Abstract book 22nd ICCPHS.1

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 37 Conclusion No difference in compliance was found between groups, suggesting that education had no impact on physical therapists' compliance with the treatment recommendations from CPGs. Improving the course content in the curriculum to provide the importance of applying empirical evidence to clinical practice for physical therapists is necessary. Keywords: Education; Compliance; Clinical practice guidelines; Knee osteoarthritis; Physical therapy Corresponding author: Sunee Bovonsunthonchai, Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Rd., Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand, Tel. (66) 2-441-5450 ext. 20804, Fax. (66) 2-441-5454, Mobile. (66) 85-592-6144, Email address: [email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 38 Background Coronavirus disease 2019 (COVID-19) is the deadliest pandemic in the 21st FHQWXU\DQGLW¶VVWLOODPDMRU health crisis globally. Considering the longer duration of the national COVID-19 vaccination program and widespread nature of the pandemic, it is necessary that people equally comply with both vaccine and non-therapeutic health protective behaviors against COVID-19. Objective The study investigated the public adherence to vaccination and behavioral changes against COVID-19 and their determinants in Bangladesh in the new normal context of the pandemic. Methods The study was conducted during the first half of 2022 among 940 rural and urban adults of Dhaka and Chattogram divisions selected by multi-stage sampling. Data were collected through face-to-face interviews using a pretested questionnaire. Hierarchical regression was performed to predict significant predictors and the causal model of COVID-19 prevention behavior was also tested and justified through structural equation modeling (SEM) based on the theory of planned behavior (TPB). Results Nearly half of them (48.2%) showed poor vaccine adherence and health practices regarding COVID19 prevention and only around one-fourth showed good level of health practice. Majority of the respondents (86.7%) used face masks during the pandemic crisis but only 12.7% of the respondents used it regularly. Less than half of the respondents (44.9%) took COVID-19 vaccines regularly. Not only the background factors but also knowledge (p<0.001), attitude (p<0.01) and intention (p<0.001) regarding COVID-19 prevention were significant to predict the vaccine adherence and healthy health practices in hierarchical regression. Self-control significantly influenced COVID-19 prevention behavior directly and through intention showing the highest effect (p<0.001) in SEM. Attitude (p<0.01) and self-control (p<0.001) showed significant direct effects on intention in causal relationships. OP13 COVID-19 Vaccine Adherence and Behavioral Changes of Community People in the New Normal Context of the Coronavirus Pandemic Md. Nazmul Haque1 , Muhammed Ashraful Alam2 , Suphawadee Panthumas3 *, Shuvashis Saha4 , Afrin Ahmed Clara5 1 Director, Dhaka Medical College Hospital, Bangladesh ([email protected]) 2 Assistant Director, Dhaka Medical College Hospital, Bangladesh ([email protected]) 3 Lecturer, Public Health Department, Mahidol University, Amnatcharoen Campus, Thailand ([email protected]) 4 Research Assistant, Center for Integrated Social Development (CISD), Bangladesh ([email protected]) 5 Senior Lecturer, Public Health Department, North South University, Bangladesh ([email protected])

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 39 Conclusion Adequate knowledge, positive attitude, proper motivation and positive intention can encourage adults more to ensure vaccine adherence and their healthy behavior regarding COVID-19 prevention. The theoretical model of the study was effective to explain vaccine adherence and COVID-19 prevention behavior of people in a more rational way and policies based on this model could be adopted to improve the current status of preventive health practices. Keywords: Vaccine adherence, behavioral change, COVID-19 prevention Corresponding author: Suphawadee Panthumas, Public Health Department, Mahidol University, Amnatcharoen Campus, Thailand, Tel. 085-241-9125, E-mail: [email protected]@ mahidol.edu

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 40 Abstract Khon masked dance is one of the famous Thai traditional dance that requires long-term training. One of the essential training position is performed in the squat position which can affect basic activity especially walking pattern of dancer. This study aimed to compare the lower extremity kinematics in the sagittal, frontal, and transverse planes during walking between Khon masked dancers and nondancers. Twenty healthy males participated in this study (10 Khon masked dancers and 10 healthy males) were participated in the study. Professional Khon masked dancers who had at least 5 years GDQFLQJH[SHULHQFHRIJLDQWRUPRQNH\UROHSOD\DQGDOOSDUWLFLSDQWVZHUHWR\HDUV¶KHDOWK\PDOH with body mass index (BMI) 18.5 ± 30 kg/m². Participants walked at a self-selected speed on the 9- meter walkway in the 3D motion analysis setting. Kinematics variables included the angles of pelvic tilt, obliquity, and rotation, hip and knee flexion/extension, adduction/abduction, and internal rotation/external rotation, and ankle dorsiflexion/plantarflexion were collected and analysed. Kinetics variables included anterior, posterior, medial, lateral, and vertical forces were also monitored. Data were then statistically analysed between professional dancers and non-dancers by using the independent sample t-test with a level of significance at p<0.05. There was no significant difference in all testing variables between the two groups of participant. However, Khon masked dancers were revealed higher anterior pelvic tilt angle at terminal swing and external rotation angle at terminal stance, hip flexion angle at mid-swing, knee flexion angle at loading response, and adduction at mid-swing. Gait pattern in Khon mask dancers demonstrated increased pelvic anterior tilt in conjunction with the increased lumbar lordosis. This study demonstrated that long-term Khon training were not affected gait pattern in the dancers. However, more sample size is still necessary in the future to investigate a clearer picture of gait alteration in Khon masked dancers. Keywords: Khon masked dancers, kinematics, kinetics, gait analysis. Corresponding author: Warin Krityakiarana: Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand, Email: [email protected] OP14 Lower Extremity Kinematics and Kinetics During Walking: A Comparison between Khon Masked Dancers and NonDancers Zin Wai Htet1 , Sunee Bovonsunthonchai1 , Pagamas Piriyaprasarth1 , Nopporn Jongkamonwiwat2 , Warin Krityakiarana1 * 1 Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand, 2 Department of Anatomy, Center for Neuroscience Research, Faculty of Science, Mahidol University, Krung Thep Maha Nakhon, Thailand

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 41 Background Global burden of disease data shows low back pain as the fourth leading cause of disability. Lumbar multifidus muscle (LM) deficit is one of the underlying mechanisms for compromised spinal stability causing chronic low back pain (CLBP), particularly in the movement control impairment (MCI) subgroup. Although evidence demonstrated the association between CLBP and kinesiophobia, there is insufficient evidence regarding the roles of LM in lumbar stability, disability, and kinesiophobia. Objectives This study aimed to determine the associations between LM function and clinical outcomes (lumbar stability, disability level, and kinesiophobia). Methods 33 participants with CLBP during remission and having MCI were recruited. The sample size was not calculated because this study was a part of an intervention study with a pre-specified sample size. Rehabilitative ultrasound imaging was used to measure LM thickness at rest and maximum voluntary isometric contraction and was further used to calculate percent LM thickness change (%LM). An electromagnetic motion tracking system was used to measure lumbar stability at lumbar levels L4 and L5 during rest and leg raise positions of prone instability test. These data were used for the lumbar stability index. Thai-version Oswestry disability index (ODI) and Tampa scale of kinesiophobia (TSK) ZHUHXVHGWRDVVHVVGLVDELOLW\DQGNLQHVLRSKRELDUHVSHFWLYHO\6SHDUPDQ¶VUDQNFRUUHODWLRQFRHIILFLHQW was used to assess statistical associations. Results The mean duration of CLBP was reported to be 3.5 years with mean recurrent episodes of 9 times within the last 6 months. The participants had a minimal disability with an ODI percentage ranging from 4% to 12% and low to high levels of kinesiophobia with TSK scores ranging from 35 to 44. Additionally, findings demonstrated a significant moderate positive correlation between %LM and lumbar stability index at L5 ȡ 3fi DQGDWUHQGDW/4 ȡ 3fifl ZKLOH/0ZDV not significantly associated with disability and kinesiophobia (P>0.05). OP15 Lumbar Multifidus Thickness is Associated with Lumbar Stability but not Disability and Fear in Movement Control Impairment Subgroup of Chronic Low Back Pain Soniya Maharjan1 , Khin Win Thu1 , Kanphajee Sornkaew1 , Sasithorn Konguon1 , Katayan Klahan1 , Peemongkon Wattananon1 , * 1 Spine Biomechanics Lab, Faculty of Physical Therapy, Mahidol University, Salaya, Thailand

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 42 Conclusions Association between %LM and lumbar stability index suggests the role of LM in providing stability to the lumbar spine. No significant association between %LM and other clinical outcomes suggests clinicians should consider LM deficit might not be key to decreasing disability and fear of movement, and additional interventions may be needed to treat this subgroup of CLBP. Keywords: Multifidus, Lumbar stability, Movement control impairment, Low back pain Corresponding author: Peemongkon Wattananon, PT, Ph.D., Email: [email protected]. th, Faculty of Physical Therapy, Mahidol University. 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170 Thailand.

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 43 Background Dengue fever is transmitted to humans through virus-infected Aedes aegypti and Ae. albopictus mosquitoes. The most important breeding sites for Aedes mosquitoes are all artificial containers with water. In Taiwan, we have imported dengue cases every year from 1989-2022. All Indigenous dengue cases are original from imported cases. However, the imported case was not necessary to induce indigenous cases all the time in Taiwan. Objective This paper intends to find out the importance of high awareness of clean-up the artificial water containers and dengue cases follow in dengue control. Methods We analyze the government publications about all dengue and indigenous data from 1989 to 2022 with Pearson correlation coefficient and regression analysis. Results We find the relationship between imported and indigenous cases is 0.331 (p>0.05) during 1989-2022 whole period. When broke it down to three period, correlation coefficient in 1988-2001 is 0.404(p>0.05), 2002-2015 is 0.579 (p< 0.05), and 0.495(p>0.05) in2016-2022. We estimate that after high epidemic, government and people all have high awareness for breeding sites clean-up and pesticides control, and vice versa. After long time no or low number of cases, they have low awareness. High dengue epidemic had outbreak in 2014 and 2015. More imported case brings more indigenous case. There were no or low cases after high outbreak in 2016-2022. Therefore, environmental awareness to clean-up the breeding sites and following the imported cases efficiently are two critical dengue prevention measures. Once the imported dengue cases be quarantined enough time and cured in hospital, it decreased the transmission of dengue. In regular border quarantine, screening to identify dengue in airport and success to track to community before COVID-19 pandemic on 2020 were below 40%. In other words, most of dengue cases were missed after entrance from airport into community. During the COVID-19 pandemic period, 14 days border quarantine was implemented in Taiwan. Because of decreasing number of passengers, strict border quarantine in 2020~2022 (up to Jul. 2022), the imported cases decreased to 64, 12, and 16, and Indigenous cases decreased to 73, 0, and 0. OP16 Epidemic Trend of Dengue under High Awareness and Border Quarantine in Taiwan Yeong Ren Chen 1*, Ji Sen Hwang 2 , and Yu-Ning Chien 3 1 Department of Health and Welfare, University of Taipei, Taiwan; [email protected]. 2 Department of Earth and Life Science, University of Taipei, Taiwan; [email protected]. 3 Department of Health and Welfare, University of Taipei, Taiwan; [email protected]; [email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 44 Conclusion According to 2020 statistics, if there were no good quarantine and breeding sites cleaning, outbreak of dengue will happened after imported case. From international reality, it is impossible to continue 14 days border quarantine or restrictions on traveler enter into Taiwan forever. Once the traveling become normal, how to encourage and reward the suspecting dengue cases are very important for dengue control. So does breeding sites clean-up and mosquito surveillances. Keywords: Dengue fever, breeding sites clean-up, quarantine, Aedes mosquito. Corresponding author: [email protected] (Y. R. C); Tel.: +886-2-2871-8288 (ext 3104).

