of 100%. Monks completed the
survey in July 2013.
Results: The prevalence of migraine headaches among Thai monks was 57.9% with 53.7% of sleep problem,
46.3 % of throbbing pain, 68.4% involved daily activities, 59.9% showed Left or right hemiplegic headache,
32.6 % resulted from stress, and 58.1% show moderate to high intensity of headache. Migraine intensity was
positively correlated with sleeping hour (r= 0.477, P= 0.000).
Conclusions: Migraine headache intensity was positively correlated with sleeping hour Giving an
intervention to reduce migraine it may thus be possible to reduce intensity of migraine headache improve the
Thai Monk quality of work life.

Poster 26(ID981)
The Evaluation of Payment Mechanism Regarding Health Promotion and Disease Prevention
Programs in Northeastern Thailand
Suchada Paileekleea, Kesorn Thaewnongniewb, Kitti Laosupapc, Darika Chaiyakund, Supattra Wattanasene
a Khon Kaen University, Khon Kaen, Thailand

b The office of Disease Prevention and Control Region 6, Khon Kaen, Thailand

c Nongkungsri District hospital, Kalasin, Thailand

d SamSung District Hospital, Khon Kaen, Thailand

e Sirithorn Public Health College, Khon Kaen, Thailand

Background/objective: Payment mechanism is considered to affect quality and efficiency in health care
services. The National Health Security Office review that quantity of activities regarding health promotion
and disease prevention programs were in satisfaction level, but the quality of services were under
consideration. This study aimed to reflect the outcome of health promotion and prevention programs of
which different payment mechanism.
Method: A Cross-sectional community survey. The health promotion and prevention programs to be
evaluated were vaccination, pre-school child health, school health, antenatal and postnatal care, chronic
diseases screening, home health care for the disabled and elderly. Study populations were population aged
30-60, women in reproductive age, pregnant and postnatal women, the disabled and the elderly. Multi-stages
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sampling was applied to obtain 560 samples form 34 villages in 4 provinces. Data were collected using
full-structured interview, reviewing and checklist of relevant documents. Data were analyzed using
descriptive statistics.
Results: The study revealed that all of health promotion and prevention activities providing at the sub
district health promoting hospitals had high coverage. Vaccination coverage was greater than 98% in every
target groups, consistent with per visit payment. The antenatal and postnatal care, of which per case payment
has high coverage in term of cases, but the number of visit and time to visit were not consistent with
guideline. Considering other activities such as school health, maternal and child health, and screening of
chronic diseases, paid by capitation, had high coverage but proper record or documentation need to be
improved.
Conclusions: The health prevention and promotion activities were high coverage. Activities which
retrospective payment seem to have better coverage and recording system, whist activities paid by capitation
seem to have high coverage but documentation need to be improved.

Poster 27 (ID1059)
Effectiveness of SKT Meditation Innovation Exercise on Spatial Disorientation and Vestibular
effects: A Pilot study in an Hostage
Somporn Kanthardussadee Triamchaisri a, Siripich Triamchaisrib, Vanvisa Sresumatchaic
a Associate Professor, Department of Occupational Health and Safety

b Endocrinologist, Ramathibodi Hospital, Mahidol University

c Lecturer, Department of Biostatistics, Mahidol University

Background & Objective: Spatial orientation in flight is difficult to achieve because numerous sensory and
motor stimuli (visual, vestibular, and proprioceptive stimuli) due to vary in magnitude, direction, and
frequency. Any differences or discrepancies between visual and vestibular sensory inputs resulted in a
sensory mismatch can produce illusions and acute vestibular perception lead to spatial disorientation. SKTs,
a group of meditation innovation were a set of Thai traditional medicine, is a 3 years research project
conducting to heal chronic illnesses and the end of life patients nationwide is accepted to heal spatial
disorientation. This study aimed to test the effectiveness of SKT3 and SKT5 Meditation innovation exercise
in Thailand to improve a severe motor and sensory health problems to spatial disorientation.
Methods: A hopeless severe case of spatial disorientation with unable to walk, sit, eat, and sleep, and
progressive paralysis liked feature, a full scale intensive treatment from 3 hospital, was referred to be
practice SKT 3 and SKT 5 meditation exercise by a physician . Three times a day for 20-30 minute session
practicing of SKT3 and SKT5, non- invasive traditional medicine were trained. Motor and sensory testing
and symptoms evaluation were recorded everyday for 3 month.
Results: After practicing SKT3 and SKT5 meditation exercise, the function of visual illusions is reduced,
hearing problem and posture disorientation is 30 % improved, and quality of life of patient related to eating,
standing, sleeping is improved within 1 week. The improvement of walking, posturing, hearing, sleeping,
memory losing, walking status were reported after 1 month regularly practicing 3 times a day. Eighty percent
of spatial orientation is met after practicing for 1 month. Ninety percent holistic improvement of visual and
vestibular functions is improved as a normal healthy people within 3 month practicing the meditation
exercise.
Conclusions: SKT3 and SKT5 can heal spatial disorientation within 3 months. Prospective studies should be
done to prove the effectiveness of SKT3 and SKT5 related to others spatial disorientation related to visual
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and vestibular problems.

Poster 28(ID1083)
Prevention and Control of Iodine Deficiency of Pregnant Women Associated with Neonatal
Neurobehavioral Development
Noppanun Nankongnaba, Pornpimol Kongtipa, Anu Suracha, RewadeeChongsuwatb,
Suttinun Chantanakula, Susan Woskiec
a Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand

b Department of Nutrition, Faculty of Public Health, Mahidol University, Bangkok, Thailand

c Department of Work Environment, University of Massachusetts Lowell, Lowell, MA,USA

Background: Maternal iodine deficiency leads to delayed neonatal neurobehavioral development. Iodine
salt or iodine tablet supplementation was introduced to all pregnant women visited the prenatal clinics.
Methods: 28-week pregnant women (n=50) visited prenatal clinics in the mild iodine deficiency areas were
interviewed using characteristics, food frequency questionnaire, iodine salt/iodine tablet supplementation.
The maternal, cord serum thyroid hormones (TSH, FT4 and T4) were measured at the full term delivery and
heel prick TSH was measured at 2-day infants. All newborn infants were examined for Neonatal Behavioral
Assessment Scale (NBAS) within 2-3 days.
Results: The 30.6% of maternal FT4 were below the normal range; 28.2% of cord serum TSH was in the
iodine deficiency range and 6% of the heel prick TSH was above the normal range. The maternal
FT4positively associated with motor and autonomic systems of NBAS and heel prick TSH negatively
associated with autonomic systems. The maternal FT4 was the most sensitive indicator to detect maternal
iodine deficiency and it was associated with infant neurodevelopment.
Conclusion: The maternal FT4 should be used for monitoring maternal iodine deficiency status to prevent
delayed infant neurodevelopment. The early iodine supplementation in the first month of pregnancy is
recommended.

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United States(美国)

370
Guest Lecture
Can Lessons Learned from the Growth of Advanced Practice Nursing Roles in the U.S.
Inform New Strategies for Meeting Health Needs of Geographically Isolated Populations in
China?
Dr. Elizabeth Merwin
The School of Nursing, Duke University, U.S.A.

In the United States there are continued health disparities based on the geographic location of residence in
the rural areas. Rural areas are challenged by the lack of health providers, including both primary care and
specialty care providers, the lower availability of health care facilities, difficulties with transportation and
long distances to specialty care. These challenges are compounded by rural areas having higher rates of
unemployment, lack of insurance and the general lower availability of resources to be used to meet the health
care needs of the populations. Against these challenges have been the ever growing availability of advanced
nurse providers educated to take on new roles in the health care delivery system and to expand access to high
quality patient care. Strategic programs and interventions have been developed to expand the preparation and
availability of these nurses and to improve access to care in rural areas. Barriers to improving access that
have been faced often include regulations, the lack of funding, and the lack of availability of specialty care as
well as provider isolation.
Over recent decades, there has been tremendous growth in educational programs to prepare four main types
of advanced practice nurses: Certified Nurse Anesthetists (CNRAs), Nurse Midwives (NM), Nurse
Practitioners (NPs) and Clinical Nurse Specialists (CNSs). Part of the motivation for supporting the growth
of these practitioners was to provide additional resources for underserved rural areas. Innovative educational
initiatives have provided this training to nurses residing in rural areas and supported their practice. The
increasing availability of technology and of internet access has facilitated the implementation of educational,
research and practice initiatives. These initiatives have sought to enhance access to care or to support the
implementation of evidenced-based care into rural nursing practice to improve the health status of
individuals residing in geographically isolated rural areas.

