monday poster session - oxford academic

Monday Poster Session

Poster Number: M214 Abstract #: 2328Associations between NeighbourhoodDisadvantage and Fruit and VegetableConsumption in Seven Countries.

K. E. Lamb, PhD1, K. Ball, PhD1, N. Andrianopoulos, PhD1, C.Costa, MS2, N. Cutumisu, PhD3, A. Ellaway, PhD4, C.Kamphuis, PhD5, G. Mentz, PhD6, J. Pearce, PhD7, P. Santana,PhD2, A. J. Schulz, PhD6, J. Spence, PhD3, L. E. Thornton, PhD1,F. van Lenthe, PhD5 and S. Zenk, PhD8

1Deakin University, Melbourne, Australia, 2University of Coimbra,Coimbra, Portugal, 3University of Alberta, Edmonton, AB, Canada,4Medical Research Council Social and Public Health Sciences Unit,Glasgow, United Kingdom, 5Erasmus MC, Rotterdam, Netherlands,6University of Michigan, Michigan, MI, 7University of Edinburgh,Edinburgh, United Kingdom, 8University of Illinois, Chicago, IL

INTRODUCTION: Low consumption of fruit and vegetables is a

risk factor for poor health. Some studies have shown consumption

varies across neighbourhoods, with lower intake in disadvantaged

neighbourhoods. However, findings are far from consistent. Such

inconsistencies suggest that socio-spatial inequities in diet may be

context-specific, highlighting a need for international comparisons

across contexts. Our study examined variations in fruit and vegeta-

ble consumption among adults living in neighbourhoods of varying

socioeconomic status (SES) across seven countries (Australia, New

Zealand, Canada, Netherlands, USA, Scotland, Portugal).

METHODS: This study used data from seven existing studies with

key variables assessed in adults from neighbourhoods of varying

SES. Data were harmonised and logistic regression was used to

examine associations between neighbourhood SES and binary fruit

and vegetable consumption separately, adjusting for neighbourhood

clustering and age, gender and education.

RESULTS: Analyses showed evidence of an association between

neighbourhood SES and fruit consumption (P<0.05) in New

Zealand, Canada and Scotland. Results showed increased odds of

fruit intake in higher SES areas. Results for vegetable intake were

less consistent. In Australia, New Zealand and Canada, there was

evidence of reduced odds of vegetable consumption for those resid-

ing in low SES areas, while in Portugal adults in the highest SES

areas had lowest odds of consumption. The other studies showed no

difference by SES.

CONCLUSIONS: This study highlights that associations

between diet and neighbourhood deprivation vary across countries.

Neighbourhood environments have the potential to influence

healthy behaviour and further research is required to examine the

context in which these associations arise. It may be that differential

access to resources in which this produce is available was a factor

explaining the associations in this study. However, it is important to

acknowledge discrepancies across the studies in terms of sampling,

measures, and definitions of neighbourhoods, meaning we cannot

draw strong conclusions.

Poster Number: M195 Abstract #: 2365Investigation of Deaths for Severe AcuteRespiratory Syndrome by InfluenzaA(H1N1)pdm09 (pH1N1) in Metropolitan areas ofthe State of Sao Paulo – Brazil.

R. S. Martins, BS, S. I. Junior, BS, T. R. Carvalhanas, MPH, P.

M. Ferreira, PhD and R. I. Spinola, BS

Center for Epidemiological Surveillance Prof. Alexandre Vranjac, Sao

Paulo, Brazil

INTRODUCTION: Infection with pH1N1 can quickly develop the

Severe Acute Respiratory Syndrome (SARS), resulting in respiratory

failure and as a consequence lead to death. Thus, this study was

designed to describe the deaths by pH1N1according to person, time

and place, as well factors associated with their occurrence and to

analyze the timely initiation of antiviral treatment for cases that pro-

gressed to death.

METHODS: Descriptive study of deaths in the metropolitan region

of Sao Paulo between 8th and 30th epidemiological weeks (EW)

2013, through the review of medical records.

RESULTS: This paper reviewed 131 records of deaths by

pH1N1between May and November 2013. There was a predomi-

nance of males with a median age of 49 years (ranging from zero to

89 years). The most prevalent symptoms were dyspnea, fever and

cough. The deaths occurred between 8th and 30th epidemiological

weeks, peaking at 19EW. Of the 131 cases, 81 (61.8%) deaths had a

comorbidity reported in medical records, with higher prevalence of

obesity, diabetes and respiratory diseases. Results showed from 119

deaths that used antiviral 11 deaths (9.2%) did in a timely manner.

The median time of progression to death from the onset of symp-

toms was 14 days (ranging from zero to 79 days). Thirty-six cases

(27.9%) were transferred from other health services for the hospital

where the death occurred. And from 131 deaths, 96 cases (73.3%)

required admission to the intensive care unit. Vaccination against

influenza 2013 was found in four medical records, and only one had

complete information about the date of vaccination.

CONCLUSIONS: Deaths showed clinical, treatment and person

characteristics similar to deaths that occurred during the seasonality

of the disease in previous years in Brazil, however, it was observed

that there was an early occurrence in deaths this year.

Poster Number: M93 Abstract #: 2551Temporal Changes in Small-for-Gestational AgeLive Births Associated with ObstetricIntervention in the United States.

A. Metcalfe, PhD1, S. Lisonkova, PhD2 and K. Joseph, PhD2

1University of Calgary, Calgary, AB, Canada, 2University of British

Columbia, Vancouver, BC, Canada

i134 International Journal of Epidemiology, 2015, Vol. 44, Supplement 1

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INTRODUCTION: Iatrogenic early delivery through labour induc-

tion/cesarean delivery given suspected fetal/maternal compromise is

the foundation of modern obstetrics. It has been hypothesized that

increasing rates of obstetric intervention may be responsible for

decreasing rates of small for gestational age (SGA) births at the pop-

ulation level, as fetuses that would have been delivered spontane-

ously at later gestations after a period of impaired growth are

instead being delivered earlier, prior to the onset of SGA.

METHODS: Population-based data on singleton live births born

between 24–43 weeks of gestation in the United States from 1990 to

2010 were obtained. The fetuses-at-risk approach was used to calcu-

late the gestational-age specific rates of SGA and obstetrical inter-

vention. Kitagawa decomposition was used to assess the relative

contribution of changes in the gestational age distribution and the

gestational age-specific SGA rates to the overall temporal changes in

SGA rates.

RESULTS: The rate of SGA births declined steadily from 10.1% in

1990–92 to 8.9% in 2002–04; however, starting in 2005–07, the

SGA rate slowly increased and was 9.1% in 2008–10. The changing

rates of early delivery associated with obstetric intervention mir-

rored this change, with a 45.8% increase in labour induction/cesar-

ean delivery between 1990–92 to 2002–04, followed by a 29.8%

decrease between 2002–04 and 2008–10. The Kitagawa decomposi-

tion indicated that the initial decline in SGA rates was entirely due

to changes in the gestational age distribution, whereas the increase

in the later time period was due to changes in the gestational-age

specific SGA rates. This change in the gestational-age specific SGA

rates was only observed in the term/post-term population.

CONCLUSIONS: Changing rates of obstetric intervention are asso-

ciated with temporal patterns in SGA rates. Further study is neces-

sary to elucidate the appropriate balance between early delivery at

appropriate birth weight for gestational age or later delivery of SGA

infants.

Poster Number: M166 Abstract #: 2199Association of Parental History of DiabetesMellitus with the Offspring’s Incidence isModified by Offspring’s Body Weight, Findingsfrom a Japanese Worksite-Based Cohort.

C. Wang, MS1, H. Yatsuya, PhD1,2, K. Tamakoshi, PhD3, H.Toyoshima, PhD4, K. Wada, PhD5, Y. Li, PhD1, E. H. Hilawe,MPH1, M. Uemura, MS1, C. Chiang, PhD1, Y. Zhang, MS1 andA. Aoyama, PhD1

1Nagoya University Graduate School of Medicine, Nagoya, Japan, 2FujitaHealth University School of Medicine, Toyoake-shi, Aichi-prefecture,Japan, 3Nagoya University School of Health Science, Nagoya, Japan,4Anjo Kosei Hospital, Anjo-shi, Aichi-prefecture, Japan, 5Gifu UniversityGraduate School of Medicine, Gifu, Japan

INTRODUCTION: Parental history of diabetes mellitus (DM) is a

well-known established risk factor for offspring’s DM incidence.

However, there is an indication that the association may be modi-

fied by body weight of the offspring.

METHODS: Subjects were 4446 Japanese workers (3492 men and

954 women) without a history of diabetes at baseline. Parental his-

tory of DM was self-reported separately for father and mother.

Type 2 DM (T2DM) incidence was ascertained from 2002 through

2011 by annual health check-ups and self-reports. Cox proportional

hazard model adjusted for sex, smoking (current, never, past), fre-

quency of ethanol consumption (times/week), body mass index

(BMI, kg/m2), physical activity (yes/no) was used to estimate hazard

ratios (HRs) and the 95% confidence intervals (95% CIs) of the

parental history groups. Stratified analyses by sex and overweight

(BMI >¼25 kg/m2) were performed, and the interaction was tested

by likelihood ratio tests.

RESULTS: During the follow-up, 277 cases (227 men, 50 women)

of T2DM (incidence rate: 7.94 per 1000 person-year) were

observed. The HRs (95% CIs) of diabetes history in father, mother,

and both parents compared to neither were 1.73 (1.21–2.48), 1.72

(1.11–2.67), and 3.12 (1.28–7.58), respectively. Stratified analysis

by overweight revealed that there was an increased risk of T2DM

associated with maternal history in normal weight subjects (inci-

dence rate: 5.2 vs 13.2 per 1000 person-year, HR: 2.57, 95% CI

1.61–4.12), not in overweight subjects (incidence rate: 14.2 vs 12.8

per 1000 person-year; HR: 0.86, 95% CI 0.40–1.86, P for multipli-

cative interaction¼0.014). The same pattern was not observed for

paternal history of DM and overweight.

CONCLUSIONS: Maternal history of DM increased offspring’s risk

of T2DM in normal weight subjects to a degree that was observed in

overweight subjects in middle-aged male and female workers in

Japan.

Poster Number: M229 Abstract #: 2447Knowledge, Determinants and Use of ModernContraceptives among Married Women in SabonGari Zaria, Northern Nigeria.

A. Aliyu, PhD

Ahmadu Bello University, Zaria, Nigeria

INTRODUCTION: Improving reproductive health of young

women in least developed countries requires access to safe and effec-

tive contraceptive methods. We conducted a study on knowledge,

determinants and use of modern contraceptives among married

women in Sabon Gari, Zaria-Northern Nigeria.

Objective: The study aimed to assess contraceptive knowledge, sour-

ces of information, determinants and use of modern FP.

METHODS: This was a cross sectional descriptive and health

facility-based study. Respondents were selected consecutively from

the out-patient clinic register of Comprehensive Health Centre,

ABUTH Sabon Gari, Zaria. A structured questionnaire was used to

collect data.

RESULTS: Only 309 questionnaires were finally analyzed. Mean

age of respondents was 32.8 þ/9.6 years. Majority (78%) were

Muslim, married and in monogamous union (72.2%). Knowledge

of modern FP was almost universal 97.7% even though knowledge

of two or more methods was 55.3%. Mean number of contracep-

tives known by respondents was 2. About 42.7% of respondents

have ever used any contraceptive method. The Contraceptive

Prevalence Rate (CPR) was 15.2% and the preferred FP choice

among respondents was the injectable contraceptives (5.2%).

Sources of information on FP were Nurse 42.1% and relatives/

friends 19.7%. Significant determinants of FP current use among the

respondents include the age, education, occupation, religion and

choice of the respondents (P< 0.05).

CONCLUSIONS: FP use among study participants attending the

centre is low despite good knowledge of modern contraception.

Factors associated with contraceptive use should be used by all tiers

of Government to organize sustained publicity awareness campaigns

in order to improve acceptability and usage.

International Journal of Epidemiology, 2015, Vol. 44, Supplement 1 i135

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Keywords: Contraceptives, Knowledge, Determinants, Use of

Modern FP, Northern Nigeria.

Conflict of interest: nil

Tukur Dahiru1, Adegboyega M Oyefabi1 and Ladan M Awwal2

1Departments of community medicine & 2Nursing sciences,

Ahmadu Bello University Zaria-Nigeria

Poster Number: M87 Abstract #: 2381Autoimmune Liver Disease in Alaska Native

People: Prevalence Update.

T. Choromanski, BS, B. McMahon, MD, S. Livingston, MD, E.

Ferucci, MD and J. Plotnik, BS

ANTHC, Anchorage, AK

INTRODUCTION: Autoimmune liver disease has been previously

reported to occur with a high prevalence in the Alaska Native popu-

lation. The objective to this study was to update the prevalence and

examine characteristics of autoimmune liver disease in Alaska

Native people.

METHODS: Alaska Native people consented to a population-based

study of autoimmune hepatitis (AIH) were included in the analysis.

The diagnosis of AIH was confirmed as probable or definite AIH

according to the International Autoimmune Hepatitis Group

(IAHG) criteria. Prevalence was calculated based on the 2012 year

Alaska Native user population data for Alaska Area IHS, with 95%

confidence intervals. Demographic characteristics and clinical fea-

tures were described and compared across groups.

RESULTS: 120 people with definite or probable AIH were identified

(84 alive as of 1 January 2012). Based on this number, the prevalence

of AIH Alaska Native people was 58.58/100,000 (95%

CI¼47.32–72.51). The mean age at diagnosis was 50.5 years. The

female to male ratio overall was 13:1. Of the 120 patients, 61 pre-

sented with acute hepatitis (ALT>400 10XULN). The demographic

characteristics (age, gender) were similar in those presenting with

acute vs non-acute hepatitis (P>0.05). There were a total of 38

deaths. Of those deaths 24 (63.2%) were not liver related deaths and

11 (28.9%) were liver related. The mean age at death was 63.1 (and

does not differ by liver related vs non-liver-related cause of death).

CONCLUSIONS: This study demonstrates that the prevalence of

AIH is higher than previous reports in the Alaska Native population

and much higher than reported prevalence in other populations.

Since only consented people were included in this analysis, the true

prevalence of AIH is likely even higher.

Poster Number: M26 Abstract #: 2599Lower Breast Cancer Risk among Women

Following Lifestyle Recommendations: A

Case-Control Study in Spain.

A. Castello, PhD1,2, M. Martin, PhD3, A. Ruiz, PhD4, A. M.

Casas, PhD5, J. M. Baena-Canada, PhD6, V. Lope, PhD2, S.

Antolın, PhD7, M. Ramos, PhD8, M. Munoz, PhD9, A. Lluch,

PhD10, A. de Juan-Ferre, PhD11, C. Jara, PhD12, M. A. Jimeno,

BS13, P. Rosado, PhD14, E. Dıaz, PhD15, V. Guillem, PhD4, E.

Carrasco, PhD13, B. Perez-Gomez, PhD2, J. Vioque, PhD2,16 and

M. Pollan, PhD1,2

1Instituto de Salud Carlos III. National Center for Epidemiology, Madrid,Spain, 2CIBERESP, Instituto de Salud Carlos III, Madrid, Spain, 3InstitutoDe Investigacion Sanitaria Gregorio Maranon/Universidad Complutense,Madrid, Spain, 4Institut Valencia d’Oncologıa, Valencia, Spain, 5HospitalUniversitario Virgen Del Rocıo, Sevilla, Spain, 6Hospital UniversitarioPuerta Del Mar, 11009, Spain, 7Complejo Hospitalario Universitario ACoruna, A Coruna, Spain, 8Centro Oncologico De Galicia, A Coruna,Spain, 9Hospital Clınic, Barcelona, Spain, 10Hospital Clinico Universitariode Valencia/INCLIVA, Universidad de Valencia, Valencia, Spain,11Hospital Universitario Marques De Valdecilla, Santander, Spain,12Hospital Universitario Fundacion Alcorcon, Alcorcon, Spain, 13SpanishBreast Cancer Research Group (GEICAM), San Sebastian De Los Reyes,Spain, 14Hospital Universitario Puerta Del Mar, Cadiz, Spain, 15HospitalUniversitario Virgen Del Rocio, Sevilla, Spain, 16Universidad MiguelHernandez, Sant Joan D’Alacant, Spain

INTRODUCTION: In 2007, the World Cancer Research Fund

(WCRF) and the American Institute of Cancer Research (AICR)

issued eight general and two special recommendations for cancer

prevention based on available evidence. The objective of this study

was to explore the association between the WCRF/AICR recommen-

dations and breast cancer risk.

METHODS: Epi-GEICAM is a nation-wide case-control study,

1019 cases from 23 hospitals were matched to 1019 controls by age

and municipality of residence. The cases were sub classified by

tumor subtype: 1) Estrogen Receptor(ER)þ or Progesterone

Receptor(PR)þ with Human Epidermal Growth Factor Receptor

2(HER2)-; 2) HER2þ; and 3) ER-,PR-&HER2- tumors. We con-

structed a score (0–9) based on 9 of the 10 WCRF/AICR recommen-

dations. The score was grouped in four categories (0 to <4, 4 to

<5, 5 to <6 and �6) and its association with BC risk was evaluated

using conditional logistic regression models adjusted by total calorie

intake, smoking habit, age at first delivery, education, history of

breast problems, family history of BC and menopausal status.