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 45 Background Nasopharyngeal carcinoma (NPC) manifests vague initial symptoms and signs. Delaying diagnosis of NPC causes increased morbidity and mortality. Previous studies have shown that patients with NPC have an average duration of symptoms of 8 months before diagnosis, with the longest possible delay of up to 3 years. This study hypothesized that categorizing individual healthcare-seeking patterns using a medical claim data-based intelligent decision support system (IDSS) may shorten the diagnostic process of NPC. Methods This study compared claim data from patients with NPC and non-NPC in a population-based health insurance database from 2001 to 2008. We compared the performance of five machine learning algorithms, namely LightGBM, XGBoost, MARS, RF, and Logistics, to establish optimal prediction models for early detection of the occurrence of NPC. Results Using a minimum of 13 features, two ensemble learning models±LightGBM and XGBoost, had maximum predictive power. The calculated areas under the ROC curve of LightGBM and XGBoost models for the validation set and the unbalanced test set were 89.4%, 89.3%, 82.4%, and 82.3%, respectively. Conclusions LightGBM and XGBoost-driven NPC-IDSS may assist in shortening the diagnostic process of NPC. Patients who exhibited high-risk categories in the IDSS deserve timely referral. Keywords: nasopharyngeal carcinoma; machine learning; delaying diagnosis. Corresponding author: [email protected] (Y.-N. C.); [email protected] (H.-Y.C.); Tel.: +886-2-2871-8288 (ext. 3105) (Y.-N. C.); +886-37-206166 (ext. 36300) (H.-Y.C.) OP17 Machine Learning Algorithm-Driven Prediction System for Early Diagnosis of Nasopharyngeal Carcinoma Using Medical Claim Database Jeng-Wen Chen 1‚ , Shih-Tsang Lin 2‚ , Yi-Chun Lin 3 , Bo-Shian Wang 4 , Hung-Yi Chiou Ɛ Yu-Ning Chien 7,* 1 Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital and Fu Jen Catholic University, Taiwan 2 Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital and Fu Jen Catholic University, Taiwan 3 School of Public Health, Taipei Medical University, Taiwan; [email protected]. 4 Institute of Population Health Sciences, National Health Research Institutes, Taiwan 5 Master in Global Health and Development Program, College of Public Health, Taipei Medical University, Taiwan 6 Institute of Population Health Sciences, National Health Research Institutes, Taiwan 7 Department of Health and Welfare, University of Taipei, Taiwan

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 46 Introduction The notion that healthcare is a public good emerged at the end of the 19th century in Europe. In Pakistan, the public and private sectors are both involved in healthcare system. The country's constitution states that, with the exception of territories under federal control, the provincial governments are primarily in charge of overseeing national health policy. Historically, the provision of healthcare has been governed jointly by the federal and provincial governments, with districts generally in charge of the execution. The Drug Regulatory Authority of Pakistan (DRAP) Act 2012 established the federal regulatory agency charged with the regulation of medications throughout the country. In accordance with the Act, regulations cover all aspects, including pharmacy, clinical, hospital, and community levels for both basic services (such as dispensing, procurement, storage, distribution of therapeutic products, and counselling) and enhanced medicine services (such as pharmaceutical care, pharmacovigilance, pharmacoepidemiology, pharmacoeconomic, and services offered at drug information and poison centers). The higher education commission (HEC) established the Department of Pharmacy Practice in Pakistan's private and public universities in 2014 to improve pharmacists' clinical experience. Objectives This review study examines the role of pharmacists in the development of public health policies in Pakistan focusing on aspects pertaining to the conceptualization, development and implementation. The goal of the study is to understand how health policies are established, how they're enforced, as well as role of pharmacists in Pakistan's healthcare system. Methods The databases PubMed/Medline, Embase, Scopus, Web of Science, and Google Scholar were searched for publications published in the English language between January 2000 and September 2021 using the keywords Public Health, Health Policy, Pharmacist, and Pakistan. Along with articles that have been thoroughly searched, relevant national documents were also included, such as the Pakistani national health strategy, national action plan, management and control plans for TB, polio, and malaria, as well as national quality improvement initiatives developed by the Pakistani national institute of health. Public health policies in Pakistan are presented as systematic reviews, observational research, and cross-sectional studies, as well as the linked (professional, public policy, and political) aspects. The exclusions include studies published prior to January 2000, brief communications, and conference proceedings. Articles unrelated to the professional, governmental, or political influences on health policies are not included. OP18 Public Health Policies and Roles of Pharmacists in Pakistan Tawseef Ahmad* Sirima Sitaruno. Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90112, Thailand

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 47 Findings The results show that Pakistan's planning and policy-making for the healthcare sector are competent at the planning stage but not at the execution stage. The Peoples Health Scheme of 1972, the National Health Policies of 1990,1997,2001, and 2009, Vision 2030, and the National Health Vision 2016±2025 are models of national policies. Pakistan's Planning Commission and Federal Ministry of Health (now the Ministry of National Health Services, Regulations, and Coordination) are responsible for developing the country's health policies, but the provinces are responsible for planning and execution as well. In a newly decentralized structure, the districts also get responsibility for implementation. A set hierarchy of steps is used by the Ministry of Health to execute all the Policies. The public health responsibilities for individual pharmacists vary, depending on their background, skills, education, and place of employment. Nonetheless, they all share the same goal of enhancing public health regardless of whether they are working independently or alongside administrators and other healthcare professionals. Pharmacists have a variety of responsibilities in Pakistan's public health initiatives, such as antimicrobial stewardship, infection control, preventing drug abuse and misuse of controlled substances, managing drug product shortages, encouraging tobacco cessation, and emergency planning and response. Conclusion To sum up, Pakistan's health policy still needs some work for it be totally evidence-based, coherent, dynamic, all-encompassing, and pragmatic. The challenges associated with implementation are largely due to the fact that policies are formulated on the basis of assumptions rather than reliable empirical data. Additionally, more than half of pharmacists work in community pharmacies, which is a crucial component of population healthcare. Sadly, well-articulated plans from the government to strengthen and include the community pharmacists' role in public health policy are nonexistent. The seventy-fiveyear history of health planning in Pakistan has been marked by a variety of initiatives at different points, but it has always required a solid and clear process. Keywords: Public Health; Pharmacist; Health policy; Pakistan. Corresponding author: Tawseef Ahmad, Department of Clinical Pharmacy, Faculty of Pharmaceutical science, Prince of Songkla University, Email: [email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 48 Introduction/Background Metformin, a first line drug for the treatment of type 2 diabetes mellitus, also has been implicated to slow down ageing in various organisms including C elegans. It has been shown that the drug tends to accumulate in mitochondria. Recently, the mitochondrial unfolded response (UPRmt) was shown to affect lifespan in UPRmt activated worms. UPRmt is mitochondrial stress response pathway instigated in response to alleviate mitochondrial proteostasis. Under stressed conditions, atfs-1: a transcription factor involved in regulating UPRmt, relocalizes to nucleus to enhance the expression of mitochondrial chaperones and detoxifying enzymes operating in metabolic networks. We, therefore, surmised that metformin might affect ageing by exerting its effect on UPRmt. Objective To investigate the interaction of metformin with UPRmt on lifespan of worms. Material(s) and Method(s) Synchronized 100 to 150 wildtype (N2) worms were used for lifespan study, which were scored for their viability everyday by gentle touch. The UPRmt was induced by feeding the nematodes with dsRNA-producing (RNAi) bacteria including ech-6, pdhb-1, and wah-1 along with empty vector (EV) DVDFRQWURO,37*LVRSURS\Oȕ-D-thiogalactoside) at 5 mM was used to activate dsRNA synthesis in RNAi bacteria. Double RNAi was initiated by mixing bacteria at 1:1 concentration. Metformin at final concentration of 50 mM was supplemented onto the cultured agar. UPRmt activation and its interaction with metformin was observed using the reporter strain hsp-6p::GFP. Image J (fiji) software was used to calculate the integrated pixel density of the acquired fluorescent images and normalized by the number of worms per condition. The experiment was conducted in triplicate for every condition. Lifespan experiments were analyzed by Mantel-Cox log-rank test and the experiments pertaining to UPRmt were analyzed by t-test. Results The activation of UPRmt was observed in ech-6, pdhb-1, and wah-1 RNAi worms by detection of fluorescence from the reporter strain hsp-6p::GFP. Lifespan of ech-6 and pdhb-1 RNAi worms were found to be significantly reduced in comparison to EV. In contrast, wah-1 RNAi worms had significantly extended lifespan. Moreover, RNAi knockdown of atfs-1 which leads to inactivation of UPRmt (confirmed by dimming of fluorescence in the reporter strain hsp-6p::GFP) further shortened the lifespan of N2 worms with respect to EV. Upon blocking UPRmt by atfs-1 RNAi, the lifespan reduction conferred by pdhb-1 RNAi was significantly rescued towards normal lifespan. Metformin significantly increased lifespan in wildtype worms fed with OP50 bacteria as well as EV. Metformin, however, significantly decreased the lifespan of all RNAis except pdhb-1, where it had no significant change in lifespan. Metformin also significantly suppressed the UPRmt at different adulthood days in ech-6 and wah-1 RNAi. OP19 Metformin Activity on Longevity and Mitochondrial Unfolded Protein Response (UPRmt) across UPRmt Invoked C .elegans Anubhav Aryal1 , Chutipong Chiamkunakorn1 , and Wichit Suthammarak1 1 Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 49 Discussion and Conclusion Metformin increased lifespan in N2 under OP50 and EV fed conditions, which is consistent with previous reports. The variable nature of lifespan in UPRmt invoked worms (ech-6, wah-1 and pdhb-1) reciprocates with the complex nature of UPRmt in relation with lifespan. Metformin suppressed UPRmt in ech-6 and wah-1 regardless of decreased lifespan. It implies that metformin might exert toxic effect in these worms. The effect was still the same even after blocking UPRmt by atfs-1 RNAi in both ech-6 and wah-1 and is indicative of the interaction of metformin with the pathway where these genes exert their function. The lifespan phenotype conferred by UPRmt in pdhb-1 was partly abolished when fed together with atfs-1 RNAi. This indicates the clear role of UPRmt in lifespan regulation pertaining to UPRmt activated worms. Moreover, upon double RNAi feeding of afts-1 with ech-6 or wah-1, completely blocked the UPRmt, which validates our lifespan experiments involved with double RNAi. Interestingly, metformin did not change the lifespan of pdhb-1, which suggests that the drug might exert its effect by downregulating the function of pdhb-1. Keywords: Metformin, C. elegans, Ageing, Unfolded Protein Response Corresponding author: Wichit Suthammarak, Department of Biochemistry, Siriraj hospital, Mahidol University, E-mail: [email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 50 Introduction Heavy metal pollution is still one of the environmental concerns in society. The contamination can be through water, soil, air, and food. One of them is heavy metal contamination in paddy fields and rice. Heavy metal pollution in agricultural products such as rice comes from the use of pesticides, fertilizers, and natural soil with pH conditions. White rice is a commonly eaten rice type by people in Indonesia, especially the people of Palembang The consumption of rice can be a source of heavy metal contamination in the community. Objectives This study aims (1) To determine the concentration of heavy metals and (2) To find the noncarcinogenic and carcinogenic risks from local white rice consumption in Palembang, South Sumatra, Indonesia. Methodology Rice was collected from the three largest local markets in the city of Palembang with a total sample of 6 local white rice samples, 100 mg/sample. There were 2 types of local white rice that commonly consume namely Pandan Wangi and Pulen rice. The initial stage of the analysis was sample preparation where the rice is transformed into a flour-like shape, then followed by the digestion stage. The final stage was the analysis of heavy metals in rice using the inductively coupled plasma optical emission spectrometry (ICP-OES) method. Results The results of both Pandan Wangi and Pulen rice showed all the concentrations of arsenic (As), cadmium (Cd), lead (Pb), and copper (Cu) were below the detection limit. All rice samples found As, Cd, and Pb lower than standard, which were 0.800 ug/gr, 0.038 ug/gr, and 0.839 ug/gr, respectively. Meanwhile, copper (Cu) was found in Pandan Wangi rice with an average concentration of 0.89 ug/gr, ranging from 0.26 to 1.62 ug/gr. In Pulen rice, copper (Cu) was found with an average concentration of 1.12 ug/gr, ranging from 0.95 to 1.17 ug/gr. Risk assessments showed there was a non-carcinogenic effect for adults and kids which HI were 13.394 and 9.822 respectively for Pandan wangi rice and 13.397 and 9.824 respectively for Pulen rice. On other hand, the assessment showed the same results of TCR between Pandan wangi rice and Pulen rice. The results showed there was a carcinogenic risk, in which TCR were 8.03 x 10-3 for adults and 2.94 x 10-2 for kids. OP20 Heavy Metals Contamination in Local White Rice: A Preliminary Study at Palembang, South Sumatra, Indonesia Dian Islamiati*1 , Pokkate Wongsasuluk1,2 1 College of Public Health Sciences, Chulalongkorn University 2 Health and Social Sciences and Addiction Research Unit (HSSRU), Thailand