Guest Lecture
Health and Education in the United States: Moving Towards a Virtuous Cycle
Dr. Carolyn R. Hodges,
Vice Provost and Dean, University of Tennessee Graduate School

From a public health perspective, education is often thought of as one of the fundamental social determinants
of health, along with socioeconomic status, neighborhood violence, access to resources, transportation, and
public safety. These “upstream” forces have tremendous impact on what a population experiences
“downstream”: poor quality schools, poverty, high levels of crime, and limited access to resources combine
to lead to poorer health status. Other upstream determinants of health – the natural and built environment,
health policy, health services, genetics, and individual behavior – also powerfully influence the health status
of populations and communities. There are consistent findings across all major geographic levels – from
local, to county, state or province, nations, and continents: as the social determinants of health improve, the

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health of populations improves, and length and quality of life improves.
While many studies show cross-sectional associations between education and health, the more common
approach is to consider the direction of “causality” from education to health, i.e., as education improves,
health improves; less consideration is given to the opposite impact: that health can have an impact on
education. Examples that highlight this causal direction come again from multiple levels. In a rural county in
the Appalachian Mountains in East Tennessee, community residents identified lack of access to oral health
care for children as one of the major determinants of education and overall health. In another elementary
school located in a low income urban area in East Tennessee, improving health is one of the major strategies
to improving educational outcomes. At the national level, improved access to health care through health
reform bodes well for improving national educational outcomes. Health and education thus can be the
virtuous cycle for improving quality and longevity of life.

Guest Lecture
Multiple Approaches to Reduce the Consumption of Sugar-Sweetened Beverages
Jay Maddock, Ph.D.
Office of Public Health Studies, University of Hawaii at Manoa

Obesity is a major public health concern in the United States along with most other developed nations.
Overconsumption of poor quality foods and lack of physical activity have been strongly associated with
obesity. Sugar sweetened beverages (SSB) are a major source of non-nutritive calories in the diet
especially among adolescents. In Hawaii, the State Health Department has partnered the University of
Hawaii to find solutions to increasing rates of obesity. As part of a comprehensive approach to addressing
obesity, reducing the consumption of SSB has been selected as a focal point. This talk will describe the
efforts of the state in: 1) increasing understanding of the consumption of SSB through surveys and focus
groups; 2) the development, implementation and evaluation of a media campaign targeted toward reducing
SSB consumption in adolescents; 3) reducing availability of SSB and 4) efforts to pass a bill to tax SSB.
Implications and future directions will also be discussed.

Guest Lecture
The Roles of Vitamin A in the Regulation of Hepatic Glucose and Fatty Acid Metabolism
Yang Li, Guoxun Chen
Department of Nutrition, University of Tennessee, Knoxville, TN

Background: The rise of obese population has become a concern of public health. Despite the obvious link
between over-nutrition and the development of obesity, the roles of individual nutrients such as vitamin A
(VA) have not been studied. We have shown that VA status affects obesity development, the plasma glucose
and lipid levels, and hepatic gene expression in rats. This study is aimed to determine whether dietary VA
intake and its hepatic metabolism may regulate the expression of genes for glucose and lipid metabolism in
response to fasting-refeeding cycle.
Methods: Male Zucker lean rats at weaning (21 days age) were fed with a VA deficient (VAD) or a VA
sufficient (VAS) diet for 8 weeks. The VAD or VAS rats were divided into four groups: fed ad libitum,
fasted for 48 hours or re-fed a VAD or VAS diet for 6 hours. The plasma parameters such as insulin and
leptin were measured using commercial kits. The hepatic protein and mRNA levels were respectively
examined by Western blot and real-time PCR.
372
Results: The responses of plasma insulin and leptin levels to the feeding cycle were altered in VAD rats
compared to VAS ones. The hepatic mRNA levels of Gck, Srebp-1c, and Fas were reduced after a 48-hours
fasting regardless of VA status. The 6-hours refeeding of a VAS diet induced their mRNA levels in VAD
and VAS rats. However, the 6-hours refeeding of a VAD diet only induced the expression levels of these
genes in VAS, but not VAD rats. The protein levels of the corresponding genes were altered accordingly
Conclusions: We conclude that VA status affect the expression of genes involved in hepatic glucose and
fatty acid metabolism. Dietary VA and its hepatic metabolism dynamically contribute to the regulation of
plasma hormone levels and hepatic gene expression in rats.

Guest Lecture
Addressing Oral Health Disparities among Middle-aged and Older Americans: Comparison
of Asians with other Racial/Ethnic Populations
Bei Wu
Duke University School of Nursing and Global Health Institute, Durham, United States

Background: As a result of immigration and high fertility rates, Asian Americans are one of the fastest
growing segments of the US population. However, Asian Americans are not a homogeneous group, but
rather consist of a number of distinctly separate groups. Despite the increasing numbers of Asian
Americans from diverse backgrounds and experiences in the United States, very little is known about their
oral health. We estimated national trends of the prevalence of edentulism (complete tooth loss) for Asian
American subgroups in the United States and investigated factors that could contribute to improvements in
edentulism across populations over time.
Methods: We used 10 waves of the National Health Interview Survey data collected from 1999 to 2008.
Eligible respondents were those aged 50 years and older who completed the question on tooth loss. We
contrasted the odds and probabilities of edentulism over time in Chinese, Filipinos, Asian Indians, and other
Asians with those in Whites, Blacks, and Hispanics.
Results: The rates of edentulism differed substantially across Asian subgroups. Compared with Whites,
Chinese and other Asians had a lower risk of being edentulous, whereas being Filipino increased the odds.
The rate for Asian Indians was similar to that for Whites. Nonetheless, rates of decline were similar across
the Asian population groups.
Conclusions: Asian Americans are heterogeneous in edentulism. Given the increasing numbers of adults
retaining their natural teeth—who have a higher risk of dental caries and periodontal diseases—interventions
designed to assist individuals in maintaining healthy teeth become more critical. Innovative and sustainable
public health programs and services are essential to prevent oral health diseases and conditions.

Guest Lecture
Yuanan Lu
Dr. Yuanan Lu's research interests focus on employing cutting-edge molecular biology and virology
technology for the development of novel preventive and therapeutic strategies to combat pathogenic viruses
of human and marine species. Several ongoing research projects include testing the possible use of
blood-derived monocytes/macrophages as a novel gene delivery system for the central nervous system and
testing candidate neuroprotective factors for their neuroprotection potential in vitro and in vivo. Another
major research area in Dr. Lu’s laboratory is directed to testing and establishment of a novel, rapid molecular

373
based method for the detection of multiple pathogens and pathogen indicators in Hawaii environmental
waters. Other research activities in Dr. Lu's laboratory include marine drug development with a focus on
screening marine microorganism extracts for their antiviral potential, the development of cell lines from
marine species with aquaculture importance for Hawaii Aquaculture Disease Management, the employment
of in vitro cell cultures as a sensitive biological indicator for enhanced monitoring of environmental pollution,
and study and characterization of newly isolated promoter gene from penaeus shrimp for their potential
application in the development of transgenic shrimp with virus resistance.
Dr Lu will give a lecture at AIDS Prevention and Control on October 26, 2013.