Multinomial logistic regression models were used to evaluate the

association of the WCRF/AICR score with each of the intrinsic BC

subtypes. These models were adjusted by age, hospital, and the same

set of potential confounders described above.

RESULTS: The women with higher score showed a decreased

risk of BC (OR[6-9]vs[0-4] ¼0.51; 95% CI¼0.36–0.73 and

ORunit-increase¼0.82; 95% CI ¼0.74–0.91; P-trend<0.001). This

preventive effect was slightly more pronounced in postmenopausal

women (OR[6-9]vs[0-4] ¼0.43; 95% CI¼0.26–0.70 and

ORunit-increase¼0.81; 95% CI¼0.71–0.93, P-trend¼0.001) and in

women with ERþ/PRþ&HER2- tumors (OR[6-9]vs[0-4] ¼0.43; 95%

CI ¼0.30–0.62 and ORunit-increase¼0.78; 95% CI¼0.70–0.87;

P-trend <0.001). However, none of the differences in the magnitude

of risk by menopausal status and intrinsic tumor subtypes was statis-

tically significant.

CONCLUSIONS: Adherence to the WCRF/AICR recommendations

for cancer prevention might reduce breast cancer risk in both pre

and postmenopausal women and all cancer subtypes.

Poster Number: M41 Abstract #: 2698The AUDIT-C: A Better Screen than the Audit toIdentify Primary Child Carers at Risk of AlcoholAbuse in the Asenze Study, Kwazulu-Natal,South Africa.

M. Taylor, PhD1, S. Kauchali, MD2, M. Chhagan, PhD3, M. Craib,MD3, C. Mellins, PhD4 and L. Davidson, PhD5


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1University of KwaZulu-Natal, Durban, South Africa, 2Department of

Health, Pretoria, South Africa, 3UKZN, Durban, South Africa, 4Coumbia

University, New York, NY, 5Columbia, New York, NY

INTRODUCTION: Alcohol abuse is a problem in South Africa and

primary carers who play a critical role in children’s health and devel-

opment may be at risk. Aim. To screen primary carers of 4–6 year

old children in KwaZulu-Natal for alcohol abuse and investigate

associated factors.

METHODS: The 10 question AUDIT was used to screen for hazard-

ous and harmful use of alcohol and the abbreviated AUDIT-C was

used to identify binge drinking. Correlates between a positive

AUDIT and AUDIT-C screen and alcohol abuse were investigated

using bivariate and multivariate analyses.

RESULTS: Of the 1434 carers, 97.8% of whom were females

16.0% (228) reported alcohol consumption, with 12.7%, (n¼182)

drinking occasionally, 2.2% (n¼32) reported hazardous use of

alcohol and 1.0% (n¼14) indicated harmful use of alcohol.

Screening using the AUDIT-C s rather than the AUDIT increased the

number of carers identified at risk of alcohol abuse through binge

drinking from 46 (3.2%) to 130 (9.1%) (P<0.005). For both the

AUDIT-C and AUDIT instruments protective factors against alcohol

abuse included no child with a serious disability, OR 0.49, (95% CI

0.27,0.89), and a monthly food budget>$US 60, OR 0.39

(0.20,0.74). A risk factor for alcohol abuse was cigarette smoking

OR 7.48, (95% CI 3.27,17.11) Other protective factors for the

AUDIT were no alcohol consumption whilst pregnant, OR 0.40,

(95% CI 0.16,0.98) and no psychiatric disorders amongst carers,

OR 0.53, (95% CI 0.29,0.96).

CONCLUSIONS: Although low rates of alcohol abuse were

detected overall, the AUDIT-C detected higher rates of problem

drinking and may be a more appropriate screen to adopt in screen-

ing carers of children for alcohol abuse.

Poster Number: M95 Abstract #: 2385Awareness and Use of Electronic Cigarettes inIndonesia, Malaysia, Qatar, and Greece – GlobalAdult Tobacco Survey 2010–13.

J. Morton1, K. M. Palipudi1, L. Mbulo1, G. Blutcher-Nelson1, S.Kosen2, T. Guat Hiong3, A. Mohamed Elkhatim Abdalla4, A.Barbouni5, E. Antoniadou5 and S. Asma1

1US Centers for Disease Control and Prevention, Atlanta, GA, 2National

Institute of Health Research and Development, Jakarta, Indonesia,3Institute for Public Health, Kuala Lumpur, Malaysia, 4Supreme Council

of Health, Doha, Qatar, 5National School of Public Health, Athens,

Greece

INTRODUCTION: Electronic cigarettes are new products that

deliver nicotine to the lungs. They have been marketed as a potential

cessation and harm reduction product but are largely unregulated.

There are concerns about their safety, particularly for youth and

pregnant women, and about their effects on eroding gains in tobacco

control by renormalizing smoking, undermining smoke-free laws,

and increasing attractiveness to youth. Limited data are available on

the use of e-cigarettes particularly in developing countries. To

address this, the Global Adult Tobacco Survey (GATS) incorporated

questions on e-cigarettes.

METHODS: GATS is a nationally representative household survey

of persons 15 years of age or older and provides a global standard

for monitoring adult tobacco use and enhancing the capacity of

countries to design, implement, and evaluate tobacco control inter-

ventions. During 2010–13, four countries conducting GATS

(Indonesia, Greece, Malaysia, Qatar) asked e-cigarette questions

about awareness (‘Have you ever heard of electronic cigarettes?’)

and current use (‘Do you currently use electronic cigarettes.?’).

These indicators were analyzed by various socio-demographic

variables.

RESULTS: Awareness of e-cigarettes was higher in the developed

countries of Greece (88.5%) and Qatar (49.0%) than the developing

countries of Malaysia (21.0%) and Indonesia (10.9%). Current use

of e-cigarettes was relatively low in all four countries (Greece 1.9%,

Qatar 0.9%, Malaysia 0.8%, Indonesia 0.3%; 815,000 total users)

and they were mostly used by current smokers. Among current

smokers, use was higher among those who were interested in quit-

ting than those who were not interested in quitting.

CONCLUSIONS: Although current use was found to be low in the

four countries, monitoring and tracking of e-cigarettes is imperative

given the health and safety concerns about this emerging product.

Systematic tracking of population awareness and use of e-cigarettes

is vital to understand the public health impact globally and to facili-

tate planning for effective public health interventions.

Poster Number: M16 Abstract #: 2498Awareness of Female Sex Workers of LucknowCity Regarding Sexually Transmitted Infections.

V. K. Singh, PhD

K G Medical University UP, Lucknow, India

INTRODUCTION: Sex is a means of livelihood either by choice or

by force for Female Sex Workers (FSW). The factors like poverty,

family pressures are factors, in addition to their lives on streets

which expose sex workers to a number of health problems especially

HIV/AIDS and sexually transmitted infections (STIs).

METHODS: It was a cross-sectional descriptive study on 288

FSWs registered with Targeted Intervention-Non Government

Organisation, selected by Simple Random Sampling, done over a

period of eight months, using a pre-designed and pre-tested inter-

view schedule.

RESULTS: The average age of FSWs was 31 years. Most of the

FSWs were illiterate, married, Hindus and of general category.

Street based FSWs were more than home based, living alone, with

friends or partners. The prevalence of STI among street based and

home based FSWs were 50.6% and 29.8%, respectively. The knowl-

edge of role of condom in prevention of STI was lacking in 30.7%

home based and 10.8% of street based FSWs. Symptoms of STI in

females enumerated by the FSWs were discharge per vaginum, geni-

tal itching, abnormal bleeding, dyspareunia, lower abdominal pain,

blisters/ulcers on genitalia, burning micturition, fever and bodyache.

Symptoms of STI in males enumerated by the FSWs were urethral

discharge, blisters or ulcers on genitalia, burning micturition, genital

itching, swollen or painful testicles, fever and bodyache. Discharge

per vaginum (48.9%) was quoted most commonly as a symptom of

STI in females while urethral discharge (23.3%) & genital ulcers

(20.8%) were quoted most commonly as symptoms of STI in males.

There was a significant difference (P-value¼0.012) between both

street based and home based groups with respect to their knowledge

regarding STI-HIV link.


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CONCLUSIONS: There is a great lack in the awareness of FSWs

regarding STI and their prevention. Special IEC activities focusing

on this group of population should be planned.

Poster Number: M201 Abstract #: 2732The Burden of Disease Due to Tuberculosis in aBrazilian Southern State.

G. C. Ferrer, MS1, I. J. Schneider, PhD2 and J. Traebert, PhD1

1University of Southern Santa Catarina, Tubarao, Brazil, 2Federal

University of Santa Catarina, Florianopolis, Brazil

INTRODUCTION: To estimate the burden of tuberculosis in the

Brazilian Southern state of Santa Catarina in 2009.

METHODS: The study was composed by data of residents in the

state and reported in the Brazilian Mortality Database and the

National Case Registry Database as confirmed cases of tuberculosis

in 2009. The Disability Adjusted Life Years (DALY) was estimated

by the sum of Years of Life Lost (YLL) and Years Lives with

Disability (YLL). The YLL was estimated by the difference between

the age of death and the standardized life expectancy, 80 years for

men and 82.5 for women. A discount rate of 3% per year was

applied. The YLD was estimated by the product of the weight of

0.271 by the disease duration of 18 months for HIV-negative cases

and 12 months for HIV-positive cases. To compensate for possible

underreporting notification, a proportion of 60% of cases and

17.7% of cases of HIV/tuberculosis was increased in the notification

data. The absolute values were transformed into rates per 100,000

inhabitants. It was observed the distribution of rates by sex, age and

health macro-regions of the state.

RESULTS: 4.446,29 YLLs were estimated generating a rate of

72.67 YLL/100,000 inhabitants. 1.197,98 YLDs were estimated

generating a rate of 19.58 YLD/100,000 inhabitants. The burden of

disease due to tuberculosis was estimated at 5.644,27 DALYs,

which generated a rate of 92.25 DALY/100,000 inhabitants. The

highest rates were found in males and in the age group of 30 to 44

and 45 to 59 years with uneven distribution by health macro-region.

The highest burden was estimated in the Planalto Norte with

179.56 DALY/100,000 inhabitants followed by the Nordeste with

167.07 DALY/100,000 inhabitants.

CONCLUSIONS: The burden of tuberculosis was concentrated in

the adult age groups with variations in the health macro-regions,

mainly in males. The use the indicator of burden of disease is recom-

mended as an appropriate parameter for the evaluation of the

uneven profile of priorities according to the burden of disease due to

tuberculosis in this State.

Poster Number: M177 Abstract #: 2378Maternal Calcium Metabolic Stress andFetal Growth.

T. O. Scholl, PhD, X. Chen, MD and T. P. Stein, PhD

Rowan University-SOM, Stratford, NJ

INTRODUCTION: It was hypothesized that it was maternal cal-

cium metabolic stress in early pregnancy, rather than sub-optimal

calcium intake or insufficient vitamin D that influenced risk of small

for gestation births (SGA), and other aspects of fetal growth. Stress

to calcium metabolism was defined by elevated intact PTH (>62

pg/ml) accompanied by very low calcium intake (<60% EAR) or

insufficient 25 (OH) D (<20 ng/ml).

METHODS: A prospective cohort study of 1116 low income and

minority gravidae at entry to care 13.8 6 5.6 weeks (mean 6 SD)

from Camden NJ.

RESULTS: The concentration of PTH depended upon circulating 25

(OH) and total calcium intake. When 25 (OH) D was insufficient

even a high calcium intake which equaled or exceeded the RDA was

unable to maintain PTH or to moderate the proportion with ele-

vated PTH. When examined one at a time, very low calcium intake

(<60% EAR), very low 25 (OH) D (<12 ng/ml) and elevated PTH

(>62 pg/ml) each had a small but significant association with birth

weight (�100 g lower). Elevated PTH was also related to birth

length and risk of SGA. Elevated PTH accompanied by insufficient

25(OH)D or very low calcium intake showed two to three-fold

increased risks of SGA (15.1% vs 7.8%, AOR¼2.23, 95% CI 1.12,

4.43 all women) as well as for those without preeclampsia (17.4%

vs 7.1%, AOR¼3.26 95% CI 1.58, 6.73) and significantly lower

birth weight(�128.5 6 49.9g), birth length(�0.6360.28cm) and

head circumference(�0.4260.21cm) even after excluding women

who developed preeclampsia. Infants born to gravidae with insuffi-

cient 25(OH) D or very low calcium intake without elevated PTH or

with elevated PTH alone were unaffected.

CONCLUSIONS: Maternal calcium metabolic stress, rather than

low calcium intake or insufficient vitamin D, has an adverse influ-

ence on fetal growth.

Poster Number: M118 Abstract #: 2570The Challenge of Using Data aboutHousehold-level Characteristics Obtained fromMultiple Informants: Experience in Rural Alaska.

L. R. Bulkow, MS1, M. G. Bruce, MD1, G. Raczniak, MD2, T.

Hennessy, MD1, D. Hurlburt, BS1, D. Bruden, MS1, J. Klejka,MD3, G. Thompson, BS1 and S. Case, BS1

1CDC Arctic Investigations Program, Anchorage, AK, 2City of New

Orleans, New Orleans, LA, 3Yukon-Kuskokwim Health Corporation,

Bethel, AK

INTRODUCTION: Data obtained by individual interviews are crit-

ical for epidemiologic research, but are subject to error. We sought

to understand the extent of discordant responses to questions about

household characteristics that were obtained from more than one

household member.

METHODS: During an investigation into a skin infection epidemic

in rural Alaska, we conducted a Knowledge-Attitudes-Behavior sur-

vey of adults in three communities. Surveys were administered in-

person from a standard questionnaire. A subset of the questionnaire

contained questions about the household (HH) unit in which the

participant resided. Since different members of one HH were sur-

veyed, we were able to compare the responses to these questions

among multiple respondents from the same HH. Differences were

assessed by means of kappa statistics (j) and intra-class correlation

(ICC). All reported j-values have P<0.001.

RESULTS: The study included 126 HH with more than one

respondent. Among the dichotomized variables the greatest agree-

ment was for questions about the presence of piped water to the HH

(j¼0.94) and use of self-hauled natural water (j¼0.82).

Substantial agreement was also seen in whether the HH contained

six or more persons (j¼0.72), or one or more children under six


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years of age(j¼0.68), and use of community laundry facilities by

the HH (j¼0.75). Less agreement was seen for presence of someone

in HH who was diagnosed with a furuncle in the last six last months

(j¼0.44) and use of self-hauled treated water (j¼0.46). Intra-class

correlation of additional variables, showed generally similar results

in frequency of laundry (ICC¼0.44, P<0.001) and water re-use

for laundry (ICC¼0.60, P<0.001), and lesser correlation for

steambath cleaning frequency (ICC¼0.10, P¼0.135).

CONCLUSIONS: The use of in-person interviews to collect house-

hold data can result in varying responses dependent on who is being

questioned. Use of alternative data sources or targeting of ideal

informants may be considered.

Poster Number: M179 Abstract #: 2613Barriers to Healthy Dietary Choice AmongstSecondary School Students in a PostConflict Country.

N. Townsend, PhD

University of Oxford, Oxford, United Kingdom

INTRODUCTION: Sri Lanka has experienced a massive demo-

graphic, environmental, economic and social transition in recent deca-

des with the 27 year civil war seen to be an important factor in this.

Over this period of time the country has undergone rapid urbanisation

leading to accompanying shifts in lifestyle and it suffers a double bur-

den of under- and over-nutrition. Current programmes in the country

focus on improving the dietary behaviour of secondary school stu-

dents. In order to do this we must first understand the barriers to

healthy dietary choice that this section of the population faces.

METHODS: Focus groups (n¼7) on the barriers to healthy dietary

choice amongst students were carried out with secondary school

principals and staff, (n¼29) and Community Resource Persons

(n¼7) in Ampara an ethnically diverse region in Sri Lanka.

RESULTS: Financial constraints were a common concern, these

encouraged longer working hours and migration by breadwinners.

Cultural misconceptions and social pressures were also prevalent,

leading students away from healthy foods due to a misunderstanding

of its effect on the body, or because it was associated with lower

social classes. The promotion of unhealthy diets occurred through

widespread advertising, but also from certain religious groups who

prompted abstinence of eating certain foods, such as meat and eggs.

A national policy was identified as the kind of support needed to

encourage the production of local crops, whilst the lack of suitable

protection for small holdings made them vulnerable to wild animals,

including elephants.

CONCLUSIONS: The barriers to healthy dietary choice amongst

secondary school students in Sri Lanka are varied, supporting the

use of multifactorial programmes to promote healthy eating. Only if

we understand these barriers and find ways to counter them can we

hope to reduce the double burden of under- and over-nutrition the

country is currently suffering.

Poster Number: M42 Abstract #: 2457The Comparative Study of Life Assets amongThailand Secondary and High School Studentsfor 2009 and 2013;Finding from the NationPositive Youth Development Survey.

S. Tripathi, MD

National Institute for Child and Family Development, Mahidol University,

Nakhon Pathom, Thailand

INTRODUCTION: The purpose of this study to compare positive

youth development power in Thailand early and mid-adolescent

which is called Life Assets. Life Assets is an originating factor, which

involves life skills and mindfulness of children and youth in their

selves and their surroundings that have influenced to their living

(family, wisdom, community and peers).