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 51 Conclusion Risk assessment showed that both types of rice have potential risk even though the concentrations of rice were lower than standard. Health risks in kids were known to be higher than in adults. Heavy metals in rice should be reduced by controlling the use of pesticides and fertilizers during the rice planting process. In addition, people in Palembang might be reduced the amount of rice consumption to reduce health risks. Keywords: heavy metal, contamination, rice, Indonesia Corresponding author: Dian Islamiati, College Public Health Sciences, Chulalongkorn University, Mobile Phone (+66855787037), Email : [email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 52 Background Since 2020, in order to prevent the spread of COVID-19, various countries implemented various nonpharmaceutical interventions (NPIs), which affected human activity behavior. Past studies have found that the implementation of different NPIs can cause significant changes in air pollutant concentrations. Objective This study aims to investigate the changes in concentrations of NO2 and PM2.5 as well as possible influencing factors during the level 3 alert period of the COVID-9 pandemic in northern Taiwan in 2021. Methods Using the monthly average of hourly data from 18 central air quality monitoring stations of the Environmental Protection Administration in northern Taiwan from 2015 to 2019 for Theil-Sen trend estimation. The data from the same period in 2019 was applied to estimate the predicted concentrations of NO2 and PM2.5 during level 3 alert period in 2021 (May 16 - July 25). The predicted concentrations of NO2 and PM2.5 were further compared with the actual concentrations to calculate the percentage difference. In addition, Google Mobility Trends was used to estimate the changes in the stream of people during the level 3 alert period. Results The actual concentration of NO2 (9.7 ppb) in Northern Taiwan was significantly lower than the predicted concentration (13.4 ppb) by 27.3% (95%CI: -25.1% ~ -29.78%). The percentages of trend difference in NO2 at 16 of 18 stations were significantly reduced with the range from -15.6% to -42.9%. Among the stations, one traffic station was with the largest decreased concentration from the predicted 26.9 ppb to the actual 15.3 ppb. And, one park station was with the significantly largest raised concentration, which increased by 5.9% (95%CI: 0.5% ~ 11.9%). The actual concentration of PM2.5 in Northern Taiwan (8.93 ߤg/m3 ) increased by 1.3% (95%CI -5.4% ~ 7.3%) compared with the predicted concentration (8.82 ߤg/m3 ), which was no statistical significant. 9 of 18 stations were significantly decreased with the decreasing percentage from -1.6% to -33.4%. Among the stations, one ambient station, which is an important transportation hub in northern Taiwan, was with the largest decreased concentration from the predicted 12.1 ߤg/m3 to the actual 8.1 ߤg/m³. Mobility trends showed that the stream at Taiwan's public transit stations during the level 3 alert period was decreased by an average of 56% when compared to the period before the level 3 alert. In addition, retail and recreation decreased by 45.6%, grocery and pharmacies stores decreased by 4.6%, workplaces decreased by 21.6%, and residential areas increased 16%. OP21 The Impact on Air Pollution by of Epidemic Prevention Policy of COVID-19 in Northern Taiwan Jia-Yi Lu1 , Ruei-Hao Shie2 ,Tzu-Hsuen Yuan1,* 1 Department of Health and Welfare, University of Taipei, College of City Management, Taiwan 2 Green Energy and Environment Research Laboratories, Industrial Technology Research Institute of Taiwan, Taiwan

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 53 Conclusion Changes of human activities resulted in a decrease in traffic and a significant decrease in concentration of NO2. The emission of PM2.5 originates from human activities, so its overall concentration is not much different from the predicted concentration. However, the impact of changes in stream of human can still be found in different types of areas. In the future, it could clarify the patterns of traffic and stream of people changes during COVID-19 pandemic period to further adjust relevant traffic policies to effectively improve air pollution in the post-epidemic era. Keywords: COVID-19ࠊNO2ࠊPM2.5ࠊNPIsࠊAir pollution Corresponding author: Tzu-Hsuen Yuan, Department of Health and Welfare, University of Taipei, College of City Management, Taiwan, Tel. 02-2871-8288#4052, Email:[email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 54 Background The local Covid-19 epidemic situation in Taiwan was stable in 2020, and it was outbreak around May 2021. Therefore, Taiwan implemented the Nationwide level 3 alert from May 15, 2021, to July 26, 2021, and people started working from home and not going out unless necessary. Several studies have shown that the lockdown caused by Covid-19 had reduced the utilization of outpatient medical services. However, depression is a disease that requires regular return visits to prevent the disease from worsening. As a result, it is important to find out if the Covid-19 epidemic in Taiwan changes the outpatient visits status of depression patients. Objective The aim of this study is to observe the trend change of outpatient visits of depression patients affected by the Covid-19 pandemic status and prevention policy in Taipei of Taiwan. Methods We collected medical records during 2019-2021 from Sondge Branch (psychiatry specialization) of Taipei City Hospital. The depression cases were defined by ICD-10 codes (F32-F33). The differences in basic characteristics of patients over three years were examined by the one-way ANOVA or Chisquare test. We compared the difference in the average monthly outpatient volume between 2020 and 2021 by using t-test. We further divided three periods (before, during, and after the level 3 alert) to analyze the difference in the average monthly outpatient volume among the three periods by one-way ANOVA. And, we estimated the differences in average outpatient visit times over three years by conducting one-way ANOVA. We also selected new depression cases to calculate the rates of new to all cases before and after the level 3 alert in 2021, and we observe the rates in the same periods in 2020. Result The age of the patients decreased year by year, and there were significant differences among the three years (53.05±17.41 vs 51.17±19.246 vs 50.87±19.502, p<0.001). There were no significant differences in the sex ratio among the three years. The average monthly outpatient volume of depression in 2020 was 980.58, which was significantly higher than those of 868 in 2021 (p=0.002). Further analysis showed that the outpatient volume during the level 3 alert was significantly lower than in the period before and after the level 3 alert. The decreasing average outpatient visits times for patients were found in 2019, 2020 and 2021 (6.31, 6.04 and 5.61, respectively), and the value of 2021 was significantly lower than those of other two years (p-values both < 0.001). In addition, the rate of new to all cases after the level 3 alert increased by 2.0% when compared to that before the level 3 alert in 2021, and the increasing rate between the same two periods in 2020 was 0.6%. OP22 The Effect of Covid-19 Prevention Policy on the Outpatient Visits of Depression Patients in Taipei of Taiwan Chia-Yu Chang1 , Min-Hsin Liao1 , Chun-Ta Li2 , ShinFeng Shiu2 , Chi-Ting Tseng2 , Tzu-Hsuen Yuan1 * 1 Department of Health and Welfare, University of Taipei, Taipei, Taiwan 2 Department of Pharmacy, Taipei City Hospital, Songde Branch, Taipei, Taiwan