Guest Lecture
Edwin Trevathan M.D., M.P.H.
Edwin Trevathan, is a U.S. physician, a child neurologist and pediatrician, who is currently the Dean of the
Saint Louis University College for Public Health and Social Justice, where he is also a Professor of
Epidemiology, Pediatrics, and Neurology. Prior to his move to his Dean position in September, 2010, he was
Director of the National Center on Birth Defects and Developmental Disabilities at the U.S. Centers for
Disease Control and Prevention (CDC) in Atlanta Georgia. Prior to his appointment as a national center
director at the CDC in 2007, Dr. Trevathan was Professor of Neurology and Pediatrics, and Director of the
Division of Pediatric & Developmental Neurology at Washington University in St. Louis School of Medicine,
and was Neurologist-in-Chief at St. Louis Children's Hospital.

Oral (from APACPH)

Multi-country study of betel quid chewing: Introduction and the example of Guam
Thaddeus A. Herzoga, Kelle L. Murphyb, Melissa A. Littlea, Gil S. Suguitanb, Pallav Pokhrela, Crissy T.
Kawamotoa
aUniversity of Hawaii Cancer Center

bUniversity of Guam Cancer Research Center

Background: Betel quid is the fourth most commonly consumed psychoactive substance in the world. The
Betel Quid Dependence Scale (BQDS: Lee et al., 2012) is the first instrument designed specifically to
measure betel quid dependence. The three factor structure of the BQDS consists of “physical and
psychological urgent need,” “increasing dose,” and “maladaptive use.” The BQDS initially was validated in a
sample of male prisoner ex-chewers in Taiwan.
Objective: To replicate and extend the original validation research on the BQDS in a sample of male and
female current betel quid chewers in Guam.
Methods: A survey containing the BQDS was administered to 300 current betel quid chewers in Guam.
Results: Structural equations modelling revealed that betel quid dependence is associated with the inclusion
of tobacco in the quid, number of chews per day, years of chewing, and ethnicity.
Conclusions: The BQDS is valid for current English-speaking male and female chewers in Guam. Overall
levels of betel quid dependence were high, and most chewers included tobacco in their betel quid. The results
suggest that levels of dependence for betel quid are similar to those observed for nicotine dependence. Future
research should explore other important psychological and behavioural aspects of betel quid chewing such as
health risk perceptions and motivation to quit chewing.

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Oral 1(from APACPH)
The U.S. Tradition and Experience in Public Health Training
Elahe Nezami
Keck School of Medicine of the University of Southern California, Los Angeles, California

Background/objective: In the United States, graduate education in Public Health began in the early 1900s.
As the field of Public Health Education grew, it became apparent that educational standards should be
established to ensure students received training that would prepare them to adequately serve the public good.
While the American Public Health Association (APHA) managed Accreditation of Public Health Education
programs from the mid-1940s to 1973, in 1974, a new organization whose primary focus was Public Health
Education was founded, the Council on Education for Public Health (CEPH). Since then, CEPH has
overseen the accreditation process for graduate and baccalaureate programs and institutions.
Methods: CEPH assures uniform quality in Public Health Education and works with universities to regulate
their educational programs and training experiences. Students in graduate programs must gain experience in
professional settings as part of their study, and accreditation helps monitor and regulate these training
opportunities. Programs’ curricula, faculty, research, and administration are also evaluated to be in line with
accepted national standards. CEPH also evaluates international Public Health Education and training
programs, if desired by an institution.
Results: Accreditation of schools and programs of Public Health allows prospective students and Public
Health employers to have an understanding of the quality of training an institution or program provides to its
students, as well as an estimation of graduates’ preparedness for work in the Public Health sector.
Conclusions: By standardizing measures of quality for programs and institutions, CEPH allows universities
to regulate their own programs in accordance with accreditation guidelines, which assures that the Public
Health field remains staffed by educated, knowledgeable individuals who understand basic concepts of
Public Health and their applications.

Oral 2 (from APACPH)

Environmental and Policy Approaches to Reducing Obesity in the USA
Jay Maddock
Office of Public Health Studies, University of Hawaii at Manoa

Obesity is rapidly becoming a major public health issue worldwide. Inadequate physical activity and poor
nutrition are the central contributors to this epidemic. Despite increased awareness of these issues, rates of
obesity continue to rise. More comprehensive approaches that address not only individual level factors but
also social, community and society level changes are needed. The Healthy Hawaii Initiative was created in
2000 using tobacco settlement funds. Based on the social-ecological model, the Healthy Hawaii Initiative
provides long term funding to address physical inactivity and poor nutrition. Major channels of
intervention include schools, worksites, county and state policy, and social marketing. Policy changes and
challenges including Complete Streets and Safe Routes to School will be addressed. The discussion will
focus on the opportunities and challenges of the largest per capita state-wide program in the US to address
obesity. Several national studies conducted by the Physical Activity Policy Research Network will also be
included.

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Oral 3(from APACPH)
Impact of Motorcycle Injury Prevention Policies in the Asia-Pacific Region
Walter K. Patrick MD PhD
Secretary-General APAPCH, University of Hawaii

Assessment of the impact of prevention policies and their effectiveness is both a complex and long term
process. This report is an initial analysis among select countries in the Asia-Pacific Region using two
category of variables one related to socio-economic development and infrastructures and the other related to
Motorcycles.
Objective: To assess trends observe co-relations to policies where possible.
Methods: Review of data from respective countries on Trends on Motorcycles accidents (Tuk Tuks
included), # accidents, deaths, injuries (serious, minor), the laws on Helmet Use introduction dates, data on
implementation measures such as training of Police, Fines etc
Results: All countries in the study showed improvement – reduced mortality and reduction in serious
morbidity with use of helmets. The most remarkable and consistent achievement was in Taiwan. Several
problems have emerged: Increased morbidity due to head and spine injuries. A unique phenomenon is the
number of fatalities in Tuk Tuk accidents. This emerging problem is likely to increase unless strict safety and
legal measures as Tuk Tuks (tri-wheeler motorcycles) have emerged as alternatives to taxi-cabs in most
economically less developed countries in Asia.

Oral (from APACPH)

Future Research Directives in Oral Cancer Prevention and BQC - Cessation
Prof. Walter K. Patrick MD PhD
Secretary-General APACPH, University of Hawaii

Consultations with experts in this field and literature reviews indicate that three major research trends have
emerged:
1. Investigations related to the Carcinogenicity of quid components.
2. Investigations related to patho-physiology of cancer mediators - Precancerous to Cancer (markers triggers
DNA).
3. Behavioral and Addiction studies in BQC especially the potential for increased use of chewing tobacco in
the chew with effectiveness of smoking cessation programs.
Data collection in the multi-country study will be directed opportunistically and cost effectively to address a
few select research questions.

Oral（from APACPH）
Global Collaboration for the Health of Indigenous Peoples
Prof. Walter K. Patrick MD PhD
Secretary-General APACPH, University of Hawaii

APACPH, over the years has promoted collaboration of not only scientists and researchers but institutions
and policy makers to address Indigenous Health issues. An Indigenous Health Collaborating Research Center
is to be established shortly with lead universities in India, Australia and Malaysia taking the lead. Globally
376
oriented educational programs focused on Indigenous Health has been proposed with a significantly problem
based model similar to one used in medical - public health – nursing education in KIIT.
Exciting opportunities related to this development will be discussed.