METHODS: Data from the National Positive Youth Development

survey in 2009 and 2013 were used to asses trends of Positive power

(Power of Self, Family, Wisdom, Community and Peers) among

Thailand secondary and high school students. The study randomly

selected 12,200 and 15,980 subjects of 14–18 years old in 2009 and

2013, respectively from every parts of the country: Bangkok and

Vicinity, Central Thailand, Northern Thailand, Northeastern

Thailand and Southern Thailand. The participants were scored and

Graded to calculate positive power by the Life’s Assets

Questionnaire (alpha coefficient¼0.797). Grading was categorized

from A¼ excellent (>80%), B=Good (70–80%), C=Fair (60–70%)

and F=Poor(< 60%).

RESULTS: The Positive power of the students was 68.90% (Grade

C; Fair) and 70.94% (Grade B; Good) in 2009 and 2013, respec-

tively. There were five weakest indicators: Media literacy in school,

Volunteer activity, Meaningful participation in community,

Commitment to learn and Self-confident, which were failed in 2009

while there were not any indicators failed in 2013 and all these five

indicators were scored increasing from Grade F in 2009 to Grade C

in 2013.Moreover there were 17 indicators in ‘Good’ result (Grade

B) in 2009 while in 2013 were 27 indicators.

CONCLUSIONS: The trend of Life Assets is to determine the direc-

tion in order to be a systematic formulating strategies and creative

activities in different contexts, both site-based and issue-based

accordingly for enhancing youth development and strengthen posi-

tive power.

Poster Number: M47 Abstract #: 2643Blood Lead, Mercury and CadmiumConcentrations in 1- to 4-year-old ChildrenAttending Day Care Centers in Sao Paulo, Brazil– Preliminary Results.

K. P. K. Olympio, PhD1, C. E. Fiorio, MD1, F. Barbosa Jr, PhD2,A. S. Silva, PhD3 and M. R. A. Cardoso, DrPH1

1Faculdade de Saude Publica—USP, Sao Paulo, Brazil, 2Faculdade deCiencias Farmaceuticas de Ribeirao Preto—USP, Ribeirao Preto, Brazil,3Pan American Health Organization (PAHO-WHO), Washington, DC

INTRODUCTION: In Brazil, there are scarce data on metals con-

tamination, especially for the more vulnerable population composed

by preschool children. Information on the prevalence of the expo-

sure to metals is essential to formulate public health policies. The

aim of this cross-sectional study was to estimate the blood lead (Pb),

cadmium (Cd) and mercury (Hg) levels in children attending Day

Care Centers (DCCs) in Sao Paulo, Brazil.

METHODS: This study included 50 DCCs, totalizing 2,463 chil-

dren aged 1-4 years. Venous blood samples were analyzed by induc-

tively coupled plasma mass spectrometry with quadrupole (q-ICP-

MS) and dynamic reaction cell (DRC-ICP-MS). Prior to analysis by

ICP-MS, 200 mL of each blood sample was diluted 1:50 into a

15-mL polypropylene FalconVR tube with a solution containing


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0.01% (v/v) TritonVR X-100, 0.5% (v/v) nitric acid and 10 lg L�1

of Rh as the internal standard. Descriptive statistics was used.

RESULTS: We present here the preliminary results of 354 children

attending 9 DCCs. Geometric means for blood Pb, Cd and Hg levels

were: 15.70 mg/L (95% CI 14.95–16.54 mg/L); 0.30 mg/L (95% CI

0.28–0.33 mg/L) and 0.76 mg/L (95% CI 0.68–0.84 mg/L),

respectively.

CONCLUSIONS: These preliminary results showed that, consider-

ing the Fourth National Report on Human Exposure to

Environmental Chemicals by CDC (2013), in Brazilian children, the

blood Pb concentrations are very similar to those found in the U.S.

children, but the blood levels are higher for Cd and Hg. However, it

should be emphasized that these data included only a subsample of

the whole study and it is necessary to wait for the results of the

whole epidemiological study to know if the Brazilian children are at

risk of these metals poisoning.

This study was approved by Ethical Committee (CEP-USP,

?128.943) and funded by FAPESP (Grants 2011/13076-0, 2011/

23272-0 and 2012/21840-4).

Poster Number: M172 Abstract #: 2648Maternal Dietary Patterns and Risk ofPostpartum Weight Retention.

M. Drehmer, PhD1, M. A. A. Nunes, PhD1, A. P. Pinheiro, PhD1,

J. A. Ahlert, MS1, C. A. Melere, MS1, J. A. Hoffmann, MS1 and

M. I. A. Schmidt, PhD2

1Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,2Federal University of Rio Grande do Sul, Porto Alegre, Brazil

INTRODUCTION: Pregnancy has been suggested to be one of the

causes for developing overweight and obesity in women. Unhealthy

dietary habits promote excessive weight gain that predisposes to

postpartum obesity.

OBJECTIVE: This study examined the association between dietary

patterns in pregnancy and five years postpartum weight retention

(PPWR).

METHODS: Cohort study. Pregnant women (n 391), enrolled in

primary care clinics in Southern Brazil, were followed during for

five years postpartum. The food intake assessment in pregnancy was

performed using the food frequency questionnaire (FFQ). Dietary

patterns were identified by cluster analysis. In baseline, women self-

reported their prepregnancy weight. Five years after pregnancy, they

self-reported their current weight. Poisson regression models with

robust variance were built in order to measure the effect of dietary

patterns during the pregnancy period on five years PPWR. We

defined substantial postpartum weight retention as retaining over 10

kg above the prepregnancy weight.

RESULTS: Weight retention occurred in 35.2% (n¼139). The

mean (6SD) PPWR was 8.2 Kg 6 9.1. At five years after pregnancy,

26% (n¼101) were obese and 39.1% (n¼152) were overweight.

Women with a restrict dietary pattern had a higher risk of PPWR

compared to those who presented a varied consumption pattern (RR

1.61, 95% CI 1.14 to 2.25). In fully adjusted model, the restrict diet-

ary pattern was still associated with PPWR (RR 1.39, 95% CI 1.00

to 1.94), when we controlled for gestational weight gain, prepreg-

nancy body mass index, age, total parity and socio-economic status.

CONCLUSIONS: Important maternal weight retention occurred in

these women in five years postpartum. The restricted pattern, char-

acterized by a higher consumption of sweet cookies, whole milk,

yogurt, French fries, snacks, soft drinks, natural juice, powdered

chocolate and ice cream, was associated with more weight retention

and obesity risk in the period following childbirth.

Poster Number: M133 Abstract #: 2483Blood Pressure Pattern and HypertensionRelated Risk Factors in an Urban Community inSouthwest Nigeria: The Mokola HypertensionInitiative Project, Ibadan, Nigeria.

I. O. Ajayi, PhD, A. Asinobi, MD, N. Afolabi, MS, I. Ayede, MD,S. Kadiri, MD, E. A. Bamgboye, PhD and M. Soyannwo, MD

College of Medicine, University of Ibadan, Ibadan, Nigeria

INTRODUCTION: An epidemic of premature cardiovascular mor-

tality and early appearance of hypertension, a risk factor, is develop-

ing in Nigeria. To plan effective life course approach to prevention,

the magnitude of the problem across all ages needs to be ascertained.

METHODS: House to house baseline total population survey was

carried out in Mokola, a multi-tribal community, inhabited mainly

by low/middle class families. Interview with semi-structured ques-

tionnaire and anthropometric measurements of 5540 persons aged

�3 years was carried out. Average of three blood pressure readings

was used. Hypertension (HTN) was defined as BP �140/90mm Hg

in any individual or �95 percentile for gender and age in children.

Obesity was determined using International Obesity Task Force

classification. Logistic regression was used to examine the associa-

tion of body mass index, age, gender and hypertension.

RESULTS: Children, adolescents and adults (�18 years) constituted

17.1%, 14.6% and 68.3% of the subjects, respectively. Prevalence

of hypertension was 27.3% in adults and 12.8% in children<18

years. Isolated systolic hypertension was found in 20.0% adults and

8.3% children while isolated diastolic HTN was found in 3.4%

adult and children, respectively. Obesity was present in 13.1% chil-

dren and 23.2% adults. Among adults, 8.3% ever smoked, 27.0%

used alcohol and 42.4% mentioned they engaged in regular exercise.

Significant association (P<0.001) was found between being male,

widowed, employed, obese and use of alcohol and tobacco and

hypertension in adults. Children obese were 1.03–2.20 times and

adult overweight and obese were 1.7–2.5 and 1.9–2.7 times, respec-

tively more likely to be hypertensive. Being male adult and above

18 years were 1.1–1.5 times and 2.2–3.0 times, respectively, more

likely to be hypertensive.

CONCLUSION: Both modifiable and non-modifiable risk factors

were found associated with the high prevalence of hypertension in

this population. Life course and community based approach to

intervention with focus on lifestyle is suggested to stem the increas-

ing trend in hypertension.

Poster Number: M181 Abstract #: 2329The Effect of Periodontal Therapy on CarotidIntima-Media Thickness among AboriginalAustralians: A Randomised Controlled Trial.

K. Kapellas, BS1,2, L. J. Maple-Brown, PhD2,3, L. M. Jamieson,PhD1, L. G. Do, PhD1, K. O’Dea, PhD4, A. Brown, PhD5, D. S.Celermajer, PhD6, G. D. Slade, PhD7 and M. R. Skilton, PhD6

1The University of Adelaide, Adelaide, Australia, 2Menzies School of

Health Research, Darwin, Australia, 3Royal Darwin Hospital, Darwin,


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Australia, 4University of South Australia, Adelaide, Australia, 5South

Australian Health & Medical Research Institute, Adelaide, Australia, 6the

University of Sydney, Sydney, Australia, 7University of North Carolina at

Chapel Hill, Chapel Hill, NC

INTRODUCTION: Periodontitis is characterised by chronic

inflammation of the tissues around teeth. Evidence from observatio-

nal cohort studies and non-randomized trials suggest a possible asso-

ciation between periodontitis and atherosclerotic vascular disease.

Currently, a causative relationship is unsupported due to a lack of

evidence from randomized trials.

METHODS: This parallel-group, randomised, open label clinical trial

enrolled 273 Aboriginal Australians aged �18 years with periodonti-

tis. Intervention participants received full-mouth non-surgical perio-

dontal scaling during a single, untimed visit while the control group

received no treatment. Pre-specified primary endpoints measured vas-

cular health; change in pulse wave velocity (PWV) at 3-months and

change in mean & maximum carotid intima-media thickness (cIMT)

at 12-months following periodontal therapy. Within-group change in

cIMT was assessed using paired-t-test. Primary analysis was based on

the complete-case approach using ANCOVA.

RESULTS: Endpoints could be calculated for 169 participants with

follow-up data at 3-months and 168 at 12 months. Maximum cIMT

decreased after 12 months in the intervention group (mean

reduction¼�0.023 mm [95% CI �0.038, �0.008]), but not in the

control group (mean increase¼0.002 mm [95% CI �0.017,

0.022]). The difference in change in maximum cIMT between

groups was statistically significant (-0.026 mm [95% CI �0.048,

�0.003], P¼0.03). By contrast, there were no significant differen-

ces in mean cIMT (�0.013 mm [95% CI �0.030, 0.004], P¼0.134)

or PWV (mean difference 0.06 m/s [95% CI �0.17 to 0.29],

P¼0.594). The intervention improved periodontal health at 3-

months post-intervention (mean pocket depth: �0.16 mm [95% CI

�0.25, �0.07], P¼0.0008) treatment versus control but not at 12-

months (mean pocket depth: �0.09 mm [95% CI �0.19, 0.01],

P¼0.08).

CONCLUSIONS: Periodontal therapy reduces the severity of sub-

clinical atherosclerosis but not PWV among Aboriginal Australians

with periodontal disease. This suggests a possible causal link

between periodontal disease and atherosclerosis.

Poster Number: M13 Abstract #: 2449Men Who Have Sex with Men (MSM) in Kisumu,Kenya: Membership in a Support Group andKnowledge of HIV Risk Factors.

D. A. Okall, BA1, F. O. Otieno, MPH1, M. O. Nyikuri, MA1,

L. A. Mills, MD2, F. Hardnet, MPH2, K. Turner, MPH3 and

D. A. Gust, PhD2

1KEMRI/CDC Research and Public Health Collaboration, Kisumu, Kenya,2Centers for Disease Control and Prevention, Atlanta, GA, 3The

University of Georgia, Athens, GA

INTRODUCTION: Men who have sex with men (MSM) are an

important yet marginalized population for HIV prevention in

Africa. Social organizations provide psychosocial benefits to mem-

bers of marginalized groups, such as MSM in Africa, and can serve

as a source of accurate health information. Study objectives were

to: 1) assess determinants of MSM membership in support groups in

Kisumu, western Kenya, 2) describe the percentage of MSM who

could correctly identify specific risk factors for HIV, and 3) identify

unmet needs of MSM and their support groups.

METHODS: We conducted a two-phase study (in-depth interviews

and a survey) of MSM, 18–34 years of age, and living in Kisumu,

Kenya. Participants were recruited through a multi-faceted strategy

using 1) link persons: persons with specific knowledge of MSM pop-

ulation 2) peers: MSM referring other MSM and 3) direct staff con-

tact with MSM. Exact logistic regression models were used for

survey data analysis.

RESULTS: Approximately half (27/51) of survey respondents

reported belonging to an MSM support group. Odds of belonging to

support groups were greater for older men [aged 24–34 versus

18–23 years (OR¼5.20; CI¼1.27–26.66)]. Most respondents

(94.1%) correctly reported lack of condom use during vaginal sex as

a risk factor for HIV, but slightly fewer (82.4%) recognized lack of

condom use during anal sex as an HIV risk factor. There was no

association between knowledge of HIV risk factors and being in an

MSM support group. Among the 15 interviewees, the following

were noted as greatest needs: health information (n¼5), safe lubri-

cants (n¼4), condoms (n¼3), health care facility or MSM friendly

health services (n¼3), and advocacy (n¼2).

CONCLUSIONS: Kenyan MSM have developed support groups

and have unmet needs for services. Partnering with MSM support

groups offers an opportunity for organizations to reach MSM with

accurate health information, provision of safe sexual lubricants,

condoms and other health and social services.

Poster Number: M20 Abstract #: 2677Body Mass Index and Weight Change in Menwith Prostate Cancer: Progression and Mortality.

S. E. Bonn, MS1, F. Wiklund, PhD1, A. Sjolander, PhD1, R.Szulkin, MS1, P. Stattin, PhD2, E. Holmberg, PhD3, H. Gronberg,PhD1 and K. Balter, PhD1

1Karolinska Institutet, Stockholm, Sweden, 2Umea University, Umea,Sweden, 3Sahlgrenska Academy at University of Gothenburg,Gothenburg, Sweden

INTRODUCTION: Body Mass Index (BMI) is a modifiable life

style factor that has been associated with an increased risk of fatal

prostate cancer and biochemical recurrence. The main purpose of

the present study was to investigate the association between the

exposure BMI at the time of a prostate cancer diagnosis and weight

change after diagnosis, and the outcomes of prostate cancer progres-

sion and mortality in a large cohort study.

METHODS: Data from 4376 men diagnosed with clinically local-

ized prostate cancer between 1997 and 2002 were analyzed. BMI

and weight change were self-reported in 2007. Hazard ratios (HRs)

with 95% confidence intervals (CIs) were estimated using Cox pro-

portional hazards models.

RESULTS: Progression was experienced among 639 (14.6%) of the

study participants, and in total 450 (10.3%) deaths of any cause and

134 (3.1%) prostate cancer specific deaths were recorded during fol-

low-up. Obese men had a 41% increased rate of overall mortality

compared to normal weight men (HR: 1.41, 95% CI 1.02–1.94). A

weight loss of greater than 5% after diagnosis doubled the rate of

overall mortality compared to maintaining a stable weight (HR:

2.01, 95% CI 1.50–2.69), while a weight gain greater than 5% was

associated with an almost 60% increased rate of prostate cancer spe-

cific mortality (HR: 1.59, 95% CI 1.00–2.53).


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CONCLUSIONS: Being obese was associated with an increased

rate of overall mortality and gaining weight after a prostate cancer

diagnosis was associated with an increased rate of prostate cancer

specific mortality.

Poster Number: M3 Abstract #: 2729The Effects of Changes in Disability and LimitingLong-Term Illness on Well-Being among OlderUK People.

C. L. Booker, PhD

University of Essex, Colchester, United Kingdom

INTRODUCTION: Increasing age is associated with increased dis-

ability, however well-being remains fairly stable. This study investi-

gated how changes in disability and limiting long-term Illness

(LLTI) are associated with subjective well-being (SWB) in an older

people.

METHODS: Data come from waves 1–3 of Understanding Society:

The UK Household Panel Study. Adults 65 years and older

(n¼7166) were included. SWB was measured using the GHQ-12 and

life satisfaction. Limiting long-term illness (LLTI) and number of dis-

abilities at each wave were the measures of disability. Change scores

were created to model change in disability between waves. Linear

regression model was used; effect of partner’s LLTI was also tested.