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 55 Conclusion From this study, it can be found that the use of hospital outpatient services for depression patients decreased during the level 3 alert period and the rate of new cases increased after the level 3 alert and that Covid-19 prevention policy has caused instability in the frequency of patient return visits, which may worsen the disease condition in the future. On the other hand, the development of new depression patients by the Covid-19 pandemic still needs more concern and followed up. As a result, it is important for the authorities concerning to develop an appropriate alternative to outpatient services such as online medical services. Keywords: Covid-19, depression, outpatient, medical services. Corresponding author: Tzu-Hsuen Yuan, Department of Health and Welfare, University of Taipei, College of City Management, Taiwan, Tel. 02-2871-8288#4052, Email:[email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 56 Abstract The Khon masked dance is an authentic Thai classical performance that has been relinquished for centuries. "Ten-Sao", the basic training movement is maintained in the semi-squat or knee flexion and varus with toes out throughout the performance. The excessive knee flexion and varus position could exhibit an impact force and stress on the knee structures and leads to knee injury risk. The evidence of Ten-Sao related to the knee kinetics (knee joint force and ground reaction force) and kinematic (knee joint angle) information remains far from obvious. This research presented the comparisons of kinetics and kinematics over the starting and leg raising phases of Ten-Sao between Khon masked dancers and non-dancers. Twenty healthy males, including Khon masked dancers (n = 10) and non-dancers (n = 10) participated in the study. All participants performed Ten-Sao 10 cycles, then the kinetics and kinematics of starting and leg raising phases were investigated using force plates and 3D motion analysis. For kinetics, the findings showed lower knee anterior (p = 0.009) and compressive (p = 0.001) joint forces in Khon masked dancers when compared to the non-dancers at the starting phase. Moreover, Khon masked dancers showed lower medial (p = 0.012) and vertical (p < 0.001) ground reaction forces at the starting phase. For kinematics, Khon masked dancers had lower knee varus angle (p = 0.038) at the starting phase but had higher knee internal rotation angle (p = 0.028) at the leg raising phase. The reduced joint force and ground reaction force are achieved by decreasing knee varus and external rotation, both of which contribute to less stress on the knee structures and involve the dance technique. However, leg raising with a high knee internal rotation could be a cause of increased compression and tension on the knee joint. The results obtained from this study might provide the knee biomechanics evidence of Ten-Sao and be used in prevention, development and teaching movements. Keywords: Thai Traditional Dance, Khon Masked Dance, Knee Joint, Biomechanics, Injury Prevention Corresponding author: Warin Krityakiarana, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand, Email: [email protected] OP23 Knee Kinetics and Kinematics during TenSao Danceffl A Comparison between Khon Masked Dancers and Non-Dancers Pakamas Jearudomsup, Sunee Bovonsunthonchai, Roongtiwa Vachalathiti, Pagamas Piriyaprasarth, Warin Krityakiarana* Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 57 Introduction Wife beating is a major issue of intimate partner violence in Indonesia. Many studies have tried to ILJXUH RXWZRPHQ¶VDFFHSWDQFH DQG IDFWRUVDVVRFLDWHGZLWKZLIH EHDWLQJ Commonly known as the SHUSHWUDWRUV LGHQWLI\LQJ PHQ¶V DWWLWXGH WRZDUGV ZLIH EHDWLQJ IURP WKH PHQ¶V SHUFHSWLRQ LV also important to obtain another understanding. In contrast, there is still a lack of references to men's attitudes toward it, especially in the Indonesia context. In the last ten years, the prevalence of justifying wife beating among men has remained staJQDQWDW:LWKDTXDUWHURIWKHFRXQWU\¶VSRSXODWLRQ consisting of young people, it is interesting to examine whether the attitude towards wife beating varies by age or not. This study then aims to assess the association of socioeconomic characteristics with men's attitudes toward wife beating. Methods The Indonesia Demographic and Health Survey (IDHS) 2017 dataset was used for this study. This current study included 10,009 married men aged 15 ± 54 years. The statistics descriptive was used to present the prevalence of wife beating justification regarding the age group. A binomial logistic UHJUHVVLRQ ZDV HPSOR\HG WR H[DPLQH WKH DVVRFLDWLRQ RI UHVSRQGHQWV¶ DJH DQG VRFLRHFRQRPLF characteristics with their attitude towards wife beating justification. Results Men from the youngest age group (15 ± 29 years) were the most prevalent to justifying wife beating (22.99%). Across the age groups, the most common reason for wife beating justification was neglecting children. It was confirmed that age was significantly associated with men's attitude towards wife EHDWLQJMXVWLILFDWLRQ7KHOLNHOLKRRG RIZLIHEHDWLQJMXVWLILFDWLRQ GHFUHDVHGDVWKH UHVSRQGHQWV¶DJH increased, indicating younger men were more tolerant of accepting wife beating than their counterparts. Some socioeconomic characteristics also significantly affected attitude towards wife beating. Men in rural areas were 1.26 more likely to agree with wife abuse than their counterparts. Men who owned a mobile phone were 1.24 times more likely to justify beating wives. Men from poor families tended to justify wife beating than their counterparts. Moreover, men who had a bank account were 0.88 less likely to justify beating their wives than those who did not have. Conclusion Based on age, men acted differently towards wife beating. The younger they were, the more tolerant of wife beating they were. Those who lived in rural areas, owned a mobile phone as one of their communication tools, were poor and had no bank account tended to endorse wife beating more than their counterparts. Community programs related to intervention and the prevention of wife abuse are QHHGHGWRLQFUHDVHPHQ¶V HGXFDWLRQ DQG DZDUHQHVV RI JHQGHU HTXDOLW\ZKLFKLQIOXHQFH SDWULDUFKDO values. Keywords: EHDWLQJZLIHZLIHDEXVHPHQ¶VDWWLWXGH Corresponding author: [email protected] OP24 The Attitude towards Wife Beating: Do Young Men Act Differently? Desy Nuri Fajarningtiyas1*, Riza Fatma Arifa1 1 Research Center for Population, Indonesian National Research and Innovation Agency

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 58 Introduction The problem faced by nursing students is the achievement of nursing students' competence which is found to be less than optimal. One of the obstacles identified as the cause is that the learning model applied is still using the traditional conventional model. Palliative care requires implementing a learning model that emphasizes authentic relationships. Therefore, it is necessary to implement learning that prioritizes authentic relationships Objective This study aims to see the effectiveness of the palliative learning model based on transformational learning theory to increase the nursing student's competencies in palliative care. Methods The study was conducted quasi-experimental with a control group design. The total sample of 52 students for each group. The variables in this study were the TLT-based palliative learning module and nursing students' competencies. The instrument used was a TLT-based palliative learning module and Nursing Student Competency Achievement questionnaire. The statistical test used Generalized Linear Models Repeated Measure (GLM-RM). This research has received ethical approval from the ethics committee. Results The results showed an effect of applying the TLT-based palliative learning module on the achievement of nursing students' competence in palliative care (p=0.000). Conclusion The application of the TLT-based palliative learning module has been proven to increase competency achievement for nursing students in palliative care. Learning media and competencies regarding palliative care can contribute to increasing the achievement of nursing students' competencies in palliative care. Keywords: Clinical Competency, learning, nursing students, palliative Corresponding author: Nursalam Nursalam, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia, Tel (031) 5913754, E-mail: [email protected] OP25 Effectiveness of Palliative Learning Model Based on Transformational Learning Theory on The Achievement of Nursing Student's Competency Ni Luh Putu Inca Buntari Agustini1,2, Nursalam Nursalam1*, Tintin Sukartini1 . 1 Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia 2 Faculty of Health, Institute of Technology and Health Bali, Denpasar, Indonesia

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 59 Abstract Penyengat Island is a small island that is subject to cultural values and has been designated as a cultural heritage by the government of the Republic of Indonesia. The problem in the arrangement of healthy settlements on Penyengat Island is that some residents have built settlements in the former remnants of existing cultural heritage buildings; This is due to the increase in population, resulting in increased population settlements that threaten the existence of existing cultural heritage sites. This study aimed to offer the arrangement concept of sustainable healthy settlement based on the socio-cultural life in the community so that the existence of cultural heritage sites can be maintained. This article used a qualitative descriptive method with data collection techniques through library research with an empirical study approach. The results showed that the socio-cultural life on Penyengat Island was a very valuable asset that became the local wisdom of the local area. The concept of sustainable healthy settlements in terms of socio-cultural dimensions on Penyengat Island is a harmonization between aspects of healthy settlements in terms of ecological dimensions and cultural values that are still preserved on Penyengat Island. Introduction Penyengat Island is an exotic island and very thick with Malay history where the size is 2000 m long and 850 m wide. Penyengat Island is designated as a cultural heritage because it has two strategic values in the history of Indonesia. First, Penyengat Island was the stronghold of Raja Haji Fisabilillah during the war against the Dutch (1782-1784). Second, Penyengat Island is in the center of Malay civilization which is rich in culture and contributed to the development of Malay literature and Indonesian literature. Research by Ramelan et al. 2017, shows that the settlements and residences of the people of Penyengat Island are very close to the existing cultural heritage sites, but now people are actually building houses on the remaining footprints of the buildings from the cultural heritage. The coastal area of Penyengat Island, which is a tourist destination, certainly has quite dense activities such as ecotourism areas, marine transportation activities, construction of tourist parks, temporary shelters (TPS) for garbage and household activities that throw waste into the waters. Community activities around the coast of the island have contributed to the decline in water quality (Rosdatina et al, 2019). Various problems that exist on Penyengat Island, especially those related to the health of residential areas and the preservation of cultural heritage, of course require comprehensive handling. Penyengat Island, which has become an international historical tourist destination, if the settlements are not arranged in such a way, will cause many environmental problems and ultimately reduce the health status of the community. Objectives This study aimed to offer the arrangement concept of sustainable healthy settlement based on the sociocultural life in the community so that the existence of cultural heritage sites can be maintained. OP26 Adaptation of Sustainable Healthy Settlement to Social Cultural Life on Penyengat Island as a Cultural Reservation Area Indra Martias*, Rifardi, Agrina, Suprayogi, Syaza Halwa Amanina Environmental Science Doctoral Program, Riau University, Pekan Baru, Indonesia, The Ministry of Health Polytechnic Tanjungpinang, Indonesia