Oral (from APACPH)

GLOBAL HEALTH: THE NEW ERA IN EDUCATION FOR HEALTH
Walter K .Patrick MD MPH PhD
University of Hawaii, Secretary- General APACPH

Global Health has moved from an international colonizing cultural experience to both opportunistic and
altruistic paradigms in practice. Whatever the motivational underpinnings, there is a major shift in the
conceptualization of Global Health from an international other country external orientation, to one that
focuses on a body of values, principles procedures and practices that are universal to health both locally and
in foreign settings. In this perspective both the immediate factors as well as intermediate and long term
socio-economic determinants contributing to health easily cross borders and are of significant importance.
Therein is the dilemma for Global Health: To treat crises or invest in prevention. The paradox of course is in
the practice of Global Health where emergencies require instant intervention and donors reinforce cost
effectiveness to their pet causes. As universities try to grapple with these intrinsic challenges as well as
interests of governments and donors and train appropriate professionals and develop curricula, it is worth
reflecting on how Global Health Programs (GHP) have evolved, our past-mistakes and successes.
Historical traditions, Professional orientation, Political strategies in Global Health Assistance, even Altruism
- whether religious or corporate - have all collectively shaped Global Health practice. The eras of
sanitation and infectious disease control with an epidemiological focus have dominated Global Health
teaching. Intervention strategies based on that approach were quite effective in the past. But more recently
with more complex issues like aging populations and the burden of Chronic diseases, there is a greater
recognition of social determinants and a better understanding of the various layers in health development
and the complexity and inter-relationships contributing to health. In addition, rapid urbanization and
overwhelming poverty with reduced access to care in developing countries and in the most developed
countries has made it necessary to re- examine concepts in Global Health from an internal-external
perspective rather than the traditional donor with a predominantly external other country view. Primary
Health Care (PHC )and Health For ALL (HFA) and developmental and socio economic models were the
precursors but with globalization the current Global Health perspective of health beyond borders is slowly
becoming the accepted paradigm. The successes of low and mid level income countries especially in the
Asia-Pacific Region in achieving high levels of health at reasonably low cost has led to realization that High
tech costly care needs to be balanced with a broad range of policies and services for prevention.
No man is an Island. No community or country is Isolated or disconnected for health. The walls are porous.
Travel makes us breathe the same air. drink the same water, eat the same food. Globalization and the internet
has also breathed a new culture – a culture of love or violence. Population movements internally in
urbanization or externally in migration due to wars and ethnic violence add to the shift of borders into
foreign lands. Pandemics and Global Tsunamis and disasters have made humanity share the same burdens
and risks. Health bears the same Global DNA for us all. In this re-conceptualization of health as a global
asset, there are several challenges to universities, practitioners and donors (Global Health Assistance).
Unfortunately, the driving force is the size of donor assistance and the intensity of focus of GHA on one
specific objective or a broader set of contributory factors also. The paradox is cost effectiveness and visible
377
immediate results on the global stage. The recurrence of unintended consequences borne by local
communities reflect that the habit of negative practices in GHA is hard to break. Ethical issues, when power
differentials and poverty prevail, are easy to be overlooked when personal gain in money or publications
predominate. As we train health professionals - doctors, nurses, Global Health specialists, the tendency to
transplant rather than develop persists and ethical issues tend to lag behind. There is therefore an urgency to
incorporate ethical issues in GH training. APACPH Accreditation for GH being developed now reflects this
trend.

Oral (from APACPH)

Health Professionals as Peacemakers
Prof. Paula Palmer PhD
Professor, Associate Professor, School of Community and Global Health, Claremont Graduate University

Oral (from APACPH)

Doctors as Peacemakers
Prof. Walter K. Patrick MD PhD
Secretary-General APACPH, University of Hawaii

Oral 4(ID276)
Socioeconomic Determinants of Obesity: A GEE Analysis
Zeqing Lua, Michelle R. Warrena, Zhiyan Lub, Yongyi Bic
a School of Public Health, University of Minnesota - Twin Cites, U.S.A.
b Wuhan University, Zhongnan hospital, China

c School of Public Health, Wuhan university, China

Background/Objective: The United States has experienced a growing trend in obesity over the past
decades. Obesity is associated with numerous health risks, as well as increasing spending on healthcare. As
the epidemic poses a substantial threat to public health, investigating the link between obesity and
socioeconomic factors has been exceptionally important.
Method: The association between demographics, socioeconomic standings, education attainment, and
obesity was evaluated. Since the obesity outcome might be correlated within households, generalized
estimating equations (GEE) model was adopted to control for the clustering effects. The working correlation
structure was identified according to QIC values. The most appropriate model was selected on the basis of
QIC value and goodness-of-fit tests. SAS and R packages were used.
Results: Data was collected through U.S. National Health Interview Survey (NIHS) from 2010 to 2011.
Participants (n=66166) were evaluated based on self-reported body mass index (BMI): 28% of the adults and
16% of adolescents reported as obese. For the entire population, we observed a higher odds of obesity for
male compared to females in African-American (OR=1.07) and Caucasians (OR=1.67). When isolating
education levels, the odds of obesity for African-American compared to Caucasians as educational
attainment increases (OR=2) for high school, OR=2.34 for Bachelor’s).
Conclusions: The socioeconomic factors are related to obesity after accounting for clustering patterns.

378
However, the relationships are dynamic and complex. Interventionists and policy-makers should seek to
understand how these relationships are impacting households matching specific risk group profiles to achieve
health outcome goals more efficiently.

Oral 6(ID367)
Reactions to Framing of Cessation Messages Among Dual-Smoker Couples
Isaac M Lipkusa, Krista Ranbyb, Megan Lewisc, Benjamin Tolld
a Duke University School of Nursing, Durham, United States

b University of Colorado, Denver, United States

c Research Triangle Institute, Research Triangle Park, United States

d Yale University School of Medicine, New Haven, United States

Background/objective: Couples in which both members smoke (dual-smoker couples) have not been the
explicit target of cessation interventions. Quit rates are lower and relapse rates are higher among individuals
in dual-smoker couples. A potentially effective strategy to motivate dual-smoker couples to quit is to
convey messages that highlight how the positive outcomes of quitting (gain-frame) or the negative outcomes
of continued smoking (loss-frame) affect the couple rather than the individual smoker. We explored whether
dual-smoker couples’ smoking behaviors (e.g., amount smoked) and desire to quit would differ as a function
of message frame (gain vs. loss) or outcome focus (individual vs. couple).
Method: Dual-smoker couples (N=40) completed a baseline survey and were then randomized to review
gain- or loss-framed messages that varied whether the outcomes influenced the individual or the couple.
Main outcomes were desire to quit after reading messages and smoking behaviors at a 1-month follow-up.
Results: Couple-focused messages produced the strongest desire to quit and decreased amount of cigarettes
smoked at follow-up. The latter effect was mediated by desire to quit. Loss-framed messages produced
inconsistent effects on desire to quit. There were no significant interactions between outcome-focus and
message framing.
Conclusions: Findings suggest that messages emphasizing how smoking affects both partners can motivate
cessation among dual-smoker couples. Contrary to findings showing that gain-framed messages motivate
cessation targeting individual smokers, results suggest that loss-framed messages may be more persuasive
than gain-framed messages when the target of the outcome involves significant others.

Oral 7(ID405)
The U.S. Tradition and Experience in Public Health Training
Elahe Nezami
Keck School of Medicine of the University of Southern California, Los Angeles, California

Background/objective: In the United States, graduate education in public health began in the early 1900s.
As the field of public health education grew, it became apparent that educational standards should be
established to ensure students received training that would prepare them to adequately serve the public good.
While the American Public Health Association (APHA) managed accreditation of public health education
programs from the mid-1940s to 1973, in 1974, a new organization whose primary focus was public health
education was founded, the Council on Education for Public Health (CEPH). Since then, CEPH has
overseen the accreditation process for graduate and baccalaureate programs and institutions.
Methods: CEPH assures uniform quality in public health education and works with universities to regulate
379
their educational programs and training experiences. Students in graduate programs must gain experience in
professional settings as part of their study, and accreditation helps monitor and regulate these training
opportunities. Programs’ curricula, faculty, research, and administration are also evaluated to be in line with
accepted national standards. CEPH also evaluates international public health education and training
programs, if desired by an institution.
Results: Accreditation of schools and programs of public health allows prospective students and public
health employers to have an understanding of the quality of training an institution or program provides to its
students, as well as an estimation of graduates’ preparedness for work in the public health sector.
Conclusions: By standardizing measures of quality for programs and institutions, CEPH allows universities
to regulate their own programs in accordance with accreditation guidelines, which assures that the public
health field remains staffed by educated, knowledgeable individuals who understand basic concepts of public
health and their applications.