RESULTS: Onset of a LLTI and having a LLTI over all three was

associated with poorer well-being. Loss of a LLTI or changes in

LLTI status across waves was associated with increased anxiety but

not in changes to life satisfaction. Participants who had an increase

in the number of disabilities had significant declines in both GHQ

(b=�0.56, 95% CI=�0.76, �0.36) and life satisfaction (b=�0.14,

95% CI =�0.22, �0.06). Onset or continuity of partner’s LLTI was

associated with increased GHQ among men. Women experienced a

decreased in anxiety with the loss of their partner’s LLTI (b¼0.68,

95% CI¼0.04, 1.32). There were no effects of changes to partner’s

LLTI status on life satisfaction; additionally changes to the number

of partner’s disabilities did not have a significant effect on GHQ or

life satisfaction

CONCLUSIONS: The findings from this study suggest that onset and

continuing LLTI have larger effects on SWB than variable changes

and loss of LLTI status. Changes to partner’s LLTI status do have

effects on own well-being, and these effects differ by gender.

Poster Number: M101 Abstract #: 2802Body Mass Index is Associated with MaternalLines but Height is Heritable Across Family Linesin the Lifeways Cross-Generation Cohort Studyin Republic of Ireland.

G. E. Kelly, PhD1, C. Murrin, PhD2, K. Viljoen, MD1, J. O’Brien,PhD2 and C. C. Kelleher, MD1

1University College Dublin, Dublin, Ireland, 2University College Dublin,Dublin 4, Ireland

INTRODUCTION: Increasing levels of body mass index (BMI) in

populations and high levels of obesity are problems associated with

modern societies but heritability patterns across generations and

over the life-course are not fully understood. In the Lifeways familial

cohort study, spanning three generations, patterns across families

associated with body mass index (BMI) were examined.

METHODS: This longitudinal study collected height and weight

data at three ages of the index child, birth, age five and age nine.

There were 924 children with measurements at birth, with 506

mothers, 452 fathers, and grandparents, 323 MGM, 205 MGF, 197

PGM and 128 PGF. Parents’ measures were collected when child

was aged five, and grandparents’ at child’s birth. Data were again

available for 568 children aged five and 298 at age nine. A mixed

model analysis at three time points, adjusted for generation and age,

produced correlations between family members.

RESULTS: At all three children’s ages there were strong correlations

with BMI of the mother and to a lesser extent the maternal grand-

mother, while for girls there was an association with the paternal

grandmother at ages zero and five. There was an association also

with father and his own mother. There were no evident associations

with BMI of grandfathers. In contrast, height of the child was

strongly associated with all family members at age five, but at birth

and age nine only with the parents and paternal grandfather.

CONCLUSIONS: The results suggest that BMI is predominantly

associated either with intrauterine development, or inherited

through the X chromosome, or both, while height is a more complex

trait, with genetic influences of parents and that of paternal grandfa-

ther persisting through to age nine.

Poster Number: M171 Abstract #: 2326Body Perception Index in Children andAdolescents in Deprived Neighborhood in Brazil.

S. R. Gama, MPH1, L. Cardoso, PhD2, A. Fischer, MPH2 and M.Carvalho, PhD2

1Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, 2Oswaldo Cruz

Foundation, Rio de Janeiro, Brazil

INTRODUCTION: Obesity is one of the most important health

problems, particularly in developing countries and poor popula-

tions. Besides, tackling obesity related behavior has not been suc-

cessful in most intervention policies and recent studies focus on

adolescents and children, considered more adaptable. However, to

design an acceptable intervention, perceived body image is a valua-

ble tool to better understand personal drives towards a behavior

change. Our aim is to compare body perception index (BPI) and

WHO body mass index classification (BMC) for children and ado-

lescents in low income neighborhood.

METHODS: A questionnaire including socioeconomic, health

related behavior and perceived body image and anthropometric

measurements were applied to 353 individuals from five to 19 living

in a slum in Rio de Janeiro/Brazil. Analysis was stratified by pub-

erty. The outcome variable is the difference between BMC and BPI

(both aggregated in four categories: underweight, adequate, over-

weight and obesity), covariates included mother’s education, moth-

er’s BMC, family structure and domestic appliances.

RESULTS: Twelve per cent of children and 17% of adolescents were

classified as overweight/obese. The profile of post-pubertal individuals

presented a trend in the comparison between BMC and BPI towards

larger images, especially in women (66% BPI>BMC). In children the

outcome was less skewed towards higher BPI, 12% classifying them-

selves in lower classes then the objective measurements. In the regres-

sion models for post-pubertal individuals, sex (female) was associated

with BPI>BMC. In children, no covariate was significant.

CONCLUSIONS: In children, the BPI is probably influenced by

family opinion. In low income areas, obesity perception in older


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people does not value thin bodies. However, in adolescents the opin-

ion of pairs are more important, and the media, with all extreme val-

orization of skinny top-models. Public health intervention on

behavior needs to address what is socially valorized, carefully to nei-

ther accept inaccessible beauty standards, and consequent inadjust-

ability, nor to under-valorize excess weight in families context.

Poster Number: M170 Abstract #: 2600The Impact of Folic Acid Food Fortification onGlobal Incidence of Neural Tube Defects:Systematic Review, Meta-Analysis and Estimateof Preventable Cases.

M. Brinkhof, PhD1,2, S. Meier, MS1, J. Chamberlain, MS1,2 andL. Mader, MS1,2

1Swiss Paraplegic Research, Nottwil, Switzerland, 2University of

Lucerne, Lucerne, Switzerland

INTRODUCTION: Folic acid intake has been proven to reduce the

risk of neural tube defects (NTDs), including spina bifida and anen-

cephaly, which belong to the most common birth defects, occurring

in approximately 1/1000 births. Despite this evidence, folic acid

food fortification (FAFF) has not been universally adopted due to

concerns regarding adverse health effects; concerns which have been

largely disproven in recent research.

Objective: To assess the global impact of FAFF on the incidence of

NTDs and to estimate the number of potentially preventable NTD

cases through implementation of FAFF worldwide.

METHODS: A systematic literature search identified studies

reporting NTD incidence rates (IR) (n¼163). Included studies were

assessed for quality according to the Centers for Review and

Dissemination (CRD) guidelines. A random-effects meta-analysis

was conducted to estimate the global IR of NTD without FAFF, and

the effect size of FAFF. In a multivariate meta-regression analysis we

determined if pre-FAFF incidence rates can predict the effect size of

FAFF in the corresponding populations. The number of cases with

NTDs that could be prevented globally through worldwide manda-

tory FAFF was calculated using birth data obtained from the United

Nations population division.

RESULTS: Incidence of NTDs among studies including only live

births ranged between 3.8/10,000 (United States) to 82.1/10,000

(India) with an overall IR of 14.1/10,000 (CI¼12.3–16.1). FAFF

reduced the incidence of NTDs by 37% (IR Ratio: 0.63

CI¼0.57–0.69; I2¼89.3%). The IR before FAFF was significantly

associated with the effect size of FAFF (P¼0.03). We estimate, using

recent world population data and information on countries legislation

to mandate FAFF, roughly 70,000 preventable births with NTDs.

CONCLUSIONS: Recent research has shown the benefits of FAFF

to outweigh the possible risks. Our results suggest that FAFF would

prevent a large number of NTD cases, especially in low income

countries, and that worldwide adoption of mandatory FAFF should

be considered.

Poster Number: M28 Abstract #: 2654Breast Cancer Prevalence in Australia: PredictingFuture Health Care Needs.

X. Q. Yu, PhD1,2, C. Kahn, BA1, Q. Luo, MS1 and D. L. O’Connell,PhD1,2,3,4

1Cancer Council New South Wales, Sydney, Australia, 2The University of

Sydney, University of Sydney, Australia, 3University of New South Wales,Sydney, Australia, 4University of Newcastle, Newcastle, Australia

INTRODUCTION: Breast cancer places a heavy burden on the

Australian healthcare system, but information about the actual num-

ber of women living with breast cancer and their current or future

health service needs is limited. We used existing population-based

data and innovative statistical methods to address this critical

research question in a well defined geographic region.

METHODS: Breast cancer prevalence was estimated from cancer

incidence and follow-up data from the population-based New South

Wales (NSW) central cancer registry (1994–2007) of Australia using

the PIAMOD software (Prevalence and Incidence Analysis MODel).

Prevalence for 2008–17 was projected based on the modelled inci-

dence and survival and then divided into phases of care prevalence

according to the different stages of the survivorship trajectory.

RESULTS: It is estimated that the number of women in NSW living

with a breast cancer diagnosis will increase by approximately 31%,

from 51,264 in 2007 to 67,291 by 2017. The majority of these

breast cancer survivors will require continued monitoring (33,017)

or be long-term survivors (27,696). About 9.5% will require active

treatment (either initial therapy, or treatment for recurrence or sec-

ond cancer) and 2% will need end of life care due to breast cancer.

CONCLUSIONS: Extrapolating these projections to the national

Australian population would equate to 207,050 women living with

breast cancer in Australia in 2017, many of whom will require active

treatment or post-treatment monitoring. Thus, careful planning and

development of a healthcare system able to respond to this increased

demand is required.

Poster Number: M116 Abstract #: 2728Metropolitan Area Socioeconomic Status andDepression—A Multilevel Study.

Y. H. Wu, MS and N. L. Fleischer, PhD

University of South Carolina, Arnold School of Public Health, Columbia, SC

INTRODUCTION: Depression is one of the most common mental

illnesses worldwide, affecting 3.2% of the world’s population annu-

ally. Lower individual-level socioeconomic status (SES) is associated

with higher levels of depression. However, it is not clear how the

broader social environment affects mental health. The aim of this

study is to explore the association of SES at the metropolitan statisti-

cal area (MSA) with depression in the U.S., with particular attention

to education, income, and employment.

METHODS: We used the 1999 National Health Interview Survey,

which was the most recent year that used the Composite

International Diagnostic Interview Short Form to measure depres-

sion. Census data from 2000 were used to measure three MSA-level

markers of SES: % of population 25 years and over that had less

than high school education, % of population 16 years and over that

was unemployed, and % of households with income<$20,000. We

used generalized estimating equations to investigate the association

between MSA-level SES markers on depression, after controlling for

individual-level covariates.

RESULTS: 16,402 adults with complete information on depression

and MSA-level SES were included in the analysis. The annual preva-

lence of depression was 6.0%. MSA-level markers of education

(OR¼1.01, 95% CI¼0.99, 1.04) and income (OR¼1.01, 95%

CI¼0.98, 1.04) were not associated with depression. However,


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individuals living in MSAs with a higher percentage of unemployed

people had lower levels of depression (OR¼0.95, 95% CI¼0.92,

0.98).

CONCLUSIONS: Our results suggested that MSA-level education

and income were not associated with depression, while higher MSA-

level unemployment was associated with less depression. The unex-

pected result for MSA-level employment, and the null results for the

other SES markers, may be due to a high amount of missingness for

MSA-level information, or that the MSA level might not be the

most relevant geographic area when considering individual-level

depression.

Poster Number: M105 Abstract #: 2162Modelling Height in Adolescence: A Comparisonof Methods for Estimating the Age at PeakHeight Velocity.

A. Simpkin, PhD1, A. Sayers, MS1, H. Goldstein, PhD1, M. S.

Gilthorpe, PhD2, J. Heron, PhD1 and K. Tilling, PhD1

1University of Bristol, Bristol, United Kingdom, 2University of Leeds,

Leeds, United Kingdom

INTRODUCTION: Accurate assessment of maturational status is

an important feature in many analyses involving children and ado-

lescents, and maturity is frequently used as an outcome, exposure,

or to control for confounding. Currently there are a variety of differ-

ent methods which can be used to assess maturity, including the age

at peak height velocity (PHV). However, there are many different

ways to estimate age at PHV.

METHODS: Using a simulation study we investigated five different

methods of modelling adolescent growth, and estimating the age at

PHV. Methods included; central differencing, the Preece-Baines

growth model, multi-level models with fractional polynomials,

SITAR, and PACE. We explored the effect of measurement error,

sample size, frequency, and measurement balance on the estimates

of age at PHV and (where available) the confidence intervals and

coverage around these estimates.

RESULTS: The SITAR and Preece-Baines growth model were

unbiased in the majority of experimental scenarios, however model

convergence is problematic, especially for SITAR, when measure-

ment error is large and measurements are infrequent. Nearly all

methods demonstrated strong correlations (r>0.9) between true

and estimated age at PHV.

CONCLUSIONS: The use of parametric growth models to identify

the age at PHV is challenging, and despite their quantitative appeal,

substantial bias and variability can occur.

Poster Number: M92 Abstract #: 2509Can large but Highly Selected PopulationSurveys Provide Valid Information on theDescriptive Epidemiology and Associations ofCommon Health Conditions? An Analysis of UKBiobank Data on Chronic Pain.

G. J. Macfarlane, MD1, M. Beasley, MS1, B. H. Smith, MD2, G.

T. Jones, PhD1 and T. V. Macfarlane, PhD1

1University of Aberdeen, Aberdeen, United Kingdom, 2University of

Dundee, Dundee, United Kingdom

INTRODUCTION: Large-scale epidemiological studies to investi-

gate genetic and environmental influences on disease often have very

low participation rates. We aimed to determine the extent of selec-

tion bias within one such study, UK Biobank. The focus of the inves-

tigation was chronic pain and the extent to which this study

replicated information on prevalence and associated factors deter-

mined from previous studies.

METHODS: Persons aged 40–69 years across Great Britain, were

invited to take part in UK Biobank between 2006 and 2010. 9.2 mil-

lion invitations were sent and 5.5% participated. Participants com-

pleted questionnaires on health and lifestyle and were asked about

pain which ‘interfered with usual activities during the past month’

and if present, site(s) and duration. Pain was considered chronic if

present for>3 months. Exposures measured included psychosocial

factors (visiting a GP for ‘nerves, anxiety or depression’, the number

of episodes of depression, adverse life-events in the previous two

years). These factors have been strongly associated with pain in pre-

vious studies. Prevalence rates were directly-adjusted for the UK

population.

RESULTS: 498,071 participants provided valid answers. Prevalence

of chronic pain was 42.9% (99% CI 42.7–43.1). Prevalence was

higher in females (45.7% vs 40.0%) and the most common sites

were: back (prevalence 17.4%), knee (15.7%), shoulder/neck

(15.4%) and headache (9.7%). Prevalence increased with lower

income but only varied to a small extent by age-group. Those who

had consulted a GP for depression were more likely to report

chronic pain (Relative Risk (RR) 1.36 99% CI 1.34–1.37) and risk

increased with increasing number of episodes (P for trend <0.001).

There was a strong relationship between chronic pain and number

of recent adverse life events in the past two years (>3 vs 0 events

RR 1.70, 1.67-1.74).

CONCLUSIONS: Despite very low participation, UK Biobank has

produced estimates of chronic prevalence very close to those

reported from smaller, higher participation, chronic pain studies.

This suggests, at least for common symptoms, that there is low selec-

tion bias. It has also replicated previously demonstrated associations

with psychosocial factors but produced more robust estimates.

Poster Number: M182 Abstract #: 2764The Influence of Oral Microflora on Oral HealthAmong a Sample of Portuguese Adolescents.

C. M. Pereira, PhD1, N. J. Veiga, MPH2, O. P. Amaral, PhD1, M.

Baptista, MS1, C. Resende, PhD3, L. Cirnes, PhD3, J. C.Machado, PhD3 and I. Bastos, MD2

1CI&DETS, Viseu, Portugal, 2Universidade Catolica Portuguesa, Viseu,

Portugal, 3IPATIMUP, Porto, Portugal

INTRODUCTION: The oral cavity is inhabited by hundreds of bac-

terial strains that play vital roles in maintaining oral health or in

shifting to a diseased state such as dental caries. The aim of this

study was to determine the prevalence of salivary Streptococcus

mutans, Lactobacillus and Actinobacillus actinomycetemcomitans

and the relationship with the decayed, missing and filled teeth scores

(DMFT scores) among Portuguese adolescents.

METHODS: An observational cross-sectional study was designed

including a final sample of 447 adolescents aged between 12 and 19

years old, attending a public school in Satao, Portugal. A self-admin-

istered questionnaire with questions about socio-demographic varia-

bles and oral health behaviours was filled out by the adolescents.


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Clinical examination of oral health status was carried out in order

to determine DMFT scores. Saliva collection was accomplished by

the passive drool method and the identification of the bacterial

strains was accomplished using the Polymerase Chain Reaction

technique.

RESULTS: The prevalence of Streptoccoccus mutans in the sample

studied was 80.8%, of Lactobacillus was 99.5% and of

Actinobacillus actinomycetemcomitans was 15.2%. The presence of

Streptococcus mutans was associated with gender (male¼76.1% vs

female¼83.6%, P¼0.04) and history of dental pain at least once in

their lives (77.3% vs 87.8%, P<0.01). The presence of

Actinobacillus actinomycetemcomitans was associated with age

(<15yrs¼12.3% vs �15yrs¼20.3%, P¼0.03) and residence area

(rural¼18.2% vs urban¼11.0%, P¼0.04). No significant statisti-

cal differences were found between the DMFT scores and the bacte-

rial strains Streptoccoccus mutans (0¼78.9% vs 1–3¼80.9% vs

�4¼84.1%, P>0.05), Lactobacillus (0¼100.0% vs

1–3¼100.0% vs �4¼99.4%, P>0.05) and Actinobacillus actino-

mycetemcomitans (0¼12.2% vs1-3¼12.5% vs �4¼18.2%,

P>0.05).