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 60 Methods This study uses descriptive qualitative research methods that focus on conditions and empirical/natural object data collected collectively with literature and documentation. The analytical method used in this research is the analysis of data reduction, data presentation, and drawing conclusions. Results Penyengat Island has dozens of heritage sites and are surrounded by people who are believed to be descendants of cultural supporters who produced the material cultural heritage. The problem is whether the local community is willing to preserve and understand that the material cultural heritage can provide great benefits. The entire culture on Penyengat Island cannot be separated from the history and heritage of the ancestors that are still preserved by the local community, among others: (1) Malay customs at the wedding ceremony on Penyengat Island. (2) The uniqueness of Penyengat Island is the location of its language, which is Malay. Despite much urbanization, Malay culture and language cannot just disappear. (3) The art of Malay culture on Penyengat Island begins with a dance accompanied by musical instruments wrapped in regional and modern customs that add new flavors. (4) The religious system has penetrated the customary system starting from worship, death ceremonies, prayer readings, and marriages. The concept of sustainable healthy settlements in terms of socio-cultural dimensions on Penyengat Island is a harmonization between aspects of healthy settlements in terms of ecological dimensions and cultural values that are still preserved on Penyengat Island. Conclusion Based on the findings and the existing conditions of residential settlements on Penyengat Island, it was concluded that population growth resulted in the expansion of settlements, this resulted in the distance between settlements and cultural heritage sites being very close. A concept of sustainable healthy settlement arrangement is needed on small islands such as Penyengat Island so as to create harmonization between population growth, settlements and the preservation of cultural heritage. The goal is to improve the welfare of the community which in turn will improve the health status of the people in Penyengat Island. Keywords: healthy settlement, sustainable, social, cultural Corresponding author: Indra Martias, Environmental Science Doctoral Program, Riau University, Pekan Baru, Indonesia , Tel. 085263706120, E-mail : [email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 61 Background In December 2019, the first case of the novel coronavirus was discovered. The COVID-19 virus gave rise to an unprecedented pandemic global. The first wave in 2020 did not occur as expected in Taiwan. However, under the attack of the coronavirus variant Delta in 2021, the COVID-19 epidemic broke out. The government implemented the Nationwide level 3 alert from May 15, 2021, to July 26, 2021. Previous studies have found that lockdowns and social distancing may put people with mental disorders at risk of worsening symptoms or relapses. As a result, the lockdown caused by Covid-19 reduced outpatient medical services utilization. It is very important for psychiatric outpatients who maintain a stable condition by keeping regular revisits. Therefore, the impact of the Covid-19 pandemic and epidemic prevention policies in Taiwan may affect the regular revisits of psychiatric patients. Objectives This study explores, analyses, and compares the situations of regular revisits of psychiatric outpatients in Taipei City with the impact of the COVID-19 pandemic in Taiwan and the epidemic prevention policies. Methods We collected medical data during 2019-2021 from Sondge Branch (psychiatry specialization) of Taipei City Hospital. Outpatients visited in 2019, were over 20 years old, had regular revisits for medicines for more than 280 days, had no hospitalization or emergency records, and the main diagnosis of mental illness of ICD-10 as our research objects. To analyze and compare the differences between the two periods in 2020 and 2021. Analyze the instability rates for different diseases were examined by the Chisquare test. For the outbreak of the epidemic in 2021, we divided three periods (before, during, and after the level 3 alert) to compare the non-revisit rates by Chi-square test. Results Based on 2019 records, 7,508 eligible study subjects were screened. In 2020, there were 1577 (21%) patients who were unstable (with less than 280 days of revisit, or records of emergency or hospitalization record), and the other 5931 stable ones (79%); another 1,124 (19%) were unstable in 2021. Unstable 1577 ones in 2020, only 22% returned to steady. Among the 7,508 study subjects, three types of disorders accounted for the highest proportions: schizophrenia 41%, depression 22%, and bipolar disorder 12%. In 2021, the rate of irregular revisits for diseases was 15.2% for schizophrenia, 22.6% for depression, and 19.9% for bipolar disorder, with significant differences (p<0.01). Further analysis for 5,931 stable cases in 2020 with was observed their non-revisits rate during the three periods of the outbreak in 2021. Among the stable patients, the proportion of non-revisits rate was 0.4%, 1.9% (p<0.01), and 0.4% (p<0.01). For unstable patients, the non-revisits rate was 25.6%, 55.2% (p<0.01), and 54.9%. OP27 Evaluation of the Impact of the COVID-19 Pandemic and Epidemic Prevention Policies on Psychiatric Outpatients Chun-Ta Li12, Shin-Feng Shiu1 , Chi-Ting Tseng1 , Tzu-Hsuen Yuan2 * 1 Department of Pharmacy, Taipei City Hospital, Songde Branch, Taipei, Taiwan 2 Department of Health and Welfare, University of Taipei, Taipei, Taiwan

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 62 Conclusion Affected by the severity of the COVID-19 pandemic and the epidemic prevention level policies, the possibility of irregular revisits of psychiatric outpatients has increased. Patients with different diagnoses have different rates of instability, but patients with schizophrenia seem to be relatively stable. When the epidemic situation is severe, stable patients will be slightly affected, and they will return to stable revisits when the level 3 alert is lifted. On the other hand, the non-revisit rate of unstable patients will increase significantly during the level 3 alert. Even after the third level alert was over, the situation of revisit could not be improved immediately. It is worth noting that when the unstable state of the patient occurs, the probability of returning to stability is not high, and most of them remain in an unstable state. In the future, under the development of the COVID-19 epidemic and changes in epidemic prevention policies, it is still necessary to further observe and analyze the changes in the condition and medication of psychiatric patients. Keywords: psychiatric, outpatients, COVID-19, return visit Corresponding author: Tzu-Hsuen Yuan, Department of Health and Welfare, University of Taipei, College of City Management, Taiwan, Tel. 02-2871-8288#4052, Email:[email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 63 Abstract Acid attack, a heinous form of violence, remains an issue in India. Acid is highly corrosive and destructive; it could cause survival victims to suffer long-term treatment. This study used a qualitative nature with interviews and documentation study to explore the challenges acid attack survivors face in obtaining medical care. Though there are directions to hospitals to provide care to acid attack survivors, they face hardships in getting adequate treatment. Most government hospitals provide free medical care, but private hospitals often charge the total cost of treatment. Another constraint is the availability of specific surgery facilities (e.g., eye and plastic surgery) that could be located thousands of miles from the survivors' residences. No scheme provides payments for treatments to other state institutions/hospitals. Thus, getting proper care in a hospital is a daunting task, particularly with treatments spanning a few months to several years involving enormous costs. Therefore, policies related to treatment for survivors must also concern their ability to access adequate health care facilities and proper compensation for sustainable living. Keywords: acid attack, medical treatment, violence against women and girls OP28 Medical Treatment for Acid Attack Survivors: A Cure or a Burden? Lindawati* , Ajay Singh Tomar2 1 Research Center for Social Welfare, Village, and Connectivity, National Research and Innovation Agency, Jakarta, Indonesia, [email protected] 2 Chhanv Foundation, Agra, India, [email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 64 Background Today, the refugee challenge is one of the most complicated humanitarian issues the world is facing as approximately every 2 second, an individual is displaced coercively. Since 2015, nearly 70.8 million individuals have been forced to leave their homes because of war, lack of safety and insecurity, almost half of them is under the age of 18. Keeping these facts in mind, adolescents, in their transition from child- to adulthood, are faced with plenty of challenges to obtain and develop a wide range of skills to establish a foundation for a healthy adulthood. The combination of (specially forced) migration and adolescence increase the risk of psychological problems among refugee children and adolescents. Overall, it has been approximated that more than 90% of refugee children and adolescents that need PHQWDOKHDOWKVHUYLFHVQHYHUUHFHLYHWKHP7KXVWKHWLPHIRUGHFUHDVLQJDGROHVFHQWV¶SV\FKRORJLFDO problems is limited and any delay in effective actions significantly increases the time span of recovery and severity of the problems. Along with the significant increase in the number of refugees all around the world, investigating effective ways to improve their health status has grown. However, there is still a substantial gap regarding the presence of effective, evidence-based educational and therapeutic interventions among this vulnerable population. On the other hand, the success of broad-based health strategies depends on having a logical and reliable foundation (such as pilot studies) and needs to be integraWHG ZLWK DOO WKH DYDLODEOH FDSDFLWLHV ,Q WKLV UHJDUG WKH UHIXJHHV¶ SRWHQWLDO VKRXOG QRW EH underestimated. According to this view, reframing the nature of the issue to enable refugee adolescents WKURXJKHPSRZHULQJWKHPPLJKWEHDQHIIHFWLYH³PDVWHUSODQ´ in overcoming their challenges. Objective With the long-term goal of improving wellbeing and quality of life, this multi-method study aimed to develop a self-care and self-development intervention guidebook for refugee adolescents. The project focused on three main work packages: 1. assessment of needs and knowledge concerning self-care and self-development; 2. development of a guidebook to promote self-care and self-development for refugee adolescents; and 3. assessment of the guidebook validity. For the first work package, an intratriangulation approach including three qualitative methods [in-depth interviews, focus group discussions and photovoice] were used. The collected data were analyzed using cross-cultural and multilingual approach to thematic analysis, known as meta-theme analysis. The results of the first stage ZHUHXWLOL]HGIRUGHYHORSLQJWKHJXLGHERRNLQWKHVHFRQGPDLQ ZRUNSDFNDJHVIROORZLQJWKH³WKHRU\ RISODQQHGEHKDYLRU´7KHJXLGHERRNILGHOLW\ZDVDVVHVVHGEDVHGRQWKH1DWLRQDO,QVWLWutes of Health Behavior Change Consortium fidelity framework in the last workplan. In addition, to assess the JXLGHERRN¶VFRQWHQWYDOLGLW\WKH&RQWHQW9DOLGLW\,QGH[DSSURDFKZDVSHUIRUPHG OP29 Selfcare/self-development Interventional Guidebook for Refugee Adolescents: Steps Toward a Comprehensive Intervention Development Marjan Mohammadzadehേ1 and Christiane Stock 1,2 1 Institute of Health and Nursing Science, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, 2 Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 65 Results Empowering refugee adolescents with self-care /self-development skills can help them to sustain their ZHOOEHLQJDQGEHWWHUPDQDJHWKHFKDOOHQJHVLQWKHLUQHZVLWXDWLRQ7KLVSURMHFWOHGXVWRWKHVWXG\¶V ultimate objective as developing the first ready-to-UXQJXLGHERRNGHVLJQHGWRXVHUHIXJHHDGROHVFHQWV¶ own potentials to improve their mental and behavioral health. Finalizing this guidebook can be a significant step forward to allow refugee adolescents to take control over their lives and gain access to broadened abilities needed in the pathway to successful adulthood. Conclusion The guidebook can provide an opportunity to shift from ambition to accessible health targets for all, and most valuable of all, it can have an affirmative effect on the lives of this vulnerable population. Although the study is conducted in Germany, it is designed to be adjustable and have the potential to be used in other host countries. Keywords: Refugee adolescents, Intervention development, Self-care, Self-development Corresponding author: [email protected] [email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 66 Introduction Indonesia still upholds customs and culture. Gender roles relate to a person's attitudes and behavior that are shaped by the social environment. The traditional model views femininity and masculinity as two contradictory differences. Meanwhile, the modern model views that a woman or a man can have both femininity and masculinity (androgynous) traits, which are hereinafter referred to as sex roles. Masculine and feminine are also said to be stereotypes, attachments to individuals / groups. Gender inequality where many roles that must be carried out by women compared to men. Women are considered as obligations and do not even have protection at work even women's productive roles are less valued than men's productive roles, this causes complications during pregnancy, childbirth and postpartum such as bleeding and prolonged labor due to anemia in pregnancy, pre-eclampsia, abortion, infection and other comorbidities. Lack of knowledge in pregnant women can cause several psychological conditions when carrying out sexual activities during pregnancy, for fear of hurting the fetus or causing abortion, besides that some women feel embarrassed if they want to invite their partners to have sexual activities while pregnant. Several factors related to sexual activity are maternal characteristics including education, parity, employment status and gestational age. What is meant by gender roles in sexual activity during pregnancy are: the nature of women based on gender roles (feminine and masculine) especially in starting sexual activity during pregnancy and based on maternal characteristics. Objectives To estimate the prevalence of sexual needs during pregnancy in Sirampog village, Brebes district, Central Java, Indonesia, and identify gender roles and maternal characteristics. Methods The research method uses quantitative analytics with a correlational research design and a crosssectional approach. The population was as many as 146 pregnant women and sample technique using total sampling. The instrument uses a questionnaire. Univariate analysis was carried out with frequency distribution andbivariate with Spearman Rank analysis. Results The results of univariate analysis: from 146 pregnant women, most of them have the nature of women based on gender roles feminim as much as 129 (88.4%), low education as many as 78 (53.4%), parity multipara 74 (50.7%), pregnant women did not work 82 (56.2%), and most of in the 2nd trimester of pregnancy, 64 (43.8%), the sexual activities were carried out 1-2x/week (82.2%). The results of the bivariate analysis: gender roles and sexual activity (p-value = 0.504), characteristics: education (p-value = 0.462), occupation (0.398) and parity (p-value = 0.958), and gestational age (p-value=0.002). OP30 Relationship Between Gender Roles and Maternal Characteristics With Sexual Activityin Pregnancy at Sirampog Village, Brebes District, Central Java, Indonesia Evi Soviyati*, Merissa Laora Heryanto, Tri Sulistianingsih Institute of Health Science Kuningan, West Java, Indonesia