Oral 8 (ID442)
Promoting Health Among Asian Adults and Children Worldwide Using Culturally Tailored
Technology-centered Tools
Angela C. Sun, Terence Ng, Angelin C. Cheng
Chinese Community Health Resource Center, San Francisco, USA

Background: The use of technology for health education is rapidly increasing. Ten million Americans use
the Internet daily to access health information and 58% reported that it has affected their healthcare
decisions. Mobile health applications are commonly used with an estimated 500 million users globally by
2015. Among all racial groups, Asian Americans have the highest rates of Internet and smartphone use. Low
health literacy is associated with poor health outcomes among patients with chronic diseases.
Technology-based and culturally tailored education interventions have shown to improve health literacy and
healthcare decisions.
Methods: U.S. based health organizations have utilized technology-centered, culturally appropriate and
focus group tested tools to reach out to Asian communities nationally and globally. The tools consisted of:
interactive and multilingual web-based health resources and smoking cessation intervention; animated DVDs
to address chronic disease management; and a multilingual mobile application to address child sexual
violence and child empowerment. Community networks, social media, ethnic media, and websites were used
as methods of dissemination.
Results: The web based tools received positive feedback and generated over 1.2 million users annually in the
past 5 years. Web based tool targeting teens offered a safe platform for youth to ask questions and receive
information particularly in the area of sexuality, mental health and body image. The mobile app users
demonstrated knowledge retention and began dialogue about child sexual violence awareness. The app
received over 1,719 downloads internationally including the United States, Europe and Asia. The DVD
viewers indicated that it was a user friendly and culturally appropriate tool for chronic disease management.
Conclusions: Technology-centered and culturally appropriate health education tools are venues to promote
health messages, smoking cessation, violence prevention and manage chronic diseases among Asians
worldwide.

Oral 9(ID480)

380
Effective Concentration and Recovery of Infectious Enteric Virus from Environmental Waters
Zi Wang, Yuanan Lua
Environmental Health Laboratory, Office for Public Health Studies, University of Hawaii at Manoa, Honolulu, Hawaii
96822, USA

Human enteric viruses are presently tested for their use as alternative indicators for water quality monitoring
since the current fecal indicator bacteria system has its limitation in its correlation with health risk.
Molecular based laboratory techniques are recently established for enhanced monitoring of recreational
water for the presence of enteric viruses. To enhance virus-based risk water monitoring, establishment of
laboratory protocols for effective concentration and recovery of infectious viruses from environmental
waters are essential. In this study, a serial of comparative tests were conducted using poliovirus as a model
and in vitro cell culture based plaque assay to evaluate different reagents and protocols for viral
concentration and elution and over 90% of infectious poliovirus was recovered from spiked seawater through
using negatively-charged filter membrane for concentration and 3% beef extract in 50 nM glycine as elution
buffer. Direct elution through filtration showed to be much less effective as compared to soaking the
membrane in elution buffer. In addition, effective isolation and recovery of infectious virus from marine
shellfish were also examined using different protocols, and more than 77% of infectious viruses were
recovered from shellfish tissue homogenates following centrifugation and PEG precipitation. Furthermore,
the bioaccumulation of indigenous shellfish (isognomon spp.) for infectious virus was also examined in
laboratory tanks with spiked virus and demonstrated that poliovirus was able to retain in shellfish tissues for
a longer period of time at much higher concentration as compared to the surrounding water, suggesting the
possible use of shellfish as a natural bio-indicator to monitor environmental water. In conclusion,
establishment of laboratory methods for effective concentration and recovery of infectious viruses from
environmental waters is important and essential for the current notion in using enteric virus for water quality
monitoring, and these new laboratory techniques will facilitate the development and future employment of
enteric viruses and shellfish as indicators for monitoring recreational water and for an improved assessment
of recreational water for sewage-associated health risks.

Oral 10(ID619)
Exploring Patient Perspectives about “Potentially Preventable Hospitalizations" for Heart
Failure and Diabetes in a Hawai’i Hospital
MaliaM.Younga, May D. Vawera, ToddB.Setoa, DeborahT. Juarezb, Tetine L Sentellc
aQueens Medical Center, Honolulu, Hawai’i

bSchool of Pharmacy, University of Hawa’i at Hilo, Hilo, Hawai’i

cOffice of Public Health Studies, University of Hawa’i at Manoa, Honolulu, Hawai’i

Background: Hospitalizations for congestive heart failure (CHF) and diabetes (DM) cost the United States
over $14 billion annually, yet these hospitalizations are considered generally avoidable with good outpatient
management. The vast majority of studies about these hospitalizations utilize administrative data, which
typically lack patient perspectives. Yet patients can provide insight into their reasons for hospitalization,
which is critical to designing effective interventions. This is particularly true across diverse racial/ethnic
groups with distinct cultural perspectives and health correlates. We present preliminary findings from a
5-year, mixed-methods project on preventable CHF and DM hospitalizations in Asian and Pacific Islander
populations.
381
Methods: Asians and Pacific Islanders with a CHF or DM preventable hospitalization (N=12; target N= 280)
were interviewed at the largest hospital in Hawai’i, which is also the primary tertiary medical referral center
for the Pacific Basin. Respondents completed a structured in-person interview with a trained clinical
interviewer followed by open-ended questions on factors contributing to their hospitalization.
Results: Respondents were Pacific Islander (Native Hawaiian, Micronesian, Samoan) and Asian (Chinese,
Filipino, Korean) with ages ranging from 41 to 79 years (mean=55). Four respondents were female. More
than half had previously been hospitalized for the same problem. Preliminary findings demonstrate a number
of key factors that might contribute to preventable hospitalizations and would typically not appear in
administrative data, including: (1) significant substance abuse and/or mental health issues not listed in patient
charts; (2) communication problems with doctors due to linguistic barriers, (3) logistical challenges in
obtaining prescribed medication, and (4) delay of needed medical care because of inability to get to the clinic
when it was open.
Conclusions: Patient perspectives across diverse racial/ethnic groups are critical to fully understanding and
preventing preventable hospitalizations. Reducing preventable hospitalizations impacts four key health care
goals— reducing cost, improving quality, increasing health equity, and relieving suffering.

Oral 12(ID1084)
Health and Suffering in the Occupied Palestinian Territory
Clea McNeelya, Brian K. Barbera, Carolyn Spellingsa, Cairo Arafatb, Mahmoud Daherc
aThe University of Tennessee, Knoxville, TN USA

bSave the Children, Palestinian Territory

cWorld Health Organization, Palestinian Territory

Background: Research on the Palestinian-Israeli conflict, like research on most conflicts, focuses on the
effect of the Israeli occupation on psychological trauma. To fully understand the impact of the conflict on
human suffering, however, it is necessary to extend the array of outcomes examined to include
culturally-relevant notions of health. This study examines the association of a broad array of measures of
conflict exposure with four health outcomes among Palestinians.
Methods: A household interview was conducted in May 2011 with a representative sample of Palestinian
adults ages 30-40 (N=508). Survey items were developed based on input from key informants and group
interviews. Health Outcomes: 1) limits on functioning due to health (single item, (1) “never” to (5)
“regularly”); 2) despair (6-items (α=.81), e.g., degree respondents felt their spirit or morale was broken); 3)
feelings of depression (8-items, α=.84); and 4) trauma-related stress (17-item PCL checklist, α=.92).
Exposure to Political Conflict: 34 measures were examined. Analysis: Ordered logit and OLS models.
Results: 39% of men and 44% of women reported functional limits due to their health. Respondents also
report relatively high levels of despair (mean=2.7, range 1-5), feelings of depression (mean=0.9, range 0-3)
and trauma-related stress (mean=0.8, range 0-3). In multivariate analyses, greater insecurity and inadequacy
of resources were associated with worse status on all health outcomes. Parental death or separation due to the
occupation predicted despair, feelings of depression, and trauma-related stress. Parental loss for non-political
reasons was not related to health. Direct exposure to political violence was related only to trauma-related
stress.
Conclusions: Palestinians in this cohort reported substantial levels of exposure to political violence,
economic hardship, family loss, and political constraints. Basic human insecurity and the chronic economic
constraints that result from the Israeli occupation threaten health, perhaps more so than direct exposure to
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political violence.
Oral 13(ID1087)
Impact of early life antimicrobial exposure on reproductive outcomes
Jiangang Chen, PhD, Rebekah C. Kennedy
Department of Public Health, University of Tennessee, Knoxville, TN USA