CONCLUSIONS: We found no association between bacterial strains

and dental caries. The presence of oral microflora is clearly one of the

main etiological factors for dental caries development, but cannot be

considered in an isolated manner. Oral diseases can appear in the

presence of changes of the oral bacterial communities’ structure and

that may be related with the shift from health to disease.

Poster Number: M210 Abstract #: 2342Can Medical Insurance Coverage Reduce HealthDisparities in Long-term Care Elderly: A CaseFrom China.

K. Chen, PhD

Zhejiang University, Hangzhou, China

INTRODUCTION: China’s population is aging rapidly partly

because of the impact of one-child policy and the improvement of

health care system. Caring for bedridden seniors can be a challenge

for many families in China. The aim of this study was to identify the

inequality of income among different age groups and social status,

and evaluate the medical burden and insurance compensation in

Zhejiang Province in China.

METHODS: We measured income inequality and compensation

level of insurance among bedridden patients in urban and rural areas

of Zhejiang province, China. Factor analysis and Gini coefficient

were used to evaluate degree of income inequality and insurance

compensation level.

RESULTS: We found distinct regional disparities in Zhejiang prov-

ince, including the aspects of income, expenses and length of time

being bed-ridden. The income Gini coefficient of long-term care

individuals in urban and rural areas was 0.335 and 0.602, respec-

tively. In all age groups, the Gini coefficient increased after paying

for the medical expenditure, and the inequality still existed after

insurance reimbursement.

CONCLUSIONS: Significant income disparities were observed

between rural and urban areas of Zhejiang Province. Inequality

increased along with age growth. The medical expenditure is a huge

burden for long term care elderly, especially for senior citizens. The

medical insurance does not play a significant role in reducing the

inequalities among long-term care people.

Poster Number: M128 Abstract #: 2736Monotonicity Violations for Ill-DefinedPreference-Based Instruments.

S. A. Swanson, MS, M. Miller, J. Robins and M. A. Hernan, MD

Harvard School of Public Health, Boston, MA

INTRODUCTION: Instrumental variable (IV) methods using pref-

erence-based instruments are increasingly used in comparative effec-

tiveness research. Many IV studies estimate the local average

treatment effect (i.e. the effect in the ‘compliers’) under the assump-

tion of monotonicity, i.e. no ‘defiers.’

METHODS: We assessed this assumption empirically in a survey of

53 physicians who reported treatment plans and prescribing prefer-

ences for hypothetical patients who were candidates for antipsy-

chotic treatment.

RESULTS: Using commonly proposed proxies to measure preference

(e.g. the prior patient’s treatment), nearly all patients exhibited some

degree of monotonicity violations. In addition, patients could not be

cleanly classified as compliers, defiers, always-takers, or never-takers.

CONCLUSIONS: Our findings indicate that preference-based IV

estimates should be interpreted cautiously because bias due to

monotonicity violations is likely and because the subpopulation to

which the estimate applies may not be well-defined. Investigators

using preference-based instruments may consider supplementing

their study with a survey to empirically assess the magnitude and

direction of bias due to violations of monotonicity.

Poster Number: M187 Abstract #: 2232MRSA in the Household: Longitudinal Analysesfrom the Community-Onset StaphylococcusAureus Household Cohort (COSAHC) StudyAustralia.

C. M. Bennett, PhD1, G. Coombs, PhD2, G. Wood, PhD3, E.Bogatyreva, MPH1, B. Howden, PhD4 and P. Johnson, PhD4

1Deakin University, Burwood, Australia, 2Curtin University, Perth,Australia, 3Dorevitch Pathology, Heidelberg, Australia, 4Austin Health,

Melbourne, Australia

INTRODUCTION: To further our understanding of S. aureus epi-

demiology in the community, we describe the prevalence and dis-

semination of S. aureus strains in 291 households with community-

onset infections, and nasal colonisation for the index patient and

their household contacts.

METHODS: 291 patients with community-onset S. aureus infections

were identified via specimens from a community-based pathology serv-

ice (Oct 2008-Dec 2010). All MRSA and a frequency-matched random

subset of methicillin sensitive S. aureus(MSSA) were followed for up to

two years. Patients and household (HH) contacts provided nose and

axilla swabs (a subset of 92 also provided throat and groin) and detailed

demographic information, medical history, exposure history including

occupation, sporting activities, pets, and HH interactions. All isolates

were characterised using PFGE, MLST, spa, and pvl.

RESULTS: 729 from 291 households participated (156 initial

MSSA infections, 135 MRSA). S. aureus carriage was common

(64% of index cases colonised in nose and/or axilla, and 46% of

HH contacts). S. aureus nasal carriage for the total sample was

47% (10% MRSA, 37% MSSA). MRSA nasal colonisation rates

diminish over the two year follow-up for most strains, however


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some persisted in the index and contacts (WA-MRSA1 [ST1],

EMRSA15 [ST22]). Despite the high prevalence in clinical isolates,

WSSP (ST30) and Queensland (ST93) clones were generally absent

from nose swabs collected from these households.

CONCLUSIONS: We found high colonisation rates in the nose and/

or axilla for S. aureus (53%) and for MRSA (12%) but the patterns

of HH colonisation are complex and variable. Some strains persist

in households for up to two years whilst others were not found to

ever colonise the index or contacts over the follow-up period. As the

strains that do not persist tend to be the pvl positive community

MRSA strains, differences in persistence and penetration in the

household can guide patient and contact management.

Poster Number: M156 Abstract #: 2306The Prevalence and Determinants ofUndiagnosed and Diagnosed Type 2 Diabetes inMiddle-Aged Irish Adults.

S. R. Millar, MPH, J. M. O Connor, MPH, C. M. Buckley, MD, P.

M. Kearney, PhD and I. J. Perry, PhD

University College Cork, Cork, Ireland

INTRODUCTION: The prevalence of type 2 diabetes within the

Republic of Ireland is poorly defined, although a recent report sug-

gested 135,000 cases in adults aged 45þ, with approximately one-

third of these undiagnosed. This study aims to assess the prevalence

of undiagnosed and diagnosed diabetes in middle-aged adults, and

compare features related to either condition, in order to investigate

why certain individuals remain undetected.

METHODS: This was a cross-sectional study involving a sample of

2047 men and women, aged between 50–69 years, randomly

selected from a large primary care centre. Univariate logistic regres-

sion was used to explore socio-economic, metabolic and other

health related variable associations with undiagnosed or diagnosed

diabetes. A final multivariate analysis was used to determine odds

ratios and 95% confidence intervals for having undiagnosed com-

pared to diagnosed diabetes, adjusted for gender, age and significant

covariates determined from univariate models.

RESULTS: The total prevalence of diabetes was 8.5% (95% CI

7.4%-8.8%); 72 subjects (3.5%) had undiagnosed diabetes (95% CI

2.8%-4.4%) and 102 subjects (5.0%) had diagnosed diabetes (95%

CI 4.1%-6.0%). Obesity, dyslipidaemia, and family history of diabe-

tes were positively associated with both undiagnosed and diagnosed

type 2 diabetes. Compared with diagnosed subjects, study participants

with undiagnosed diabetes were significantly more likely to have low

levels of physical activity and were less likely to be on treatment for

diabetes-related conditions or to have private medical insurance.

CONCLUSIONS: The prevalence of diabetes within the Cork and

Kerry Diabetes and Heart Disease Study is comparable to recent

estimates from the SLAN Survey of Lifestyle, Attitudes and

Nutrition, a study which was nationally representative of the general

population. A considerable proportion of diabetes cases were

undiagnosed (41%), emphasising the need for more effective detec-

tion strategies and equitable access to primary healthcare.

Poster Number: M23Cancer Disparities among Alaska Native People.

J. J. Kelly, MPH

Alaska Native Tribal Health Consortium, Anchorage, AK

INTRODUCTION: Cancer incidence rates have dramatically

increased during the last 40 years. A disparity in overall cancer inci-

dence exists between AN people and US whites.

METHODS: Data are from the Surveillance, Epidemiology and End

Results (SEER) Alaska Native Tumor Registry, a population-based

registry which includes AN people living in Alaska at the time of

cancer diagnosis from 1969 to 2011. US white cancer incidence rates

are from SEER*Stat. Statistical significance between AN and US

white rates was determined through comparison of 95% confidence

intervals (Tiwari modification).

RESULTS: Over the 43 year period, the age-adjusted incidence rate

for all sites combined increased 32 percent. Incidence rates in AN

men are similar to US white men (rate ratio¼1.0); however, AN

women show rates that are 30% higher than US women for all can-

cers combined. Declines in cancer incidence rates that began in ear-

lier years among US whites are now occurring in AN people during

the most recent five-year period 2007–11: all sites combined (AN

men), colorectal (AN men and women), and lung (AN men).

Declines in US rates of breast and lung cancer are not seen in inci-

dence rates of AN women. Incidence rates in AN people which

exceed US white rates for the period 2007–11 are: all sites combined

(AN:US rate ratio¼1.2), nasopharynx (11.3), gastric (3.3), colorec-

tal (2.1), pancreas (1.4), lung (1.5) and kidney (1.6). Cancer inci-

dence rates are lower in AN people than US whites for: melanoma

(AN:US rate ratio ¼0.1), uterine (0.6), prostate (0.5) and thyroid

cancer (0.7), and lymphoma (0.6).

CONCLUSIONS: Declines in lung cancer among AN men may indi-

cate progress made through tobacco prevention and control pro-

gram interventions established for tribal health organizations.

Increases in colorectal screening may explain recent declines in col-

orectal cancer seen in recent years among AN people.

Poster Number: M21 Abstract #: 2182The Prevalence of HPV Infection and OtherCervical Cancer Risk Factors in a FijianPopulation.

N. Brewer (presenting author), PhD1, S. Foliaki, PhD1, N.Pearce, PhD2, P. J. F. Snijders, PhD3, C. J. M. Meijer, PhD3, L.Waqatakirewa4, G. Clifford, PhD5 and S. Franceschi, PhD5

1Massey University, Wellington, New Zealand, 2London School ofHygiene & Tropical Medicine, London, United Kingdom, 3VrijeUniversiteit Medical Center, Amsterdam, Netherlands, 4Ministry ofHealth, Yaren, Nauru, 5International Agency for Research on Cancer(IARC), Lyon, France

INTRODUCTION: Cervical cancer is the most common cancer

among women in Fiji, and the age-standardised incidence rate of 51

per 100,000 is among the highest in the world. There have been no

studies of the population prevalence of human papillomavirus

(HPV) in Fiji, and only one elsewhere in the Pacific – in Vanuatu.

We therefore conducted a population-based study to determine the

prevalence of HPV infection, cervical abnormalities, and other cervi-

cal cancer risk factors among women in Suva, the Fijian capital.

METHODS: Participants were recruited through community meet-

ings, church leaders, and public health outreach. Public health

nurses explained the study, sort informed consent, took the speci-

mens and administered a standardised questionnaire. Pap smears

were read at the main tertiary hospital laboratory, and abnormal-

ities were managed according to local protocols. A general primer

GP5þ/6þ mediated polymerase chain reaction assay was used for


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HPV DNA analysis. Age-standardised HPV prevalence was esti-

mated using the World standard population. Odds ratios (ORs) for

HPV positivity were estimated using logistic regression. ORs were

adjusted for age, and then also for variables which showed elevated

risks in preliminary analyses.

RESULTS: We included 1,244 women with an adequate HPV sam-

ple, aged 16–63 years. Crude HPV prevalence was 24.0% (95%

confidence interval, 21.7–26.4%) and age-standardised prevalence

was 25.5% (23.1–28.1%). Prevalence of high-risk HPV types was

13.6% (11.8–15.6%). Among 1,192 women with adequate cytolog-

ical results, 13 (1.1%) showed cervical abnormalities; the majority

were high-grade intraepithelial lesions or worse. After adjustment,

the only variables significantly associated with HPV-positivity were

age (ranging from OR 0.57 (0.36–0.89) for 16–24 year-old-women

to OR 0.43 (0.20–0.89) for 55–63 year-old-women) and ‘husband’s

extramarital sexual relationships’ (OR 1.69; 1.17–2.34).

CONCLUSIONS: These findings provide key information for future

policy decisions on the most appropriate methods of cervical cancer

prevention in Fiji and in the Pacific region.

Poster Number: M219 Abstract #: 2475Cause-Specific Gender Differences in PotentialGains in Life Expectancy at Birth in Japan,1965–2010.

Y. Liu, PhD1, Y. Zhang, PhD2, Z. Liu, PhD3, J. Wang, PhD1,

A. Arai, PhD4, Y. Obayashi, PhD4 and H. Tamashiro, DrPH5

1University of Calgary, Calgary, AB, Canada, 2University of Sydney,

Sydney, Australia, 3Beijing University of Chinese Medicine, Beijing,

China, 4Hokkaido University Graduate School of Medicine, Sapporo,

Japan, 5Hokkaido University, Sapporo, Japan

INTRODUCTION: Potential gains in life expectancy (PGLE) are

an effective indicator for measuring the impacts of causes of death.

This study aims to measure gender differences in PGLEs at birth by

eliminating major causes of death and to discover relative important

causes explaining gender gaps in life expectancy in Japan.

METHODS: Data of PGLEs due to the elimination of eleven kinds

of cause of death by gender, were obtained from Japanese official

websites (e.g. Ministry of Health, Labor and Welfare; National

Institute of Population and Social Security Research). The study cov-

ered a period of 1965–2010. The PGLEs were measured using cause

elimination life table technique. Gender differences in PGLE were

calculated by PGLE in Male and in Female. Figures were displayed

with Excel 2013.

RESULTS: Cancer, heart diseases and cerebrovascular diseases had

been the dominant causes of death since 1970s for both genders.

PGLE in cancer increased till 1990s and then kept stable with about

four years for male and three years for female. PGLE in cerebrovas-

cular diseases decreased over the study period from three years to

one year for both genders (Figure 1). Gender differences in PGLE in

cancer kept increasing with a peak value of 1.17 years in 1996 and

then fluctuated slightly remaining above the level of 0.9 years.

Gender differences in PGLE in suicide increased from 0.06 years in

1965 to 0.42 years in 2010. However, gender differences in PGLE in

accidents had decreased from 0.98 year to 0.22 year (Figure 2 &

Figure 3).

CONCLUSIONS: The gender differences in PGLEs have provided

an easy-to-grasp summary of the relative important causes of death.

It also provides the potential benefits of intervention programs in

future studies on the relative important priority causes in Japan,

such as cancer and suicide.

Poster Number: M72 Abstract #: 2284New risks, New Strategies: Greenlandic InuitResponses to Climate Change.

K. R. Derry, BA1 and L. Stallones, PhD2

1Polar Field Services, Littleton, CO, 2Colorado State university, FortCollins, CO

INTRODUCTION: As climate change accelerates, its effects are

especially pronounced in the Arctic region. The Arctic’s indigenous

people are facing increasing challenges, most notably their ability to

harvest food resources. Changes in sea-ice conditions related to cli-

mate change may be increasing the risk of injuries during travel on

ice for Greenlandic Inuit hunters and fishers.

METHODS: Data collection included participant observation,

informal interviews, and formal semi-structured interviews.

Participants included male hunters and fisherman (n¼19) and

women who travel on sea ice (n¼8).

RESULTS: Observations of climate change by Greenlandic Inuit

include changing wind and snow patterns; the sea ice that is forming

now is not as solid or as thick, making travel especially dangerous;

and there is more open water and less sea ice; variation in local

weather patterns, such as an increase in precipitation and fog, and

large storms develop at an increasing rate. Many fishermen observe

that halibut is being replaced by cod, which is unusual but not sur-

prising considering that cod is a warmer water fish than halibut. In

addition, in general there are fewer fish. Others report that there are

more pilot whales and killer whales in Uummannaq and an

increased number of humpback and narwhal whales in Ilulissat.

Acceptable risks/injuries include frostbite and losing fingers.

Younger generations are hunting less. The shift from the traditional

mode of teaching is seen by older hunters as placing younger Inuit at

greater risk of injuries while traveling on the sea ice. Many hunters

and fishers are seeking wage employment in other communities.

CONCLUSIONS: Climate related changes in sea ice conditions

increase vulnerability to potential injury events during travel for

Greenlandic Inuit hunters and fishers, particularly those living in

remote areas. Local hunters value modern technology and tradi-

tional ecological knowledge for managing injury-related risks while

traveling on sea ice.

Poster Number: M115 Abstract #: 2445Change in Number of Patients After the GreatEast Japan Earthquake and Tsunami Disaster: AnAnalysis of the Data of the Patient Survey inJapan, 2008 and 2011.

R. Tsukinoki, PhD1, Y. Murakami, PhD2, T. Hayakawa, PhD3 andS. Hashimoto, PhD4

1Osaka Medical College, Takatsuki, Osaka, Japan, 2Shiga University ofMedical Science, Otsu, Japan, 3Fukushima Medical University,Fukushima, Japan, 4Fujita health University School of Medicine, Toyoake,Aichi, Japan

INTRODUCTION: The Great East Japan Earthquake and tsunami

struck off the coast of northeastern Japan on 11 March 2011. Many

people in the area were affected by diseases and sustained injuries,


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but few studies have investigated this issue using official national

statistics. We compared the number of patients before and after the

disaster using the data of the Patient Survey in Japan.