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 67 Conclusion Based on these results, there is no relationship between gender roles and characteristics of pregnant women (education, parity, employment status) with sexual activity during pregnancy, and there is a relationship between gestational age and sexual activity during pregnancy. Suggestions for pregnant women can increase knowledge about sexual activity during pregnancy through information media such as the internet so that they can carry out healthy sexual activities. Health workers provide health services regarding the fulfillment of sexual needs for pregnant women, such as counseling or health education Keywords: Gender roles, characteristics, sexual activity Corresponding author: Evi Soviyati, Institute of Health Science Kuningan, West Java, IndonesiaTel. 087847484111, email: [email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 68 Introduction In June 2017, the Taiwanese government raised the cigarette tax per pack of cigarettes from 11.8 NTD to 31.8 NTD, a nearly 63% increase. The raised 20 NTD cigarette tax was all used for the long-term care fund. Objectives The purpose of this study was to investigate whether adult smokers in the three-year period 2016-2018 were affected by the increase in cigarette tax in 2017 and quit smoking. Results Data were obtained from the annual national cross-sectional telephone interview survey of Taiwan Adult Smoking Behavior Surveillance System (ASBS) during the period of 2016 to 2018, and ASBS is used to monitor tobacco use and trends in adults over 15 years old. The study sample consisted of ever-smokers over the age of 18 each year, excluding those who had quit smoking more than 1 year prior to the survey. The dependent variable was quit smoking which defined as the smoker currently no smoking. The independent variable is the year, 2017 is the year of the cigarette tax increase, 2016 is the year before and 2018 is the year after the cigarette tax increase. Pooled analysis of three years data was analyzed using logistic regression to estimate quitting status after the cigarette tax increase. Analysis was weighted by the previous year population distribution. Other control variables included gender, age, marital status, education level, job, personal monthly income, household secondhand smoke exposure, and self-perceived health. Results The study found that the number of smokers in the three years from 2016 to 2018 has dropped obviously from 3574 to 2894. In addition, the quit rates of smokers also increase significantly from 12.1% in 2016 to 19.2% in 2017. Logistic regression after controlling for other variables, the increase in cigarette tax in 2017 resulted in a significant increase in smoking cessation among smokers compared with 2016 (OR=1.6), but a significant decrease in smoking cessation in 2018 (OR=0.8). Males (OR=0.6), those had a job (OR=0.8), and those exposed to secondhand smoke (OR=0.5) were less likely to quit smoking. Elder (OR=1.9), those were married (OR=1.8), and those with a higher (OR=2.7) or middle (OR=1.7) educational level were more likely to quit smoking. OP31 Dose the smokers quit smoking when the cigarette tax increased? Li-Chuan Chang1 , Yue-Chune Lee2 , Pei-Ching Chen3 * 1 Geriatric and Long-Term Care Research Center, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan 2 Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan 3 Department of Health and Welfare, College of City Management, University of Taipei, Taipei City, Taiwan

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: 7KH&KDOOHQJHVRIFKDQJLQJ(UD´ 69 Conclusion It appears that the expectation of a price increase was sufficient to prompt many people to quit smoking, not only the number of smokers drop but so the quitting rate of smokers up, except for 2018. We suggest that the government should continue to promote smoking cessation and raise tobacco taxes gradually to reduce the smoking rate and the number of smokers. The content of this research may not represent the opinion of the Health Promotion Administration, Ministry of Health and Welfare. Keywords: quit smoking, cigarette tax, smokers. Corresponding author: Pei-Ching Chen, Department of Health and Welfare, College of City Management, University of Taipei, Taiwan, Tel. +886-2-28718288#8342, E-mail: peiching@ utaipei.edu.tw

POSTER PRESENTATION

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 70 Introduction Vitiligo is a pigmentary skin disease that affects both sexes equally and has an estimated incidence of 1-2 percent of the world's population. It is characterized by areas of depigmented skin caused by the loss of melanocytes. Potent topical corticosteroids, narrow-band UVB irradiation, and topical psoralen with UVA light are some of the current re-pigmentation treatments (topical PUVA). The use of corticosteroids is restricted due to the risk of adverse effects such as skin atrophy. Narrow-band UVB therapy necessitates expensive equipment and highly experienced workers, whereas PUVA has been linked to cancer induction. New medicines that are both safe and effective are desperately needed. The topical calcineurin inhibitors pimecrolimus cream 1 percent (Elidel®) or tacrolimus ointment 0.1 percent and 0.03 percent (Protopic®) have recently been demonstrated to be effective in the treatment of vitiligo. Calcineurin inhibitors act on T cells and mast cells, reducing T-cell activation and cytokine production and blocking mast cell degranulation from releasing pro-inflammatory mediators. In the treatment of vitiligo, topical calcineurin inhibitors are used as a second-line drugs. However, no comprehensive assessment of all efficacy has been made. The topic has piqued the curiosity of researchers. Objectives This study aimed to review literature systematically on the effectiveness of topical calcineurin inhibitors in vitiligo. Methods A systematic search of databases that satisfied the criteria for inclusion and exclusion. PubMed was used to find relevant information. Keywords like topical calcineurin inhibitors and vitiligo were discovered by a comprehensive database search. We looked for randomized controlled studies that looked at topical calcineurin inhibitors for vitiligo and were written in English. Two separate writers reviewed the title, abstract, study quality, and data extraction, with disagreements resolved through consensus-forming conversations and, if required, referral to a third reviewer. Results A systematic search of databases revealed that 4 articles met the inclusion and exclusion criteria from 33 articles. The result showed that topical calcineurin inhibitors be effective for the treatment of vitiligo. (Figure 1) PP1 A Systematic Review on the Effectiveness of Topical Calcineurin Inhibitors in Vitiligo PiyanuchSamtip, BuaphetSriphet, KitipanKhaonim Southern Regional Hospital of Tropical Dermatology, Department of Medical Services, Ministry of Public Health 33 Articles Identified by Searching the MEDLINE database through PubMed 24 Articles Excluded at the Title

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 71 Figure 1 Flow diagram: Identification and screening of studies for systematic review. Quality assessment results The Cochrane Handbook for Systematic Reviews of Intervention 4.2.6 found four publications to be of good quality in terms of RCT quality. (Figs. 2 and 3). Random Sequence generation Allocation (Selection bias) concealment (Selection bias) Blinding of participants and personnel Blinding of (performance bias) outcome assessmet Incomplete (detection bias) outcome data (attrition bias) Selective reporting (reporting bias) Other bias Dawid 2006 Radakovic ffi Cavalié  Veronica  Figure 2 Risk of bias for each study Random Sequence generation (Selection bias) Allocation concealment (Selection bias) Blinding of participants and personnel (performance bias) Blinding of outcome assessmet (detection bias) Incomplete outcome data (attrition bias) Selective reporting (reporting bias) Other bias % 25% 50% 75% 100% Low risk of bias Unclear risk of bias   High risk of bias   Figure 2 Risk of bias of all included studies 9 Articles Screened 5 Articles Exclude - Not full text articles (2)  Not RCT (1) - Not include a comparison of interest (2) 4 Full text articles Included + + " " + + + + + + + + + + + + + + + + + + + + + + + +

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 72 Conclusion Vitiligo can be treated with topical calcineurin inhibitors as an alternative. However, randomized controlled studies are still needed to collect and analyze data for meta-analysis, as well as to establish the efficacy of topical calcineurin inhibitors. Keywords: Calcineurin, Vitiligo, Effectiveness, Topical, Systematic Review. Corresponding author: KitipanKhaonim, Southern Regional Hospital of Tropical Dermatology, Tel. 075270264, E-mail: [email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 73 PP2 Effect of PKDUPDFLVW¶VInvolvement in Cross-functional Team Clinical Care and Intervention on Medication Adherence and Clinical Outcomes of Outpatients with Diabetes Jiunn-Bey Pao1,3, Wei-Hsiang Huang2 * 1 Department of Pharmacy, Taipei City Hospital 2 Fire Department, New Taipei City Government 3 Department of Health Promotion and Health Education, National Taiwan Normal University Introduction Patients with diabetes often have multiple medication use problems, which results in wasting medical resources. Hence, in clinical care provision, combining teams of different professions is often necessary for patients to receive more comprehensive care. If pharmacists were included in clinical care teams, medication use problems and medication adherence behaviors of patients with diabetes should be improved; thereby, improving the clinical outcomes and achieving better disease control. Objective This study aimed to investigate tKHHIIHFWRISKDUPDFLVWV¶LQYROYHPHQWLQFURVV-functional team clinical care and intervention on the resolution of medication use problems, medication adherence, and clinical outcomes improvement in outpatients with diabetes. Methods This is a longitudinal study that adopted the non-equivalent control group design. From March to December 2021, a total of 70 patients with diabetes from a regional teaching hospital in Taipei City were selected as the study participants via convenience sampling. The study was conducted using a non-randomized controlled pre- and post-test design; whereby, the experimental group included pharmacists in the cross-functional team clinical care and performed 60 min of intervention, while pharmacists were not included in the care team for the control group. The study tools included the eightitem Morisky Medication Adherence Scale questionnaire and monitoring of clinical outcomes. Results The study results were analyzed using generalized estimating equations. After controlling the equation IRUWKH³JURXS´DQG³GXUDWLRQ´SKDUPDFLVWV¶LQYROYHPHQWLQFURVV-functional team clinical care for the UHVROXWLRQ RI PHGLFDWLRQ XVH SUREOHPV LQ SDWLHQWV ZLWK GLDEHWHV ZDV ȕ ffi Sfiff PHGLFDWLRQ DGKHUHQFHEHKDYLRUZDVȕ ffiS fiffDQGFOLQLcal outcome (using low-density lipoprotein as the FOLQLFDOWUHDWPHQWLQGLFDWRU ZDVȕ -12.93, p=0.009. All of which had significant positive effects. Conclusion Pharmacists significantly improve the medication use problems, medication adherence behavior, and low-density lipoprotein levels in patients with diabetes through their involvement in the crossfunctional team clinical care provision. It is recommended that medical institutions should include pharmacists in the clinical care team. Additionally, the results presented were only from a short-term study. Therefore, conducting a long-term study in the future to further validate the prolonged effect is recommended. Keywords: diabetes, pharmacist, adherence, behavior, clinical outcomes