Background: Numerous empirical and epidemiological studies have linked exposure to various compounds
found in consumer and personal care products with altered endogenous signaling and reproductive function.
Although the underlying mechanisms of these compounds’ action could be diverse, and likely more than one
biologic pathway could be involved, the emerging evidence of exposure to these compounds in daily life and
their detection from human biological samples and other species has raised public concern regarding their
potential ecological and human health impacts. Triclocarban is one of the high production volume chemicals
being added in the personal care products. Environmentally, the removal of Triclocarban through wastewater
treatment plant is insufficient accounting for the pervasive existence of Triclocarban in US waterways and
abroad. In addition, a significant proportion of the nutrient-rich sludge generated from wastewater treatment
plants is recycled and applied as fertilizer for agriculture use which raises safety concerns about the potential
to enter into food chain.
Methods: Sprague-Dawley rats were exposed to Triclocarban at various life stages through food. Maternal
body weight, food intake, systemic and reproductive organ weight were measured. The growth rate of pups
was also evaluated throughout the studies.
Results: We found that earlier life Triclocarban exposure adversely affected the reproductive outcomes of
treated dams; in contrast, postnatal exposure to Triclocarban after weaning did not significantly affect the
biological growth of neonates.
Conclusion: Our results indicate exposing an environmental factor to a developing fetus or infant may have
very different consequences from exposure of the same compound to a young adult. From a public health
perspective, more research is warranted to address and evaluate whether early life Triclocarban exposure in
human would impact on the trajectory of biological development of an individual later in life.

Oral 14(ID1088)
iCook: Development and Pilot Testing of a Cooking Intervention for Youth and Adults
Sarah Colbya, Lisa Franzen-Castleb, Kendra Kattelmannc, Melissa Olfertd, and Adrienne Whitee
aThe Department of Nutrition, University of Tennessee, Knoxville, TN USA

b Panhandle Research and Extension, University of Nebraska-Lincoln, Scottsbluff, NE USA

c Health and Nutritional Sciences Department, South Dakota State University, Brookings, SD USA

d Davis College of Agriculture, Natural Resources and Design Division of Animal and Nutritional Sciences, West

Virginia University, Morgantown, WV USA

e Food Science and Human Nutrition, University of Maine, Orono, ME USA

Background: Increased rates of eating outside of the home and decreased cooking skills have been
associated with the development of obesity. The objective of this research was to develop and pilot test an
intervention to increase culinary competence and family mealtime of youth and adults using
community-based participatory research, integrating research and Extension through 4-H programming in a
five state partnership.
Methods: A pilot intervention was pilot-tested with dyads (n=61) of youth (9-10 years old) and adults. Six
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lessons included content on family mealtime and communication, physical activity, and goal setting. Youth
received cameras and were asked to create videos on the lessons for an interactive website. Surveys were
completed at baseline and post-intervention to assess participants’ dietary behavior, quality of life, and
perceived cooking skills. After each lesson, dyads also completed online process surveys.
Results: Based on process evaluation, overall youth and adults enjoyed the program, 75% of youth reported
making videos, and the majority of youth (65%) reported intent to set goals to increase fruits, vegetables and
physical activity. Based on pre to post evaluations, increased percentages were seen for biweekly family
meals (82% to 88%) and cooking with their children (35% to 57%). Post intervention evaluations revealed
positive youth outcomes including: decreased intake of foods/beverages with sugar added (pre=7 tsp, post=5
tsp; P<0.0003); increased quality of life (physically, emotionally, and socially) (P<0.05); and increased
perceived ability to perform kitchen tasks, both alone (P<0.02) and with help (P<0.04). Adult positive
outcomes included: increased kitchen proficiency (P=0.006); increased daily mean intake of fruits and
vegetables (P=0.009); and decreased restrictive child feeding practices (P=0.0005).
Conclusions: Encouraging pilot results and a strong collaborative partnership across
and within the five states have set the stage for the delivery and testing of the iCook intervention with a
larger population.
Funding Source: USDA/NIFA/AFRI, Integrated Proposal for Childhood Obesity Prevention Challenge Area
#2012-68001-19605 and state experiment stations.

Oral 15(ID1089)
Income, inequality, and infant mortality rates in the U.S.
Anne Kershenbaum, MD, MPH, Paul C. Erwin, MD, DrPH
Department of Public Health, University of Tennessee, Knoxville, TN USA

Background: There is a lack of consensus about whether and how income inequality affects infant mortality
rates (IMRs). This study examines the pattern of association of income level and one measure of income
distribution - gini coefficient - with infant mortality rates (IMRs) at the U.S. state level.
Methods: The 3-year 2006-8 American Community Survey data provided the state median income, gini
coefficient and poverty level. Centers for Disease Control and Prevention provided the linked birth/infant
death records for the IMRs (total, black, and white IMR). An average of all IMR measures from years
2006-2008 was calculated. Scatter plots and correlation coefficients were used to examine bivariate
associations and bubble plots used to examine 3-way associations.
Results: State IMR was positively associated with the state gini coefficient (R=0.343, p=0.015) and
negatively with the state median income (R=-0.516, p=0.0001) and poverty level (R=-0.494, p=0.0003).
After separation into race-specific IMRs, the association with state gini coefficient for white IMRs was
non-significant (R=0.236, p=0.098), while the associations with state median income and poverty level
remained highly significant (R=-0.756, p<0.0001 and R=0.640, p<0.0001 respectively). For black IMR, the
association with state gini coefficient and poverty level were non-significant (R=-0.227, p=0.191 and
R=0.288, p=0.094 respectively), while the association with state median income remained significant
(R=-0.479, p=0.004).
Conclusion: The association of income inequality with IMRs is complicated because of different measures
used and by different race-specific results. While total IMR increased as income distribution worsened, this
finding did not hold when race-specific IMRs were examined. Income level, as measured by median income,
appears to be a stronger and more consistent predictor of IMRs for both black and white races in the U.S.
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Oral 16(ID1090)
Effects of parabens on adipocyte differentiation and adipogenesis in vivo: is there an
environmental link to obesity?
Ling Zhaoa, Pan Hua, Jaanki S Purohita, Jiangang Chenb
aDepartment ofNutrition, University of Tennessee, Knoxville, TN, USA
bDepartment of Public Health, University of Tennessee, Knoxville, TN, USA

Background: The prevalence of obesity has risen dramatically worldwide. Similar rising trends are also seen
in the obesity-associated metabolic disorders, such as insulin resistance and type 2 diabetes. Accumulating
evidence has suggested a link between human exposure to environmental chemicals and obesity in that
developmental exposure to these compounds leads to increased weight gain and/or risks of developing
metabolic disorders later in life. Recently, we have reported that parabens, a group of widely used
antimicrobial preservatives, promote adipocyte differentiation of the two most commonly used cellular
adipogenesis models (murine 3T3-L1 and human primary adipocytes derived from adipose stem cells)
through activation of peroxisome proliferator-activated receptor gamma and glucocorticoid receptor.
However, the effects of parabens on adipogenesis in vivo have not been studied.
Methods: The effects of paraben on differentiation of multipotent mesenchymal stem cells C3H10T1/2 into
adipocytes, osteocytes or chondrocytes were evaluated. Moreover, the effects of paraben on adipogenesis in
vivo were also performed. Body weights, fasting glucose levels, glucose and insulin tolerance tests and tissue
gene expression were measured.
Results: Butylparaben, a widely used member of paraben family, induced adipocyte differentiation, but
suppressed the differentiation of osteocytes and chondrocytes, of C3H10T1/2 cells, suggesting that
butylparaben may predispose multipotent mesenchymal stem cells to become adipocytes, at the expense of
other mesenchymal lineages. Moreover, butylparaben exposure by oral gavaging starting from weaning for
10 weeks did not change food intake and gross body weight, but induced adiposity (percentage of fat by
weight), increased fasting glucose levels and mRNA expression of markers of adipocyte differentiation in
white adipose tissues.
Conclusions: Our studies support a potential novel link of paraben exposure to obesity in mice. Further
studies on perinatal exposure of parabens in animals will shed more lights on the impact of environmental
exposure of parabens on obesity pandemic.