METHODS: The Patient Survey in Japan is the National Health

Statistics Report, which is conducted in October every three years;

this survey estimates the number of patients using stratified random

sampling. The changes in the number of both inpatients and outpa-

tients between 2008 and 2011 were investigated by comparing the

data obtained in Iwate (coastal and non-coastal regions) and the

control (other prefectures in Japan, except Fukushima and costal

Miyagi where the 2011 survey was not conducted). Classification of

disease and injuries was according to the International Statistical

Classification of Disease-10.

RESULTS: Approximately seven months after the earthquake, the

number of outpatients with urogenital diseases increased in coastal

Iwate (89!114) compared with the numbers in non-coastal Iwate

(423!337) and control (277,972!259,994). The number of inpa-

tients with mental disorders increased in coastal Iwate

(1079!1102) compared with the numbers in non-coastal Iwate

(3003!2730) and control (289,053!275,678). This trend was also

observed in cardiovascular diseases (coastal Iwate [548!592], non-

coastal Iwate [2862!2436], and control [269,912!245,739]). No

apparent difference in the number of patients between the two

regions of Iwate and control was observed for any other disease.

CONCLUSIONS: The patient survey in Japan suggested that the

number of patients with renal diseases, mental disorders, and cardi-

ovascular diseases have increased in coastal Iwate seven months

after the Great East Japan Earthquake and tsunami.

Poster Number: M141 Abstract #: 2819The Relationship between Leisure-Time Exerciseand Lipid Profiles is Affected by Q192RPolymorphisms of Paraoxonase-1 amongJapanese Women.

R. Fujii, BS

Nagoya University Graduate School of Medicine, Nagoya, Japan

INTRODUCTION: Paraoxonase-1(PON-1) is an antioxidant

enzyme which protects against lipid peroxidation by destroying proin-

flammatory molecules formed by the oxidation of LDL-cholesterol.

Previous studies demonstrated that PON-1 polymorphism, rs662

(Q192R) affects the development of such life-related diseases as ische-

mic stroke and chronic kidney disease. In addition, some environmen-

tal and lifestyle factors are likely to modify the effect of this SNP. In

this study, we aimed to examine the effect of PON-1 polymorphisms

on the relationship between leisure-time exercise and lipid profiles.

METHODS: Subjects were 5070 (1439 men and 3631 women) indi-

viduals who were enrolled in the baseline survey at a site of the

Japan Multi-Institutional Collaborative Cohort Study (J-MICC

Study). We used the OPA-CTPP method, an inexpensive and con-

venient method, for genotyping single nucleotide polymorphism

(SNP). We classified the subjects into two groups based on leisure-

time exercise (MET-hour per week). We used the v2 test to confirm

the Hardy-Weinbarg equilibrium and linear regression analysis to

investigate the interaction effect between PON-1 polymorphisms

and exercise on lipid profiles after adjusting for some confounders.

RESULTS: The mean age was 52.5610.3. The genotype

frequencies for Q192R are A/A:573 (11.3%), G/A:2303 (45.4%)

and G/G:2194 (43.3%), respectively. The proportion of Q192R

genotype was in accordance with previous studies. When the inter-

action between lifestyle and Q192R was evaluated, the effect of

exercise on HDL-C levels (P¼0.02) and TG levels (P¼0.03) was

significantly affected by PON-1 polymorphisms in women, indicat-

ing a sharp contrast among those with A/A genotype. However,

such relationships were not observed in men.

CONCLUSIONS: Our study shows that improvement in lipid pro-

files by leisure-time exercise is more prominent among women with

Q192R A/A genotype than others. It will be necessary to examine

the influence that PON-1 polymorphisms confer for the association

between other lifestyle factors and lipid profiles in the future study.

Poster Number: M9 Abstract #: 2336The Role of Duration on the Association betweenObesity and Risk of Physical Disability.

E. Wong, MD1,2, S. Tanamas, PhD1, R. Wolfe, PhD2, C.Stevenson, PhD3, A. Abdullah, PhD4 and A. Peeters, PhD1

1Baker IDI Heart and Diabetes Institute, Melbourne, Australia, 2Monash

University, Melbourne, Australia, 3Deakin University, Burwood, Australia,4University Muhammadiyah Aceh, Aceh, Indonesia

INTRODUCTION: Obesity has been demonstrated to increase the

risk of physical disability. With prevalence of obesity increasing in

young and middle age groups amidst an ageing population, it is

important to know if the association between obesity and disability

is impacted by the duration of obesity. We aimed to relate obesity

duration in mid-life with subsequent incidence of physical disability.

METHODS: Study population: Framingham Offspring Study (FOS)

participants aged 45–65years at examination 4 (1987–91; ‘baseline’

for our analysis). Obesity was defined by body mass index

(BMI)>¼30kg/m2. Obesity duration was calculated during the 20

years between examination 1 (1971–75) through to examination 4.

Disability data (defined as any limitation to at least one of eating,

bathing, dressing, transferring, toileting and walking 50 yards) was

available at examinations 5 (1991–95) through 7 (1998–2001). Cox

regression was used, first adjusting for age, sex and smoking fol-

lowed by additional adjustment for baseline BMI. Participants were

followed up to the development of disability, or censored at death or

the end of the follow up period.

RESULTS: Of 2281 participants, 223 reported disability (incidence

rate¼6 per 1000 person years). Obesity duration ranged from zero to

17 years (mean of 1.7 years (total population); 6.9 years (with base-

line obesity)). When adjusted for age, sex and smoking, obesity dura-

tion was associated with an increased risk of disability (HR 1.06 per

year of obesity; 95% confidence interval (CI) 1.04, 1.09). This associ-

ation was attenuated on further adjustment for baseline BMI with

borderline significance (HR 1.02 95% CI 0.98–1.05). The same was

observed when analysis was restricted to those with baseline obesity.

CONCLUSIONS: There is a suggestion that obesity duration increases

the risk of disability over and above BMI. Future work with longer

durations is needed to explore the possibility that duration has an inde-

pendent effect on the association between obesity and disability.

Poster Number: M158 Abstract #: 2755Non-Adherence to Lifestyle Modification and itsDeterminants among Bangladeshi type 2Diabetic Patients.

S. J. Mumu, MS, F. Saleh, MS, F. Ara, MS and L. Ali, PhD

Bangladesh University of Health Sciences, Dhaka, Bangladesh


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INTRODUCTION: Non-adherence to preventive and therapeutic

lifestyle recommendations among patients with diabetes is special

challenge in the management of these patients. Understanding the

determinants of non-adherence to lifestyle changes can help to plan

and implement more intensive interventions to assist patients’ long-

term task of achieving beneficial lifestyle changes. This study aimed

to measure the proportion of non-adherence and its determinants to

lifestyle modification (diet and exercise) among a group of

Bangladeshi type 2 diabetic patients.

METHODS: Under an analytical cross-sectional design 374 type 2

diabetic patients (age>20 years), diagnosed for at least one year,

were purposively selected from different health care centers operated

by the Diabetic Association of Bangladesh (DAB). Data were collected

by a pre-tested, interviewer-administered questionnaire. Three-point

scale (yes, no, sometimes) were used to assess patient adherence to

lifestyle measures (diet and exercise). Patients were considered compli-

ant if patients had adhered to a recommended dietary chart, maintain

specific time of food intake and followed advised quantity and quality

of food. Exercise were considered adhered if they did exercise>30

min/day. Self management was assessed by self monitoring of blood

glucose, foot care and smoking practice. Anthropometric measure-

ments were done by using appropriate tools and all biochemical data

were collected from record book.

RESULTS: Of the respondents 58% were females. The mean6SD age

was 51 (611.3) years, about 35% were aged between 40– 59 years,

46% had completed high school with mean monthly income US$398

(6375) and 75% lived in urban areas. Mean BMI was 25.7(63.6)

Kg/m2 and about 69% were overweight or obese according to Asian

BMI cut-off value. Mean fasting serum glucose was 8.4(63.4) mmol/l

and about 58% patients’ HbA1c level was>7%. About 60% patients

attended diabetes education class at least once followed by 24% never

attended. Non-adherence rate of diet was 88% and exercise was 25%

-overall 89% (95% CI 87.4–91.0) had non-adhered to both diet and

exercise. About 32% patients non-adhered to self blood glucose moni-

toring, 70% to foot care and 6% had smoking habits. The main bar-

riers to adherence to blood glucose monitoring was that they did not

believe it is useful (65%) and barriers to do exercise were always

being busy (44%) and coexisting diseases (9%). Association was

found between non-adherence of diet and residence and nonattend-

ance to diabetes education classes (P<0.05). Age, gender and nonat-

tendance to diabetes education classes were associated with

non-adherence to exercise (P<0.05). Binary logistic regression sug-

gests that level of education (P¼0.03) and nonattendance to diabetes

education classes (P¼0.05) are correlates of non-adherence of diet,

and gender (P¼0.04), family history of diabetes (P¼0.04) and age

(P¼0.04) are correlates to non-adherence to exercise.

CONCLUSIONS: Although majority of the patients do not follow

dietary and foot care recommendations, the adherence to exercise

and blood glucose monitoring is comparatively high. Diabetes edu-

cation and sociodemographic factors need to be considered to

improve adherence to lifestyle modification and self care.

Poster Number: M169 Abstract #: 2810Consumption of Calcium in Adolescents: APopulation-Based Study in Campinas, Sao Paulo,Brazil.

M. Messaggi Dias, DO1, A. A. Barros Filho, PhD2,D. de Assumpcao, MD3, M. Barros, PhD4, R. M. Fisberg, PhD5

and M. C. Alves, PhD6

1State University of Campinas—UNICAMP, Brazil., Campinas, Brazil,2State University of Campinas—UNICAMP, Brazil, Campinas, Brazil,3State University of Campinas—UNICAMP, Brazil., Campinas, Brazil,4State University of Campinas—UNICAMP, Campinas, Brazil, 5Universityof Sao Paulo, Sao Paulo, Brazil, 6State Department of Health of SaoPaulo, Institute of Health, Sao Apulo, Brazil

INTRODUCTION: Calcium plays an important role in the devel-

opment and maintenance of peak bone mass in adolescence. The

aim was to evaluate the intake of calcium in adolescents aged from

10 to 19 years old, according to socioeconomic, demographic and

health-related behaviors.

METHODS: The data obtained from the ‘Health Inquiry of

Campinas’, a population-based survey. The study analyzed 924 ado-

lescents of both sexes—obtained by the population sample stratified

by clusters. The 24-hour dietary recall provided the information nec-

essary to evaluate the intake of calcium. We used Poisson regression

to evaluate the association between the average calcium intake and

the independent variables.

RESULTS: The sample studied the highest proportion in males

(51%) and aged from 10–14 years-old (55%). The prevalence of

adequacy according to the Estimated Average Requirements for the

population was 10.71% (95% CI 8.30 to 13.71%). The mean cal-

cium intake was significantly lower in segments with lower educa-

tion of the household head (P¼0.000), lower per capita household

income (P¼0.000), in that do not have private health plan

(P¼0.000), not attending school (P¼0.006), or attend public

schools than those who study in private schools (P¼0.002) and

those with fewer devices at home (P¼0.001). Individuals who con-

sumed fruit (P¼0.007), and milk (P¼0.000), with frequency less

than or equal to three times a week had lower mean calcium intake,

this was also significantly lower in smokers (P¼0.000), the ones

who drinks alcohol twice or more per week (P¼0.001), who were

sedentary in leisure (P¼0.007), reported that in nine or more hours

of sleep (P¼0.016), and those who used the computer (P¼0.003).

CONCLUSIONS: The findings revealed a low intake of calcium

according to socioeconomic variables, pointing to a need for atten-

tion to socially vulnerable segment.

Poster Number: M163 Abstract #: 2167Null Relationship of BMI to Diabetes Prevalenceat Baseline in the Mexico City Prospective Studyof 150,000 Adults with Stored Blood and 10-yearMortality Follow-Up.

J. Emberson1, J. Alegre-Diaz2, J. Halsey1, R. Collins1, R. Peto1,P. Kuri-Morales2 and R. Tapia-Conyer, MD2

1University of Oxford, Oxford, United Kingdom, 2National AutonomousUniversity of Mexico, Mexico DF, Mexico

INTRODUCTION: Adiposity and diabetes are particularly

common in Mexico, where 10 years ago the Mexico City

Prospective Study interviewed and stored blood from 150,000 adults

at baseline.

METHODS: In 1998–2004, 150,000 middle-aged Mexicans joined

a prospective study, with an interviewer-administered questionnaire

and, from all participants, stored blood samples (plasma and DNA)

and physical measurements (blood pressure, weight, height, waist

and hip). Baseline data are now described; 10-year cause-specific

mortality (from national mortality records) soon will be.


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RESULTS: By ages 55–64, 20% of men and 23% of women had

diagnosed diabetes, 29% of men and 48% of women were obese

(BMI �30 kg/m2), and 41% of both men and women had hyperten-

sion (SBP �140 mmHg and/or DBP �90 mmHg). Waist/hip ratio

was strongly correlated with diabetes prevalence but BMI was not,

because the BMI-correlated measures of waist and hip circumference

were oppositely related to diabetes prevalence. Given hip circumfer-

ence, waist circumference was strongly positively related to diabetes.

Conversely, given waist circumference, hip circumference was

strongly inversely related to diabetes. Hence, waist-hip ratio was an

especially strong correlate of diabetes. For hypertension, BMI and

waist circumference were strongly positively related to blood pres-

sure whereas, given waist circumference, hip circumference was

weakly positively related to it. Waist-hip ratio was therefore only

moderately positively related to blood pressure.

CONCLUSIONS: In this adipose, diabetic population, waist/hip

ratio is a strong correlate of diabetes prevalence but BMI is not. But,

BMI is a much stronger predictor of blood pressure than waist-hip

ratio. The first 10-year mortality results from this prospective study

will be ready for presentation to the IEA along with these baseline sur-

vey findings.

Poster Number: M94 Abstract #: 2573Time Trends in Physical Activity in the TromsøStudy, Northern Norway.

B. Morseth, PhD

University of Tromsø—The Arctic University of Norway, Tromsø, Norway

INTRODUCTION: Although numerous studies have documented

substantial health benefits of physical activity, a large proportion of

the population does not met current recommendations for physical

activity. To develop purposeful strategies, knowledge about physical

activity trends is essential, albeit scarce. We aimed to examine secu-

lar trends in prevalence of leisure-time and occupational physical

activity over the last four decades.

METHODS: We analyzed 133 518 observations from five cross-sec-

tional surveys between 1974 and 2008 that were part of the popula-

tion-based Tromsø Study (n¼37 445). Leisure time and

occupational physical activity was assessed by a self-administered

questionnaire. Analyses were performed for the total population

and stratified by sex. Age adjustments were performed to rule out

the possibility that physical activity trends could be explained by

age.

RESULTS: The percentage of sedentary men and women in leisure

time remained stable at �20% from 1974 to 2008 and showed no

sex differences. Prevalence of moderate physical activity

increased from 1974 to 2000 and then started to decrease, as the

prevalence of high activity increased during last decade, from

15% in 2001 to 20% in 2008. Across the whole time period, men

were more likely to be highly active, whereas women were more

likely to be moderately active. Prevalence of sedentary occupational

activity increased gradually across the four decades, from 35% in

1979 to 53% in 2008. This trend was explained by a decrease in

walking at work among women and in heavy manual labor among

men.

CONCLUSIONS: Our data from a general population show that the

rate of sedentary people in leisure time has been rather stable across

four last decades, whereas the rate of inactivity at work has

increased steadily from 1974 to 2008. In total, people have become

more sedentary during the last four decades, mainly due to more sed-

entary work.

Poster Number: M155 Abstract #: 2312Optimal Waist Circumference Measurement SiteFor Assessing Metabolic and Type 2 DiabetesRisk in Middle-Aged Adults.

S. R. Millar, MPH1, J. V. D. Broeck, PhD2, I. J. Perry, PhD1 and C.M. Phillips, PhD1

1University College Cork, Cork, Ireland, 2University of Bergen, Bergen,

Norway

INTRODUCTION: Body Mass Index (BMI) is traditionally used as

a measure of overall obesity. Increasing evidence suggests that cen-

tral obesity is a more important cardiometabolic risk factor. Despite

recommendations that waist circumference (WC) should be a rou-

tine measure in clinical practice, there is no international consensus

regarding measurement protocol. Our aim was to compare associa-

tions and discriminatory abilities of BMI and a variety of WC meas-

urements with metabolic features and type 2 diabetes (T2DM) to

address the hypothesis that WC is superior to BMI in the classifica-

tion of cardiometabolic risk and should more commonly be used for

screening purposes.

METHODS: BMI and WC measurements including WC measured

between the lowest rib and iliac crest (WC midway), below the low-

est rib (WCR), WCR/height ratio, WCR/hip ratio and WCR/pelvis

ratio were determined in the cross-sectional Cork and Kerry

Diabetes and Heart Disease Study of middle-aged adults

(n¼2,047). Logistic regression and area under the receiver operat-

ing characteristic curve (AUC) analyses were used to evaluate the

ability of each of these measures to predict metabolic risk and

T2DM.