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 74 PP3 Health Protocol Campaign Message Model Covid-19 At Munggu Beach Bali During Pandemic Wayan Weda Asmara Dewi*, Nufian S Febriani College of Public Health Sciences, Chulalongkorn Universiy, Bangkok, Thailand Introduction This protocol is intended for all parties without exception, from managers, owners, associations, employees or tour guides, guests or visitors, and community groups to the government in each region. The COVID-19 pandemic has provided us with an important opportunity to change our lifestyle habits and their surroundings, from how we consume tourism objects, and how we explore the natural resources in these tourist destinations. Sustainable tourism development is not only important to implement, but also must be planned for future tourism development (Windi & Wardani, 2020). Munggu Beach is a tourist area located in Munggu Village, Badung Regency, Bali. As an area that has been developed into a tourist village, Munggu Village has developed both in terms of facilities and tourist attractions, one of which is the construction of toilets in the Munggu Beach area for tourists who come to visit. Various infrastructure developments are carried out to support and support the development of tourism in this area. Munggu Beach is visited by many tourists on Saturdays and Sundays, so the tourism-aware group of Munggu Village needs to create an appropriate COVID-19 health protocol campaign message model in the area. Here is a picture of the situation at Munggu Beach. Objective Designing a COVID 19 health protocol message model campaign Methods The research method used in this study is a qualitative method (qualitative research). The process carried out in qualitative research includes the formulation of problem formulations and procedures, data collection is carried out based on the natural setting of the participants, inductive data analysis is built from general to specific themes, and finally the researcher makes interpretations of these data. Results The messages conveyed during this health protocol campaign were disseminated by highlighting the affective side or feelings felt by the community and tourists around the Munggu Beach Area, in order to achieve maximum and more optimal distribution of communication messages. The message formed can be in the form of a message that can cause a sense of alertness, anxiety, and concern for the safety and health of yourself and those closest to you, of course this form of campaign message will convey the affective feeling of the purpose of the campaign message to Munggu Beach tourists. In other words, it is hoped that tourists who enter the campaign target can understand and feel that when they ignore the existing health protocols, they not only threaten their own safety and health, but also those around them. Apart from this, of course, the media for distributing information is also an important aspect in this health protocol campaign. Campaign messages delivered through flyers are targeted to be able to reach all levels of tourists and people who currently do not have access to internet coverage, as well as social networks. This is also considered for procurement because according to Mr. Putu Suada as Chair of the Munggu Beach POKDARWIS, internet network access in the Munggu Beach area and its surroundings, often experiences internet network disturbances. Meanwhile, the use of social media

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 75 Instagram and websites is sought so that tourists from various parts of the world can easily access information about the health protocol campaign that applies to Munggu Beach before making a visit. By providing easy access to information, tourists can prepare in advance and can comply with the health protocols that have been set. Indirectly, this will reduce the risk that may be posed by tourists who do not get any information regarding the health protocols that exist on Munggu Beach. When all stages in the health protocol campaign design at Munggu Beach have been carried out, the final result is an increase in behavior change for the better related to compliance with the existing health protocols at Munggu Beach, both from local tourists and international tourists. Conclusion Campaign messages in an effort to change tourist behavior related to the COVID-19 health protocol at Munggu Beach during the pandemic can finally be conveyed through several supporting media/channels such as leaflets/flyers, Munggu Beach social media, and the Kijapali website (We Take Care of Bali's Beaches). In the end, it was felt that the procurement of this campaign was obligatory, considering the effect that it wanted to cause was urgent. The importance of delivering the message of the health protocol campaign is also as a precautionary measure and increasing vigilance in an effort to reduce the possibility of transmitting the virus to all tourists and managers when they are or are visiting Munggu Beach. With this research as an initial benchmark for conducting campaigns on health protocols more routinely at Munggu Beach, the POKDARWIS Pantai Munggu team is advised to be more careful and regular in the dissemination of existing health protocol campaign messages. Furthermore, the public and tourists who want to visit are also advised to be able to comply with all the rules that have been set, both from the management of the tourist attractions, as well as the local government. Finally, the central government's contribution to the health protocol campaign at tourist attractions is recommended to be further enhanced and emphasized, given the lack of direct contribution from the government regarding this matter, especially in several tourist destinations in Bali. Keywords: Campaign; communication model; tourism; COVID-19 Corresponding author: Nufian Febriani, Communication Science Department, Universitas Brawijaya, Tel.+6285649749998, E-mail:[email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 76 PP4 Assessing The Accuracy of COVID-19 Rapid Antigen Test (RAT) Positive by Evidence-Based Medicine (EBM) WAN-LING, CHIU* Medical Technologist, Department of Medical Laboratory, Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan Professional Specialist, Lecturer Level, University of Taipei, Taiwan Introduction From May 2021, COVID-19 began to spread around the world. Taiwan has adopted strict control strategies, including land, sea and air blockades and international exchanges, but it can still not resist the spread of the epidemic. The outbreak of COVID-19 began in March 2022. The daily number of newly confirmed patients from 20,000 to 90,000 due to high infection rates and a sharp policy shift. 2022.05.26 Changed to a positive COVID-19 Rapid Antigen Test (RAT) as a confirmed case. Objective Due to changes in Taiwan's diagnostic policy, various imported rapid antigen tests (RATs) for COVID19 significantly differ in precision and accuracy. Therefore, we wanted to use Evidence-Based Medicine (EBM) to assess the accuracy of positive COVID-19 rapid antigen tests (RATs). Methods Step 1: Ask answerable questions P Suspected COVID-19 I Rapid Antigen Test C Real-Time Polymerase Chain Reaction O Diagnosis of SARS-CoV-2 or COVID-19 Step 2: Acquire the track the best evidence ᬚ Use the evidence database to search the literature for 2018 to 2022, including published and unpublished studies results. ᬛ Enter keywords: COVID-19 diagnostic accuracy and rapid antigen detection tests. ᬜ Accessss database: Summary Clinical Texts: Best Practice (24 Items) DynaMed (2 Items) EBM Guidelines (1 Item) Systematic Guidelines: Guidelines in McMaster PLUS (0 Items) Systematic Reviews: ACP Journal Club (0 Items) McMaster PLUS (1 Item) ᬝ DynaMed database: 0 Items Trip database: Systematic Reviews 21 Items PubMed database: Systematic Reviews 13 Items ᬞ There are two articles in full compliance with the PICO; We selected one report based on the research design, the publication age, and free full-text search availability. Results Step 3: Appraise Critical Evaluation Article Title: Diagnostic Accuracy of Rapid Antigen Tests for COVID-19 Detection: A Systematic Review with Meta-analysis. Arshadi M, et al. Front Med (Lausanne). 2022. PMID: 35463027 Free PMC article. According to the 2011 Oxford Level of Evidence, the level of evidence for this systematic

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 77 review and meta-analysis is 1a. Step 4: Apply to integrate assessment with patient preferences Diagnostic Accuracy of Rapid Antigen The pooled sensitivity and specificity of the RAT were 69% (95% CI: 68±70) and 99% (95% CI: 99±99). The PLR, NLR, DOR, and AUC estimates were found to be 72 (95%CI: 44±119), 0.30 (95% CI: 0.26±0.36), 316 (95% CI: 167±590), and 97%, respectively. The AUC estimates in this report also represented a high level of test accuracy. Deek's test result indicated no likelihood of publication bias (P > 0.05). The sensitivity of RAT was slightly higher in symptomatic (65%) than in asymptomatic patients (64%). Step 5: Audit evaluates the effectiveness In many patients with suspected COVID-19, RAT can quickly confirm whether the diagnosis is approved and is less expensive than RT-PCR. The accuracy was 71% for CT>25 and 67% for CT>26. Conclusion In Taiwan, the current diagnostic criteria are confirmation of RAT positivity, expediting the diagnosis of suspected COVID-19 patients. It is faster and cheaper than using RT-PCR as the sole diagnostic criterion. However, if there are apparent symptoms of COVID-19 and the RAT is negative, further confirmation by RT-PCR is still required. Keywords: COVID-19, Evidence-Based Medicine (EBM), rapid antigen tests (RATs), rapid antigen detection tests (RADTs), RT-PCR Corresponding author: WAN-LING, CHIU, Medical Technologist, Department of Medical Laboratory, Yang-Ming Branch, Taipei City Hospital, Tel: +886989066860, E-mail: [email protected]. tw㸹[email protected] Address: 10F.-1, No. 32, Changqing 3rd St., Guishan Dist., Taoyuan City 333005, Taiwan (R.O.C.)

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 78 PP5 Characteristic Factors and Efficacy of Veins Image Acquisition Device : Preliminary Study Karuna Chuntum1 , Nuttanicha Muangmool 2 , Kanlayarat Kamlangluea3 , Samart Sinton4 1 Community Health, Faculty of Arts and Sciences, Chaiyaphum Rajabhat University, Chaiyaphum, Thailand. 2 Industrial Physics and Medical InstrumeQWDWLRQ.LQJ0RQJNXW¶V8QLYHUVLW\RI7HFKQRORJ\1RUWK Bangkok. 3 Physical Education, Faculty of Physical Education, Chaiyaphum Rajabhat University. 4 Computer Science, Faculty of Arts and Sciences Chaiyaphum Rajabhat University. Introduction In the blood draw, the venipuncture will be strapped to the arm to allow the vein to bulge so that the puncture can see the location of the blood vessel. This method requires the experience and expertise of the piercer. Blood is drawn for young patients, the elderly, obese, dark-skinned, or patients who cannot stand still and do not cooperate. As a result, it is difficult to find blood vessels and challenging to insert a needle. So the researcher built a vein imaging device. To help draw blood more safely and quickly. The vascular imaging device uses the principle that hemoglobin absorbs near-infrared light better than other tissue cells. They used a near-infrared camera Sent to Raspberry Pi, which serves as an image processing center. To be sent to the display in real time. Objective To investigate the characteristic factors that correlate with the identification of vein venipuncture sites Method 1. The development of a Veins Image Acquisition Device: In the procedure executed by this system, WKHVDPSOH¶VVNLQLVHxposed to the near-infrared (NIR) light transmitted from an 850 nm 12 W 24- LED array. Following this, Raspberry Pi 4 Model B, connected with NoIR Camera Board, is utilized as image acquisition equipment to capture the NIR illuminated skin area. Next, the raw data will be transferred to the computer to perform the filtering and processing technique before being displayed on the monitor. 2. Veins Image Acquisition Device Test: The researcher tested the device in two different sites, the arm, and forearm of 10 volunteers, for the assessment process (because the arm and forearm were used in laboratory testing and intravenous route for therapy). The subjects' demographics, such as gender, age, height, and weight for the body mass index (BMI), including skin tone, were considered as parameters. A tourniquet was not used during the experiment to maintain the nonskin contact technique. The human testing was performed per the Chaiyaphum Rajabhat University's ethical standards regarding personal data protection and a subject's confidentiality. 3. Image Processing: To increase image clarity, the researcher used the ImageJ program to use the recorded images to find the Imin and Imax values and calculate the %Contrast. 4. Statistical analysis: 4.1. Descriptive statistics. Number, percentage, mean, and standard deviation were analyzed. Of personal characteristics such as gender, age, height, and weight (To calculate the body mass index: BMI) 4.2. Pearson correlation analysis was used to analyze the relationship between BMI and %Contrast of the arm and forearm.