Poster 1(ID63)
Monitoring of Hawaiian Environmental Waters Using Enteric Viruses as A Potential
Indicator- A Seasonal Study
Erin Allmann, Zi Wang, Yuanan Lu
Department of Public Health Sciences, University of Hawaii at Manoa, Honolulu, HI 96822, USA

Background: Human enteric viruses are currently tested as a potential indicator for water contamination
since fecal indicator bacteria (FIB) don’t always correspond to the presence of some human pathogens,
including viruses. This study utilizes recently developed, highly sensitive concentration and detection
methods to conduct a seasonal study of enteric virus presence in recreational waters around O‘ahu.

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Methods: Eighteen sites were sampled at six different time points; three corresponding to the dry season
(May-November) and three corresponding to the wet season (November-April). Recovered RNA was
subjected to RT-PCR and subsequently PCR to test for three enteric viruses: enterovirus, norovirus
genogroups I and II, and one coliphage. Additionally, samples were taken to test for the levels of enterococci
and Clostridium perfringens, the two major FIB in Hawai‘i, to determine if there is any detection correlation
between FIB and enteric viruses.
Results: All eighteen sites tested positive for enteric virus during the study period, with Sand Island testing
positive the most times. Norovirus genogroup I was the most common virus detected, followed by
enterovirus, which is consistent with previous results. There are statistically significant differences between
overall detection and percent of total possible detections based on water type. Detection was significantly
higher during the wet season as compared to the dry season. Additionally, while ten of twelve sites tested
positive for at least one virus, only three tested above acceptable limits for enterococci, and none tested
above acceptable limits for C. perfringens.
Conclusions: Significant seasonal variations exist in the presence of enteric viruses around O‘ahu.
Additionally, there does not appear to be a true correlation between FIB level and enteric virus presence.
This study shows the efficacy of a highly sensitive method of viral detection in recreational waters, an
important tool for the development of future recreational water quality criteria.

Poster (ID353)
Air Quality and Pollution on Children’s Health: Results from a Cross-Sectional Survey in
Nanchang, China
Thomas H. Leea, Peng Zhang.b, Zhiqin Jiang.b, Lianjun Zhang.b, Dongmei Li.a, Jay E. Maddocka, Xiaojun
Zhoub, Zhaokang Yuanb, Yuanan Lua
a Office of Public Health studies, University of Hawaii at Mānoa, Honolulu, USA

b School of Public Health, Nanchang University, China

Introduction: Although air pollution in China impacts many areas of health, few studies have focused on the
association between air quality and parents’ perception of its effect on their children’s health.The purpose of
this study was to report attitudes and perceptions of Nanchang residents regarding their child’s health in
relation to air quality and air pollution.
Methods: A cross-sectional surveyof 721 parents was conducted in four locations in Nanchang, China
betweenMay to June 2013.Descriptive analyses and ordinal logistic regression analyses were performed to
estimate the association between the perceived effect of air quality on child’s respiratory health and five
independent variables.Beta values and 95% Confidence Intervals were used.
Results: 205 males (28.5%) and 515 females (71.5%) participated with a response rate of 89.5% (721/805).
57.1% perceived air quality strongly affects their child’s health compared to 3.9% who perceived no
effects.More than 81% observed an apparent connection between their child’s health and air pollution versus
2.1% who observed no connection.When air quality worsened, over 90% were worried about their child’s
health. Two predictors were statistically significant: 1. Have you observed a connection between your
child’s health and air pollution? (Beta: 5.729, 95% CI: 4.371, 6.938) 2. Do you worry that your child’s
respiratory health will get worse when the air quality is worse than normal? (Beta: 1.094, 95% CI: 0.440,
1.748) Gender, residence in city or countryside, most important problem to child’s health, and knowledge of
air pollution related indicators were included in the final ordinal logistic regression model analysis butnone
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were statistically significant.
Conclusion: This study serves as an indicator of the problem of air pollution in Nanchang and the adverse
effects on child's health; and illustrates the complexity of this topic.Future research utilizing this new
approach of understanding the perceptionsof Nanchang residents towards air pollution is essential.

Poster 2(ID371)
Concordance in Perceptions of Risk and Harm Among Dual Smoking Couples
Isaac M Lipkusa, Susan Silvaa, Megan Lewisb, Benjamin Tollc
a Duke University School of Nursing, Durham, United States

b Research Triangle Institute, Research Triangle Park, United States

c Yale University School of Medicine, New Haven, United States

Background/purpose: Many smokers want to quit smoking to avoid harming oneself and others’ health.
Health concerns may be especially salient in couples in which both members smoke (dual-smoker couples).
Yet, the extent to which members of dual smoking couples agree on the amount of harm smoking causes
each member and on degree of worry about such harm is largely unknown.
Method: As part of a baseline phone survey, 72 dual smoker couples were asked about the extent to which:
a) their smoking has damaged partner’s health (1=not at all to 4=a lot); b) partner’s smoking has damaged
their health (1=not at all to 4=a lot); c) they worried about how their smoking has harmed their partner’s
health; and d) their partner would suffer a serious smoking-related disease due to their smoking (1=no
chance to 7=certain to happen). Further, they were asked how often they talked about how smoking was
harming the couple (1=never to 4=very often). Spearman coefficients were used to assess degree of linear
associations.
Results: Participants’ mean age was 41.7 (SD=10.6), married/living as married from 0.5 to 39 years (M=5.9,
SD=6.9), had been smoking for 1 to 46 years (M=21.6, SD=11.0) with an average of 17.5 (SD=9.2)
cigarettes/day. Associations (rs) for all relationships tested were nonsignificant between: a) couple members’
ratings of how much one’s smoking has damaged partner’s health (+0.02), b) how much partner’s smoking
has harmed one’s health (-0.09), c) worry (+0.11), and d) risk that partner would suffer disease due to one’s
smoking (+0.14). Results did not vary by frequency of talking about harms of smoking [-0.19< rs<0.05].
Conclusions: Members of dual smoking couples’ perceptions of harms and worry do not agree, even among
those who discuss harms more often. Understanding the reasons for these weak associations remains an
area of further study.

Poster 3(ID893)
Internet Delivered Diabetes Management
Katherine Pereira
Duke University School of Nursing, Durham, North Carolina, USA

Background: Diabetes is a chronic disease with an ever increasing prevalence around the world. Paired
with the increasing obesity/overweight and physical activity indicators, there appears to be a fertile pipeline
for future development of diabetes. Diabetes requires a complex regimen of nutritional, lifestyle and medical
therapy to prevent the complications of heart disease, stroke, retinopathy, nephropathy and
neuropathyassociated with the disease. The increasing prevalence of diabetes is leading to limited
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availability of diabetes related services and support for patients, thus driving the need to develop innovative
methods of delivery.
The current evidence is reviewed regarding internet delivered diabetes management strategies and their
potential for improving the care of patients with diabetes. The internet has become more easily available for
many individuals worldwide, and in addition has the benefit of reaching individuals in both rural and urban
communities. Give the high prevalence of diabetes and the increasing burden of diabetes related care, it
seems natural that dissemination of educational and diabetes management directives could occur via internet
communication. This is already occurring via patient lab portals where patients can view their health
information.
Patient health information portals, smartphone/texting applications, educational and interactive web sites,
web based social support, automated messaging services, and downloading capabilities for health data are
among the studies reviewed. Many studies combined more than one of these features together in the study,
such as automated messaging along with access to educational information on a website. These methods of
communication were all successful in improving short term indicators of diabetes care, such as HgbA1C,
along with patient satisfaction. More research is needed to determine if these interventions could be
implemented on a larger scale and to determine their economic feasibility.