RESULTS: WCR, and rib derived indices, displayed the strongest

associations for T2DM and metabolic risk phenotypes in non-strati-

fied and gender specific regression models. In particular, WCR/

height ratio (AUC)¼0.76 [CI 0.72–0.81] males, (AUC)¼0.78 [CI

0.71–0.85] females, and WCR/pelvis ratio (AUC)¼0.77 [CI

0.73–0.82] males, (AUC)¼0.78 [CI 0.71–0.84] females, showed

significantly greater discriminatory abilities for T2DM when com-

pared to BMI, WC midway and other measures of adiposity.

CONCLUSIONS: The clinical utility of WCR and rib derived indi-

ces as potentially more accurate predictors of metabolic risk and

T2DM, compared to WHO recommended WC midway measure-

ment, requires further investigation.

Poster Number: M79 Abstract #: 2332Creating an International Initiative to SupportCapacity Building to Ensure Effective Voice forEpidemiology in Influencing National andInternational Public Health Policy.

F. M. Sim, MPH

Royal Society for Public Health, London, United Kingdom

INTRODUCTION: RSPH was approached by APHA

Epidemiology Section to meet at the 2013 APHA Meeting in Boston

to discuss matters of common interest, in particular to explore build-

ing capacity through international collaboration. The IEA World

Congress is the ideal forum to explore further the benefits of


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international collaboration to ensure that epidemiology has the

capacity, skills and voice systematically to influence health policy

around the world.

METHODS: At the initial meeting in Boston, (Nov’13) six societies

from three countries were represented. The agreed purpose of the

meeting was to explore the motivation for, desirability of, and

mechanisms by which international collaborations might be

accomplished.

RESULTS: Several areas of mutual concern or interest were identi-

fied, in three categories:

i. Epidemiological topics of mutual and global concern, e.g.:

(a) Tobacco: Plain packaging of cigarettes in UK/FDA regulation in

the US

ii. Ensuring an effective voice for the epidemiology community so

that public health policy may always be influenced by sound epide-

miological evidence, e.g.:

(a) The nexus between science and policy

(b) Identifying gaps in policy and practice to which policy makers

will respond

iii. Ethics guidelines, practice standards and policy statements, e.g.:

(a) Census cuts/elimination of population data collection occurring

in many countries

(b) Tackling inadequacies of the present peer-review system

Countering poor and malicious science (ref: Ben Goldacre)

CONCLUSIONS: This initiative, presented on behalf of those

present at the initial meeting, brought together some parties inter-

ested and influential in building international capacity, collabora-

tion and consensus to enhance the effectiveness and impact of the

voice of epidemiology around the world. The O’Connor Group is a

new forum for exploration of ideas but not a new organisation. It

hopes to meet and grow in Alaska, and agree how best to ensure we

build international capacity and support for the voice of epidemiol-

ogy to be optimally effective on the world stage of public health

policy.

Poster Number: M176 Abstract #: 2176Decennial Change of Pulse Wave Velocity andSerum Carotenoids: the Mikkabi Study.

M. Nakamura, PhD1, M. Sugiura, PhD2 and T. Ojima, PhD1

1Hamamatsu University School of Medicine, Hamamatsu, Japan, 2Okitsu

Citrus Research Station, NARO Institute of Fruit Tree Science, National

Agriculture and Food Research Organization, Shizuoka, Japan

INTRODUCTION: Antioxidant carotenoids are potentially benefi-

cial in preventing vascular complications. We aim to clarify an asso-

ciation of decennial change of brachial–ankle pulse wave velocity

(baPWV) with serum carotenoids.

METHODS: Data were derived from a health survey of residents of

Mikkabi Town, Japan in 2003 and 2013. Production of mandarin

orange, which is rich in beta-cryptoxanthin and beta-carotene, is the

key industry of Mikkabi. All study subjects gave their written

informed consent. Serum concentrations of six carotenoids were

examined using a high-performance liquid chromatography system.

The baPWV was assessed with a fully automatic device (FORM:

OMRON HEALTHCARE Co., Ltd., Japan). The difference of

baPWV between 2013 and 2003 was divided into two using a

median. Odds ratios for a higher difference of baPWV with tertile of

baseline serum carotenoids (1st tertile: reference) were obtained

using logistic regression analysis adjusting for sex, age, body mass

index, systolic blood pressure, total cholesterol, triglycerides, fasting

blood sugar, smoking status, and medication of hypertension, hyper-

lipidemia and diabetes.

RESULTS: In the 2013 survey, 102 men and 289 women were reex-

amined for baPWV from 297 men and 579 women who were exam-

ined in the 2003 survey. Serum concentration of beta-cryptoxanthin

(median: 0.86 lg/ml) was the highest and that of beta-carotene was

the second highest (0.35 lg/ml) among the six carotenoids. Odds

ratio (95% confidence interval) for higher difference of baPWV was

0.72 (0.43–1.22) in the 2nd tertile and 0.71 (0.42–1.23) in the 3rd

tertile of beta-cryptoxanthin, and 1.02 (0.59–1.76) in the 2nd tertile

and 0.82 (0.46–1.44) in the 3rd tertile of beta-carotene. None of the

six carotenoids showed a statistically significant association with

decennial change of baPWV.

CONCLUSIONS: The protective effect of beta-cryptoxanthin on

decennial baPWV change was expected, but did not reach statistical

significance.

Poster Number: M183 Abstract #: 2256Tooth Loss and Mortality from Pneumonia: AProspective Study of Japanese Dentists.

S. Suma1, K. Wakai, PhD1, M. Naito, PhD1, T. Naito, PhD2, T.Kawamura, PhD3, M. Kojima, PhD4, O. Uemura, PhD4, H.Nakagaki, PhD5, M. Yokota, PhD6 and N. Hanada, PhD7

1Nagoya University Graduate School of Medicine, Nagoya, Japan,2Fukuoka Dental College, Fukuoka, Japan, 3Kyoto University, Kyoto,Japan, 4Aichi Dental Association, Nagoya, Japan, 5School of Dentistry,Aichi-Gakuin University, Nagoya, Japan, 6Yokota Dental Private School,

Hukuoka, Japan, 7School of Dental Medicine, Tsurumi University,Yokohama, Japan

INTRODUCTION: Although associations between oral health and

pneumonia have been suggested, only a few cohort studies have

been reported for free living people. The oral bacteria propagated in

periodontal regions may drift into the lung and increase the risk of

pneumonia. We, therefore, investigated an association of tooth loss

with mortality from pneumonia in a prospective study of Japanese

dentists.

METHODS: The members of Japan Dental Association (JDA) par-

ticipated in this study (LEMONADE [Longitudinal Evaluation of

Multi-phasic, Odontological and Nutritional Associations in

DEntists] Study). From 2001 through 2006, they completed a base-

line questionnaire on lifestyle and health factors including the num-

ber of tooth loss (excluding third molars). We followed 19,778

participants (mean age6standard deviation [SD]; 51.4611.7 years,

women; 1,574 [8.0%]) for mortality from pneumonia (ICD10

J12–J18, excluding those with the underlying disease). Mortality

data were collected via the fraternal insurance program of the JDA.

The Hazard ratios (HR) were estimated with adjustment for sex,

age, BMI, smoking status and diabetes history.

RESULTS: During the mean follow-up of 8.9 years, we documented

64 deaths of pneumonia. Participants who were edentulous at base-

line were at a significantly increased risk of mortality from pneumo-

nia. The multivariate-adjusted HRs were 1.32 (95% confidence

interval [CI], 0.56–3.09) for loss of 5-14 teeth, 2.03 (0.90–4.60) for

loss of 15–27 teeth, and 2.44 (1.06–5.65) for edentulous relative to

loss of 0-4 teeth (trend P¼0.022). In addition, participants with

diabetes at baseline were at a significantly increased risk (the


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multivariate-adjusted HR was 1.85 [95% CI 1.01–3.37]), and those

without emaciation at baseline were at a significantly decreased risk

(the multivariate-adjusted HR was 0.33 [95% CI 0.18–0.63] for

18.5<BMI<25.0, and 0.35 [0.15–0.82] for BMI>25.0 relative to

BMI<18.5).

CONCLUSIONS: Our findings suggest that a large number of tooth

loss is indicative of risk of mortality from pneumonia in free living

populations.

Poster Number: M74 Abstract #: 2339Overview and Result of the Fukushima HealthManagement Survey.

S. Yasumura, MD1,2, T. Ishikawa1,2, T. Ohira, MD1,2, S.

Yamashita2,3, K. Kamiya2,4, M. Abe2 and T. F. H. M. S. Group2

1Fukushima Medical University School of Medicine, Fukushima City,

Japan, 2Fukushima Medical University, Fukushima City, Japan,3Nagasaki University, Nagasaki City, Japan, 4Hiroshima University,

Hiroshima City, Japan

INTRODUCTION: After the Great East Japan Earthquake of

March 11, 2011, Fukushima Prefecture decided to launch

‘Fukushima Health Management Survey’ in order to monitor and

support residents’ long-term health and to promote their future

well-being and to confirm whether long-term low-dose radiation

exposure has any effect on health.

METHODS: Fukushima Health Management Survey comprises of

basic survey and 4 detailed surveys. The basic survey is to estimate

the level of external radiation exposure. Target population is all

about 2.05 million Fukushima residents at time of 11 March 2011.

Detailed surveys include ‘Thyroid ultrasound examination’,

‘Comprehensive health check’, ‘Mental health and lifestyle survey’

and ‘Pregnancy and births survey’. All data including Whole Body

Counter (WBC)and Dosimeter will be gathered to a database, and it

will be utilized to support residents and analyze the radiation effect

on health.

RESULTS: As for the basic survey, questionnaires were distributed

from the end of July, 2011. Residents are required to give

Information on their dwelling place, places visited, length of time

indoors and outdoors, and travelling time during the period from 11

March to 11 July. By the end of September in 2013, 514,686

responded (response rate; 25.0%). The results for 451,364 respond-

ents (excluding radiation workers) showed that the doses for 94.9%

of the respondents were <2 mSv and 66.1% of the respondents

were <1 mSv.

CONCLUSIONS: There are so many issues caused by the NPP acci-

dent now. Fukushima residents have more concerned about their

health than ever and feel anxiety of their own health. Under such cir-

cumstances, we implemented the presented multifaceted Survey

within one year after the disaster, in collaboration with many uni-

versities and institutions in Japan.

Poster Number: M213 Abstract #: 2140Decomposition of Educational Differences in LifeExpectancy by Age and Causes of Death amongSouth Korean Adults.

K. Jung-Choi, PhD1, Y. H. Khang, MD2, H. J. Cho, PhD3 and S.

C. Yun, PhD3

1Ewha Woman’s University School of Medicine, Seoul, South Korea,2Seoul National University College of Medicine, Seoul, South Korea,3Asan Medical Center, University of Ulsan College of Medicine, Seoul,

South Korea

INTRODUCTION: Decomposition of socioeconomic inequalities

in life expectancy by ages and causes allow us to better understand

the nature of socioeconomic mortality inequalities and to suggest

priority areas for policy and intervention. This study aimed to quan-

tify age- and cause-specific contributions to socioeconomic differen-

ces in life expectancy at age 25–29 years by educational level among

South Korean adult men and women.

METHODS: We used National Death Registration records in 2005

(129,940 men and 106,188 women) and national census data in

2005 (15, 215, 523 men and 16,077,137 women aged 25 and over).

Educational attainment as the indicator of socioeconomic position

was categorized into elementary school graduation or less, middle

or high school graduation, and college graduation or higher.

Differences in life expectancy at age 25–29 years by educational

level were estimated by age- and cause-specific mortality differences

using Arriaga’s decomposition method.

RESULTS: Differences in life expectancy at age 25–29 years

between college or higher education and elementary or less educa-

tion were 16.23 years in men and 7.69 years in women. Young adult

groups aged 35–49 in men and aged 25–39 in women contributed

substantially to the socioeconomic differences in life expectancy.

Suicide and liver disease were the most important causes of death

contributing to the differences in life expectancy in young adult

groups. For older age groups, cerebrovascular disease and lung can-

cer were important to explain educational differential in life expect-

ancy at 25–29 between college or higher education and middle or

higher education.

CONCLUSIONS: The age specific contributions for different causes

of death to life expectancy inequalities by educational attainment

should be taken into account in establishing effective policy strat-

egies to reduce socioeconomic inequalities in life expectancy.

Poster Number: M160 Abstract #: 2258Trend in Stroke Incidence in Shiga, Japan,1990–2010.

M. Nagai, PhD1, Y. Kita, PhD2, N. Takashima, PhD2, Y.Murakami, PhD1, R. D. Abbott, PhD2, T. C. Turin, PhD3, N.Rumana, PhD4, K. Miura, MD1 and H. Ueshima, MD1

1Shiga University of Medical Science, Otsu, Japan, 2Shiga University of

Medical Science, Otsu, Shiga, Japan, 3University of Calgary, Calgary,

AB, Canada, 4Alberta Health Services, Calgary, AB, Canada

INTRODUCTION: Stroke mortality and incidence began to decline

in Japan in the 1960s. Our population-based registry of stroke inci-

dence using data collected from 1990 to 2001 has previously shown

that this decline may have levelled off or slowed down. Whether this

pattern of change continues in the decade that follows is uncertain.

We examined the recent trend in stroke incidence in Japan using the

same registry with follow-up extended to 2010.

METHODS: Data were obtained from the Takashima Stroke

Registry covering approximately 55,000 residents of Takashima

Country in Shiga, Japan. We estimated the gender-specific age-

adjusted first-ever stroke incidence rates (/100,000 person-years)

and their 95% confidence intervals (95% CI) using Byar’s method

in three year intervals during 1990–2010. For age adjustment, we


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used direct standardization based on the world standard population

distribution in 2000–25 from the World Health Organization. Ages

were categorized into ranges of <35, 35–44, 45–54, 55–64, 65–74,

75–84, and �85 years.

RESULTS: There were 1,224 registered first-ever stroke cases in

men and 1,083 in women. The age-adjusted incidence of stroke

nearly halved in both genders during 1990–2010. The declining

trend has been continued after 2001, in spite of an average age

increase of approximately eight years in the 21 years of follow-up.

Incidence rates across the seven observation periods in men were

161.4 (95% CI 139.3–186.0) in 1990–92, 151.1 (130.5–173.9) in

1993–95, 114.9 (97.6–134.4) in 1996–98, 135.2 (116.4–156.0) in

1999–2001, 90.1 (75.1–106.9) in 2002–04, 79.9 (66.1–95.4) in

2005–07, and 76.3 (63.2-91.1) in 2008–10 (Ptrend<0.001). In

women, the rates were 88.0 (73.3–104.5), 94.6 (79.8–111.2), 82.3

(68.9–97.4), 81.4 (68.7–95.5), 55.5 (45.5–66.8), 39.9 (31.3–49.9),

and 42.7 (34.2–52.2) (Ptrend<0.001).

CONCLUSIONS: The present study showed that significant and

continuous declining trends of stroke incidence in Japan was

observed during recent the two decades. This decline occurred in

spite of the aging population in Takashima.

Poster Number: M44 Abstract #: 2731Pediatric Health Related Quality of Life: Testingthe Wilson and Clearly Model in Children.

E. Villalonga-Olives, PhD1,2, I. Kawachi, PhD1, J. Almansa,

PhD3, C. Witte, BS2, B. Lange, PhD2, C. Kiese-Himmel, PhD2

and N. von Steinbuchel, PhD2

1Harvard School of Public Health, Boston, MA, 2Georg-August-

University, Gottingen, Germany, 3University of Groningen, University

Medical Center Groningen, Groningen, Netherlands

INTRODUCTION: To evaluate outcomes in terms of prevention,

treatment and rehabilitation in children, it is important to test

Health Related Quality of Life (HRQoL). One of the most refer-

enced theoretical models to measure HRQoL is the Wilson and

Cleary model. It proposes a series of critical concepts along a causal

pathway to measure the contributions to HRQoL. This model has

been validated in the adult population, but not in pediatric popula-

tions. Our goal was to empirically test this model in children.

METHODS: The contributory factors to HRQoL (Kiddy-KINDL)

that we included were symptom status (hospitalization/presence of

chronic disease), functions (development status), individual behavior

(behavior based on motor, cognitive and emotional development),

and characteristics of the social environment (socioeconomic status

and area of education). Structural equation modeling was used to

assess the measurement structure of the model in 214 German chil-

dren (3–5 years old) participating in a follow-up study that investi-

gates pediatric health outcomes. Baseline data were used.

RESULTS: Model fit was v2¼5.8, df¼7, P¼0.56, SRMR¼0.01.

The variance explained of HRQoL was 15%. HRQoL was affected

by the area of education, and development status (P<0.05).

Development status was affected by the area of education, socioeco-

nomic status and individual behavior (P<0.05). In turn, symptoms

did not affect HRQoL(P<0.05).

CONCLUSIONS: The results between children’ and adults’ tests

differed as expected. The goodness of fit of the model was accept-

able, and the overall variance explained was good compared to pre-

vious studies. We attribute our finding to the indicators selected in

both tests, which denote a conceptual gap between adult and chil-

dren measures. However, there is a lot of variety in pediatric

HRQoL measures, which represents a lack of a common definition

of this construct. We recommend investing more time into theory

development of pediatric HRQoL.