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 79 Results 1. After the design and construction of the vein imaging device are completed, as shown in Figure 1. Figure 1 Veins Image Acquisition Device 2. Veins Image Acquisition Device Test: 2.1. Personal characteristics of a sample of 10 people Table 1 Personal characteristics no sex age height weight BMI Interpret 1 Female 7 120 19 13.19 thin 2 male 11 132 31 17.79 thin 3 male 16 160 47 18.36 thin 4 Female 42 183 66 19.70 normal 5 male 42 156 80 32.87 very fat 6 Female 46 173 91 30.41 very fat 7 male 46 153 45 19.22 normal 8 male 54 157 72 29.21 fat 9 Female 65 170 59 20.42 normal 10 male 69 165 65 26.71 fat 2.2. Vein Imaging Device Test Results: pictures of veins on the arm and forearm No forearm arm No forearm arm 1 6 2 7 3 8 4 9 5 10 Figure 2 pictures of veins on the arm and forearm

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 80 2.3. Relationship between BMI and %Contrast Table 2 Relationship between BMI and %Contrast arm forearm p-value 0.1052 0.3870 r 0.4337 0.1040 Conclusion The correlation between BMI and % image contrast at the back of the hand and forearm was found to have very little correlation. The correlation coefficients were 0.104 and 0.438, respectively, and there was no significant difference at the 0.05 level. Keywords: Venipuncture, Near-Infrared, Image Processing, Vein-visualizing Device Corresponding author: Karuna Chuntum, Community health, Faculty of art and science, Chaiyaphum Rajabhat University, 167, Muang District, Chaiyaphum 36000, Thailand. [email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 81 PP6 Development of Veins Image Acquisition Device Nuttanicha Muangmool1 , Karuna Chuntum2 , Kanlayarat Kamlangluea3 , Samart Sinton 1 Industrial Physics and Medical InstrumHQWDWLRQ.LQJ0RQJNXW¶V8QLYHUVLW\RI7HFKQRORJ\1RUWK%DQJNRN 2 Community Health, Faculty of Arts and Sciences, Chaiyaphum Rajabhat University, Chaiyaphum, Thailand. 3 Physical Education, Faculty of Physical Education, Chaiyaphum Rajabhat University. 4 Computer Science, Faculty of Arts and Sciences Chaiyaphum Rajabhat University. Introduction The venipuncture tourniquet increases venous filling and makes the veins more prominent and easier to enter. However, this method requires the experience and expertise of the driller, especially for pediatric patients, elderly, obese people, dark-skinned people, or patients who cannot stand still and do not cooperate. As a result, finding veins and challenging to pierce a needle was difficult. Therefore, the organizer has created a vascular imaging device. To help the blood draw is safe and more quickly. The principle of the vein image acquisition device is based on hemoglobin absorbing near-infrared light more than surrounding tissue. The image was captured by a near-infrared (850 nm) camera, which Raspberry Pi controlled. The central image processing unit can display the image in real-time. Objective To develop a low-cost Vein-visualizing Device utilizing the near-infrared region (NIR) Methodology System Design ,QWKHSURFHGXUHH[HFXWHGE\WKLVV\VWHPWKHVDPSOH¶VVNLQLVH[SRVHGWRWKHQHDU-infrared (NIR) light transmitted from an 850 nm 12 W 24-LED array. Following this, Board Raspberry Pi 4 used for coding and processing, connected with Raspberry Pi Camera Module 2 NoIR (The details are as follows: sensor resolution 3280 x 2464 pixel, sensor image area 3.68 x 2.76 mm, Pixel size 1.12 µm x1.12 µm, Video mode 1080p30,720p60, and 640 x 480p60/90), it is a camera to take pictures of veins, and it is utilized as an image acquisition equipment to capture the NIR illuminated skin area. Next, the raw data will be transferred to the computer to perform the filtering and processing technique before being displayed on the monitor. (Figure 1) Figure 1 Schematic showing the operation of the device

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 82 Device design with its components 1) Assemble the camera and infrared. (Figure 2) 2) Bring the camera and the board together with the lamp. (Figure 3) 3) Connect the Raspberry Pi Camera Cable to Board Raspberry Pi 4 and Raspberry Pi Camera Module 2 NoIR. (Figure 4) 4) Connect the LCD Display to Board Raspberry Pi 4 and set the camera to take a picture of the veins and display the image on the LCD Display. (Figure 5) Figure 2 Figure 3 Figure 4 Figure 5 The algorithm development A study of Python programs to use in the operation of equipment and image processing. The command code is used to take pictures of veins. How to test device features 1) Measure the area where the device can capture the closest image. (Figure 6) Figure 6 2) Measure the area where the device can capture the furthest distance. (Figure 7) Figure 7 3) Measuring the distance from the camera to the skin nearest and farthest. (Figure 8) Figure 8

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 83 4) Test device features in normal light. (Figure 9) Figure 9 5) Experiment with photographic equipment on the arm and dorsal hand. (Figure 10) Figure 10 Result The developed Vein-visualizing Device with the NIR and reflected light principle with low energy was efficient for real-time peripheral subcutaneous vein imaging without applying a tourniquet. Conclusion In addition, it might be a guiding device in locating the vein, with a meager cost compared to the commercially available vein finders. Keywords: Venipuncture, Near-Infrared, Image Processing, Vein-visualizing Device Corresponding author: Karuna Chuntum, Community health, Faculty of art and science, Chaiyaphum Rajabhat University, 167, Muang District, Chaiyaphum 36000, Thailand. E-mail: [email protected]

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 84 PP7 Development of Natural Aerosol Sprays Against Pyrethroid-resistant Aedes Aegypti Mosquitoes, Vector of Dengue and Zika Viruses Jakkrawarn Chompoosri*, Jariya Krutbut, Chayada Khamsawads, Thanyapak Makruen, Archawin Rojanawiwat National Institute of Health, Department of Medical Sciences, Ministry of Public Health Nonthaburi 11000, Thailand Introduction The Aedes aegypti mosquito is the primary vector of dengue and Zika viruses. Although there is currently dengue vaccine with the trade name Dengvaxia available, it provides 65% protection to vaccinees. In addition, insecticide resistance in Ae. aegypti populations is reported across Thailand that causes ineffective prevention and control of the diseases. The present research pays attention to natural products used as insecticide which have low environmental impacts because of shorter latency. Methods Six study areas located in Phitsanulok, Chumphon, Chanthaburi, Kanchanaburi, Nakhon Ratchasima and Nakhon Pathom were chosen for the collection of Ae. aegypti mosquitoes in 2019 based on dengue case report between 2014 and 2018 and report of insecticide resistance in Ae. aegypti mosquitoes. The mosquito larvae were collected by droppers in 17.8-47.7% of total households per study area. The F1 female progeny derived from field-caught Ae. aegypti mosquitoes was exposed to 10 individual pyrethroid insecticides at the discriminating lethal concentration (2× LC99 for each insecticide against the susceptible Ae. aegypti laboratory mosquitoes): 0.08% Alpha-cypermethrin, 0.09% Bifenthrin, 0.674% Bioresmethrin, 0.22% Cypermethrin, 0.118% D-trans Allethrin, 0.084% Prallethrin, 0.05% Deltamethrin, 0.05% Lambda-cyhalothrin, 0.75% Permethrin, 0.076% S-bioallethrin for the insecticide susceptibility status by WHO test procedure. Mean mortality rates in the mosquitoes were analyzed and compared by one-ZD\ $129$ DQG %RQIHUURQL¶V PXOWLSOH FRPSDULVRQ WHVWV 7KH LQVHFWLFLGH susceptibility and resistance status of mosquitoes was determined according to the WHO criteria as follows: 1) Mortality between 98-100%: Susceptibility to insecticide, 2) Mortality between 90-97%: Presence of resistant genes in the mosquitoes must be confirmed and 3) Mortality less than 90%: Confirmation of existence of resistant genes in the mosquitoes. Four formulations of natural aerosol sprays; formulation 1 containing 1.0% Citral, 0.41% Citronellal, 0.52% Citronellol, 0.612% Geraniol, and 0.75% L-Linalool, formulation 2 containing 2.0% Citral, 0.41% Citronellal, 0.52% Citronellol, 0.612% Geraniol, and 0.75% L-Linalool, formulation 3 containing 4.0% Citral, 0.41% Citronellal, 0.52% Citronellol, 0.612% Geraniol, and 0.75% L-Linalool and formulation 4 containing 8.0% Citral, 0.41% Citronellal, 0.52% Citronellol, 0.612% Geraniol, and 0.75% L-Linalool were developed against the pyrethroid-resistant mosquitoes. The aerosol was sprayed at 1.0±0.1 g into glass chamber containing 20 unfed females. The mortality rate of mosquitoes was determined at 24 hours. For field evaluation, the natural aerosol was sprayed at 1.0±0.1 gram into the paper cups containing field-caught Ae. aegypti adults in six provinces covered with net fabric. The mortality rate of mosquitoes was determined at 24 hours.

The 22nd International Conference of Public Health Sciences ³Public Health and Public Health Sciences: The Challenges of changing Era´ 85 Results The results showed that Ae. aegypti mosquitoes from all six provinces were resistant to 0.75% Permethrin,  Bioresmethrin, fl D-trans Allethrin, 0.09% Bifenthrin, fl Prallethrin, 0.05% Deltamethrin,  S-bioallethrin, 0.08% Alpha-cypermethrin, 0.22% Cypermethrin and 0.05% Lambda-cyhalothrin with mean mortality rates of 9.83±12.2%, ±%, 13.50±7.0%, 16.17 ±10.71%, 17.33±8.96%, 18.33±16.04%, 19.67±7.00%, 20.50±16.78%, 22.67±21.96%, 29.50±20.01%, respectively that were significantly different  p<0 05 . The natural aerosol sprays of formulation 1, formulation 2, formulation 3 and formulation 4 provided the mean mortality rates of 27.50±6.24%, 75.83±14.48%, 91.67±8.04% and 100±0%, respectively that were significantly different  p<0.05 . The natural aerosol spray of formulation 4 provided a 100% mortality rate of Ae. aegypti mosquitoes in dengue-risk areas of six provinces. Conclusions The developed natural aerosol spray of formulation 4 was effective against the pyrethroid-resistant Ae. aegypti mosquitoes with a 100% mortality rate in both laboratory and fields. The knowledge obtained from this study was transferred by training to the people and health care workers living in all six study areas. In addition, it will be used to develop further for more effective aerosol spray products against insecticide-resistant insect vectors in Thailand. Keywordsffl Dengue, Zika, pyrethroidresistant strains, natural aerosol sprays Corresponding author: Jakkrawarn Chompoosri, National Institute of Health, Department of Medical Sciences,Tel: 02 5899850-8 ext. 99245, Fax: 02-5915449, Mobile: 081 9251224, E-mail:[email protected], [email protected]