Poster 4(ID900)
Mixed Methods for Global Health Research: Systematic Literature Review and Application to
the Study of Care of Older Adults
Kirsten N. Corazzinia,b, Deanna Befusa, Yuting Songa,c, Eleanor S.McConnella,b,d, Kyung Hee Leea, Ye Zhanga,
BeiWua,b,c
aDuke University School of Nursing, Durham, USA

bDuke University Center for the Study of Aging and Human Development, Durham, USA

cDuke Global Health Institute, Durham, USA

dGeriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, USA

Background/objective: Comparative, international datasets with shared quantitative indicators facilitate

empirically rigorous cross-cultural studies; however, such data lackrich, contextual knowledge gained from
qualitative data. Mixed methods (Creswell & Plano Clark 2011) offer a promising strategy to combine the
strengths of both. This study presents findings from a systematic literature review of the use of mixed
methods in global health research, and describes the development of a mixed-method study protocol to
compare caregiving of older adults in two countries, China and Sri Lanka.
Method: Wecombined two, published mixed methods search strategies with a global health search strategy
that built on the Cochrane LMIC filter; databases searched included PubMED, CINAHL, and Global
Health.Inclusion and exclusion criteria were applied to the original set of abstracts; thefinal set of articles
was reviewed for purpose ofusing mixed methods, design chosen, and, if included multiple countries, the use
of mixed methods in those comparisons.
Results: Mixed methods studies were identified fromall WHO regions, all major mixed methods research
designs, and diverse public health foci. A common purpose was to provide insight into barriers or facilitators
of a health program’s implementation.Use in comparative studies with multiple countries, however, was
limited. The development of our protocol revealed the additional time and iterative process required to
ensure true “mixing” of data to generate culturally relevant meanings of key study constructs.
Conclusions: While considered essential by the U.S. NIH (2011) and the WHO (2010), our findings
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indicatethe potential underutilization of mixed methods, especially in cross-national, comparative studies.
Our description of how we developed our study protocol provides strategies for those who aim to use mixed
methods in comparative global health studies.

Poster 4(ID1051)
Effects of Preterm Delivery and Early Intervention on Infants’ Mental Development_A
Two-Year Follow-Up Study
Chengwu Yang
The Pennsylvania State University College of Medicine, USA

Purposes To investigate effects of preterm delivery and early intervention on infants’ mental development
during their first two years of life. Participants and Methods 54 naturally preterm, 39 artificially preterm, and
37 full term infants with matched gender, socioeconomic status, marital status and age of mother, gestation
age averaged at 35.3, 35.9, 40.0 weeks, respectively, were assigned randomly into intervention or control
group. Only intervention group received early intellectual intervention since neonatal period. All parents
participated regular routine children health courses in both examination and guidance at out-patient clinic.
Apart from pediatric follow-up, a full neurologic assessment and the Chinese version of the Gesell Infant
Development Scales were done at the corrected age of 24 months, and the mental development quotient (DQ)
included 5 criteria with gross motor, fine motor, cognitive abilities, language skills, and social ability.
Multivariate analysis of variance (MANOVA) was applied to assess the effects of early interventions and
preterm delivery on these 5 criteria. Results Among all six factors of infants’ basic situation (gestational age,
birth-weight, age of mother, gestational complications, type of delivery, neonatal disorders), only gestational
age had influence on their intellectual development (p<0.01). After adjusting for gestational age, preterm
delivery lowered motor and cognitive status only (p<0.01). Early intervention improved all five mental
criteria substantially (p<0.01). Conclusions Preterm delivery lowered infants’ cognitive and motor skills, and
early intervention can promote their mental development.

Poster (ID1091)
Medicinal herbs inhibit castrate-resistant prostate cancer via multiple mechanisms
Jay Whelan, PhD, MPH, Yi Zhao and E-Chu Huang, PhD
The Department of Nutrition, University of Tennessee, Knoxville, TN USA

Background: Prostate cancer (PCa) is one of the most common types of cancers among males. Our
preliminary data has shown that the extracts of 10 medicinal herbs inhibit the growth of castrate-resistant
PCa in vitro and in vivo when provided at human equivalent doses. The purpose of this paper is to present
data demonstrating the multiple mechanisms responsible for these effects.
Methods: The human castrate-resistant PCa cell line, CWR22Rv1, and tumors from this cell line grown in
immune-compromised mice were treated with our polyherbal mixture.
Results: The combination of these botanicals were shown to up regulate the tumor suppressor gene p21 via
histone acetylation (epigenetically), increase the activation of AMPK, a potential tumor suppressor protein
that functions as a central energy sensor within the cell and by down-regulating mTOR (mammalian target of
rapamycin, a known activator of cell proliferation) and key downstream targets that are mediators of
lipogenesis (i.e., ACC, SREBP-1c, fatty acid synthase). Important to relapse of advanced forms of the

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disease, the combination enhanced the effectiveness of hormone deprivation therapy (in vivo) and inhibited
the expression of class I and II HDACs, PSA, IGF-1R and androgen receptor. The effects of combining any
two isolated bioactives or extracts were highly synergistic at physiological concentrations where the dose
reduction index for any bioactive when used in combination was up to 190 fold. The effects of bioactives
used in isolation were not as potent as when they were provided as part of their extracts of origin.
Conclusions: Our results suggest that combinations of herbal extracts and/or their isolated bioactives may be
used effectively in adjuvant therapy for advanced forms of PCa and their synergy of action may explain, in
part, why combinations of plant extracts are more likely to be beneficial against cancer as compared to
isolated components.

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United States Minor Outlying Islands

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Oral (ID444)
Pushing Technology Closer to the Patient: Community-Based Health Workers Can Perform
Screening Echocardiograms to Assess for Heart Failure
May D. Vawer, Ann E. Leonard, Malia M. Young, Todd B. Seto
The Queen's Medical Center, Honolulu, USA

Background/objective: Assessment of left ventricular function is important to diagnose and treat heart
failure (HF). Access to echocardiography in the community is limited and may be a factor in HF disparities.
This study was undertaken to determine if community-based health workers (CBHW) can accurately
measure left ventricular function using hand-carried ultrasound devices (HCUD).
Methods: Five community health centers selected a CBHW to complete a program with 20hrs of didactic
sessions and 20 hrs of supervised scanning. CBHWs performed echocardiography (Sonosite) on subjects at
each site, with ~10% repeated by a sonographer using a ‘gold standard’ portable machine (Cypress). All
studies were scored by the performing CBHW, sonographer, and study cardiologist on technical quality and
systolic function. The accuracy of HCUD was determined by its reliability, validity, specificity, and
sensitivity.
Results: Five CBHWs (4 medical assistants, 1 nurse; 100% Native Hawaiian/Pacific Islander) performed
916 studies, with 82 (~10%) repeated by the sonographer. CBHWs reported that 81% showed normal
systolic function, 7.0% mild-moderate dysfunction, 1.9% severe dysfunction, and 10% uninterpretable. On
review by the cardiologist, 82.5% were normal, 2.9% mild-moderate dysfunction, 1% severe dysfunction,
and 13.6% uninterpretable. Overall, the uninterpretable rate compares favorably with other studies. Of the 82
studies performed by the sonographer, 4.8% were uninterpretable to the cardiologist. Comparing studies
performed by the study songrapher with the CBHW, and interpreted by the cardiologist in a blinded manner,
there was agreement in assessment of left ventricular function in 93% of cases.
Conclusion: To our knowledge, this is the first study to show that CBHWs can use HCUD to assess left
ventricular function in the community setting, with an accuracy and interpretability similar to other studies
that involve more experienced health care providers in the hospital setting.

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