Poster Number: M184 Abstract #: 2503Descriptive Characterization of Cholera EpidemicCaused by Break Down of Public Pipe BorneWater Supply-Egbeda, Oyo State NigeriaSeptember 2013.

E. B. Adedire, MPH1, A. B. Usman, MPH2, G. A. Abbass, MPH3,

I. O. Ajayi, PhD4 and O. I. Fawole, PhD5

1Nigerian Field Epidemiology and Laboratory Training Program, Abuja,

Nigeria, 2Nigeria Field Epidemiology and Laboratory Training Programme,

Abuja, Nigeria, 3State Ministry of Health Ibadan Oyo State, Ibadan,

Nigeria, 4College of Medicine, University of Ibadan, Ibadan, Nigeria,5University of Ibadan, Ibadan, Nigeria

INTRODUCTION: Cholera is an acute illness with profuse watery

diarrhea caused by vibro cholerae serotypes 01 or 0139. In Nigeria,

frequent outbreaks do occur. Effective interventions to control these

outbreaks require the identification of the source and risk factors for

infection. In August 2013, an outbreak of cholera occurred in

Egbeda LGA. We investigated the outbreak to determine its magni-

tude, source, possible risk factors and initiate control measure.

METHODS: We reviewed cholera case-based line lists from health

facilities, hospital records and conducted active case search for

cases. We defined a suspected case as any resident of Egbeda, two

years or above, with acute watery diarrhoea with or without vomit-

ing between 26 August and 10 September 2013. We used structured

questionnaire to collect data on demographic characteristics, clinical

information, and risk factors. Data were analyzed with Epi-info

software and Microsoft excel. Environmental assessment of water

sources, water sampling, latrine use and waste disposal methods.

We collected and analyzed five stool samples.

RESULTS: There were a total of 28 cases and seven deaths case

fatality rate of 25%. Twenty seven (96.4%) of cases were from

Oke-alaafia community. Median age of cases 10.5yrs (range

2–65yrs); Age group mostly affected was 0–5years; 7/28 (25%).

Seventeen of the cases were males (60.7%). Major sources of water

were wells (38.5%), 61.4% of respondents have no toilet facilities

hence indiscriminate defaecation is commonly practiced. Open

dumping was the commonest (80.8%) waste disposal method.

Vibrio cholerae 01 was isolated in 3/5 (60%) of stool samples

analyzed.

CONCLUSIONS: The outbreak probably occurred as result of

drinking water from contaminated sources of water such as wells

following breakdown of public pipe borne water. Chlorination of

25 wells was done and we conducted an intensive health education

with emphasis of proper storage and household water.

Poster Number: M192 Abstract #: 2780Pertussis in Infants: Characterization of Risk andMaternal Immunological Protection.

M. J. Mergler, MPH1, J. A. Englund, MD2, J. M. Tielsch, PhD3, J.

Kuypers, PhD4, M. Rock, PhD5, K. M. Edwards, MD6, M. C.


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Steinhoff, MD7, S. K. Khatry, MD8, S. C. LeClerq, MPH9 and J.

Katz, PhD1

1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,2Seattle Children’s Hospital/University of Washington, Seattle, WA,3George Washington University School of Public Health and Health

Services, Washington, DC, 4University of Washington, Seattle, WA,5Vanderbilt University Medical Center, Nashville, TN, 6Vanderbilt

University, Nashville, TN, 7Cincinnati Children’s, Cincinnati, OH, 8Nepal

Nutrition Intervention Project—Sarlahi, Kathmandu, Nepal, 9Johns

Hopkins Bloomberg School of Public Health, Kathmandu, Nepal

INTRODUCTION: Pertussis is estimated to contribute to 2% of

childhood deaths worldwide. Young infants are at highest risk for

serious sequelae of pertussis disease which has recently reappeared

in high income countries with high rates of pediatric DTaP vaccina-

tion coverage. Vaccination of infants with pertussis vaccine is often

delayed in low income countries, and there are few pertussis inci-

dence estimates for infants in such setting where whole cell pertussis

vaccine is routinely utilized. Maternal vaccination with Tdap in

pregnancy is now recommended in the US/UK, but this vaccine is

not available in low income countries. This study estimated popula-

tion-based incidence of lab proven pertussis in infants <6 months of

age and maternal pertussis antibody transfer to the infants at deliv-

ery in rural southern Nepal.

METHODS: Infants were visited weekly from birth through six

months to assess respiratory illness in the prior week. If any respira-

tory symptom was reported, a mid-nasal swab was collected and

tested with a multi-target pertussis PCR assay (n¼3321). 44 paired

maternal and cord blood specimens were collected and tested for

antibodies to pertussis toxin using an ELISA.

RESULTS: In a cohort of 3,373 infants, the incidence of PCR-

confirmed Bordetella pertussis and Bordetella parapertussis was 5.4/

1000 infant years [95% CI 2.2–11.2] and 3.1/1000 infant years

[95% CI 0.8–7.9], respectively. Mean age of pertussis onset was 72

days (SD:32) and mean birth weight was 2,490 (SD: 428) grams.

There was active transfer of pertussis toxoid (PT) antibody from

mothers (GMT 9.75) to infants (GMT 11.25) at birth, with an over-

all infant/mother GMT ratio of 1.15 [95% CI 1.04–1.28]. However,

only 40% of women had detectable pertussis toxoid antibody at

delivery. The correlation of specific infant/mother antibody titers

was 0.96. Females and infants with longer gestation had more anti-

body transfer. 40% of infants had not received any DTP vaccine by

six months of age.

CONCLUSIONS: There was a low risk of symptomatic pertussis

disease among young infants in rural Nepal. When present, maternal

pertussis antibodies were actively transferred to infants. Although

infant vaccine coverage was delayed, Nepal’s immunization pro-

gram appears to control pertussis in young infants.

Poster Number: M136 Abstract #: 2411Trends in Prevalence and Mortality of AdultCongenital Heart Disease in the United Statesfrom 1968 to 2010.

C. P. Benziger, MD, A. D. Flaxman, PhD, A. D. Bertozzi-Villa, BA

and K. Stout, MD

University of Washington, Seattle, WA

INTRODUCTION: Mortality for children with congenital heart

disease (CHD) has declined with improved surgical techniques and

neonatal screening. We aim to determine the prevalence and mortal-

ity of adults with CHD.

METHODS: We combined National Vital Statistics System data on

cause-specific mortality from 1968 to 2010 and National Health

Information Survey data on CHD prevalence from 1997 to 2011

using a novel statistical model to determine the prevalence of moder-

ate to severe CHD as a function of age, sex, and year. We used para-

metric bootstrap resampling of the input data to generate 95%

uncertainty intervals (UI). We multiplied the appropriate population

estimates and the estimated prevalence to produce estimates of the

size of the CHD-prevalent population by age, sex, and year.

RESULTS: The birth prevalence of moderate and severe CHD in 2010

for males was 3.2 per 1,000 (95% UI 2.9-3.5), and for females was 3.0

per 1,000 (95% UI 2.4–3.5). From 1968 to 2010, mortality declined

72% (for all ages), from 5.1–1.4 per 100 000 person-years (PY); among

zero to 51-week olds, the decline was from 176 to 51 per 100,000 PY.

The estimated number of adults (age 20 to 64 years) with moderate or

severe CHD in 1968 was 110,000 (95% UI 65,000–140,000). By 2010,

there was an increase by a factor of 2.5 (95% UI 2.3–2.9), to 270,000

(95% UI 190,000–330,000). In 2010, there were 130,000 (95% UI

84,000–160,000) reproductive age females (age 15–49 years) with mod-

erate or severe CHD in the United States.

CONCLUSIONS: We present a novel method to determine mortal-

ity attributable to CHDs over time. We found decreased mortality in

infants and subsequent increased prevalence of adults with CHDs,

many who are in need of subspecialty providers with experience in

this field. Women of reproductive age are a substantial proportion

of this population.

Poster Number: M46 Abstract #: 2649Pest and Pesticide Exposure Trends inAlaska—2002–12.

P. Bloecher, BS

Alaska Native Tribal Health Consortium, Anchorage, AK

INTRODUCTION: Bed bugs, yellow-jackets, and other pest issues

have caught statewide attention in Alaska. This has resulted in an

increased risk for pesticide misuse. Before December 29th, 2013,

healthcare providers were not required to report pesticide exposure

cases. This has resulted in limited data on pesticide exposures in

Alaska. Pesticide exposure data for Alaska has not been previously

published. This study aimed to document pesticide exposure trends

in Alaska from 2002 to 2012.

METHODS: Data were gathered from the Oregon Poison Center’s

Toxicall-Toxic Exposure Surveillance System database, which serves

as Alaska’s Poison Center. Data were entered into an Excel spread-

sheet and sorted by total number of exposures for all ages and for

exposures in children five years of age and younger. Exposures were

further separated into the following categories: Pyrethrins &

Pyrethroids, Insect Repellants, and Rodenticides.

RESULTS: During the years 2002–12 there were a total of 1,417

pesticide exposures reported to the Alaska Poison Center. Nearly

one out of five exposures (18.4%) was managed in a health care

facility. Of the total number of exposures reported, 851 (60%) had

occurred in children under the age of five. No deaths were reported.

Of the total number of pesticide exposures reported, insect repel-

lants were responsible for the most (28.5%), followed by rodenti-

cides (23.8%), and finally Pyrethrins & Pyrethroids (21.7%). Of

insect repellant and rodenticide exposures, over 70% occurred in


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children five years old or younger (73% and 75%, respectively). A

35% increase in reported exposures occurred from 2010 to 2012.

CONCLUSIONS: As pest issues continue to rise in Alaska, the risk

for pesticide misuse will increase. A robust surveillance system might

include using Toxicall data along with pesticide cases reported by

providers, required under State law. As pest issues increase, surveil-

lance on pesticide exposures can help guide environmental public

health professionals in their approach to minimizing potentially

harmful exposures.

Poster Number: M38 Abstract #: 2353Determinants and Trends of Anaemia amongChildren in Empowered Action Group States ofIndia.

C. M. Pandey, PhD, S. Mishra, MS and U. Singh, PhD

Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

INTRODUCTION: The government of India has identified eight

economically and demographically backward states as empowered

action group (EAG) states representing about 46% of country’s pop-

ulation. Anaemia being a significant public health problem among

women and children needs special attention in this region.

According to National Family Health Survey (NFHS-3), anaemia

among children can result in impaired cognitive performance as well

as increased morbidity from infectious diseases. In India about 70%

children aged 6-59 months are anaemic.

OBJECTIVES: To examine the age-specific trend and determinants

of anaemia among children aged 6-59 months in EAG states of

India.

DATA AND METHODS: This study is based on unit level informa-

tion on 17023 children aged 6-59 months taken from NFHS- three

conducted during 2005–06. NFHS-3 undertook direct measurement

of the haemoglobin levels and classified anaemia into mild, moder-

ate and severe categories. The covariates of anaemia have been

examined using a multinomial logistic regression model. Odds ratio

and 95% confidence interval for each significant predictor are com-

puted and presented. Eleven variables of mother’s and child’s char-

acteristics were found significant on bi-variate analysis and were

included in the final model.

RESULTS: Prevalence of anaemia was reported for different age

groups. The prevalence was highest (84.2%) in age group 12–17

months and a consistent decline was observed with increasing age.

The factors significantly associated with severe anaemia were child

age, stunting and maternal anaemia with odds ratio 4.71 (CI

3.74–5.93), 3.29 (CI 2.52–4.31) and 3.16 (CI 2.51–3.99),

respectively.

CONCLUSIONS: There was an increase in anaemia levels up to

child’s age 12–17 months after which a consistent decline was

observed. For all three categories of anaemia child’s age was the

most contributing factor. Other determinants were maternal anae-

mia, nutritional status of child and mother’s education.

Poster Number: M146 Abstract #: 2612Physical Activity and Orthostatic Hypotension:JMS II Cohort Study.

S. Ishikawa, MD, Y. Nakamura, MPH and E. Kajii, MD

Jichi Mecical University, Shimotsuke, Japan

INTRODUCTION: The purpose of this study is to examine

the relationship of physical activity with orthostatic hypotension

(OH), and metabolic syndrome (MetS) in the Japanese general

population.

METHODS: The study subjects were 4,888 man and woman who

were invited to take annual health check-up examination aged 40

years and older. We obtained data about physical activity using

International Physical Activity Questionnaires (IPAQ) short version.

Subjects were categorized into four group by total calories using

IPAQ in each sex. Blood pressure was measured twice at the seated

position and then measured at the standing position. OH was

defined as systolic blood pressure (SBP) fall >¼20 mmHg or dia-

stolic blood pressure (DBP) fall >¼10 mmHg on standing from a

sitting position.

RESULTS: The mean ages were 64.9 years in men and 63.8 years in

women. Prevalence of OH and MetS were was 5.5%, 23.7% in men

and 8.5% and 6.8% in women, respectively. The relationship of

physical activity with OH was not significant in both sexes, but with

MetS was significant in both sexes (men: P¼0.16 and women:

P¼0.004). That tendency was identical even in the elderly subjects

aged 65 years and more.

CONCLUSIONS: We did not find the relationship between physical

activity in general population, but physical activity was related with

MetS.

Poster Number: M97 Abstract #: 2777Pneumonia Hospitalizations among AmericanIndian and Alaska Native Children after a Decadeof Pneumococcal Vaccine.

R. Singleton, MD1, E. Foote, MD2, R. C. Holman, MS3, T.Hennessy, MD4, M. L. Bartholomew, MD5, S. M. Seeman, BS3,M. G. Bruce, MD4 and A. Groom, MPH6

1Alaska Native Tribal Health Consortium, Anchorage, AK, 2Seattle

Childrens Hospital, Seattle, WA, 3CDC, Atlanta, GA, 4CDC Arctic

Investigations Program, Anchorage, AK, 5IHS, Rockville, MD, 6Indian

Health Service/Centers for Disease Control Field Assignee,

Albuquerque, NM

INTRODUCTION: American Indian and Alaska Native (AI/AN)

children experience high rates of pneumonia compared with the gen-

eral US child population. 7-valent pneumococcal conjugate vaccine

(PCV7) introduction in 2000 resulted in a significant decline in

pneumonia hospitalization rates among the US child population;

however, data are lacking for the impact of PCV7 on pneumonia in

AI/AN children.

METHODS: A retrospective analysis of pneumonia hospitalizations

during 1997–2011 was conducted using the Indian Health Service

direct and contract inpatient data to calculate hospitalization rates

per 100,000 for AI/AN children <5 years of age. Hospitalizations

were classified as pneumonia if pneumonia was the first-listed diag-

nosis or listed after a first-listed diagnosis of sepsis, meningitis or

empyema. Average annual hospitalization rates were compared with

published US child population rates using the Nationwide Inpatient

Sample.

RESULTS: From 1997–99 to 2007–09 the average annual rate of

pneumonia hospitalizations declined from 3006 to 2224 (26%) for

AI/AN <2 years of age, compared with 1274 to 723 (43.2%; 95%

CI 34.9-51.6) for the general US child population <2 years of age.


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In both, the largest decline occurred in 1997–99 to 2001–06 after

PCV7 introduction. Among AI/AN, an additional decline (6.7%;

2224 to 2075) occurred from 2007–09 to 2010–11. Pneumonia

hospitalization rates decreased in AI/AN 2-4 year olds (24.5; 560

to 423) for 1997–99 to 2007–09 compared to a decline of

12.5% (95% CI 2.4–22.6), for the 2–4 year old general US

population.

CONCLUSIONS: Pneumonia hospitalization rates among AI/AN

and US general child population <2 years declined dramatically

after PCV7 introduction; however, AI/AN rates remain significantly

higher. Rate declines for AI/AN continued through 2010–11. AI/AN

children 2–4 years also experienced substantial declines in the dec-

ade after PCV7. These findings likely represent the impact of PCV7

vaccination, housing improvements, and increased availability of in-

home piped water.

Poster Number: M119 Abstract #: 2815Using Clinical Models at the Bedside:Overcoming the Conundrum of Missing Data.

S. A. Fletcher, BA, S. Deppen, PhD, M. Aldrich, PhD, H. Chen,PhD, J. B. Putnam, MD and E. L. Grogan, MD

Vanderbilt University, Nashville, TN

INTRODUCTION: Clinical prediction models require complete

data for estimating individual risk, yet complete data is often not

available in clinical settings. We investigated four imputation meth-

ods applied to a lung cancer risk prediction model intended for use

at the bedside.

METHODS: The TREAT risk prediction model was developed

using a study population of 492 individuals with known or sus-

pected lung cancer being evaluated as candidates for lung surgery at

Vanderbilt Medical Center. Using this cohort, we artificially induced

missing diagnostic information in 264 patients with complete data.

Simulations investigated model behavior when a low impact predic-

tor, (OR’s near 1) Forced Expiratory Volume in one second (FEV1)

was missing; a high impact predictor (OR>3) 18F-fluoro-deoxyglu-

cose positron emission tomography (FDG-PET) was missing, and

when both predictors were missing simultaneously. The four impu-

tation methods imputation were 1)median imputation (MedI),

2)subgroup mean imputation, 3)multiple imputation (MI), and

4)condensed predictor imputation (CPI). Model behavior was

measured by mean risk difference between estimated risk and the

actual outcome (MRD) and mean square error for risk difference

(MSE).

RESULTS: For FEV1 the four techniques yielded similar results

(MRD: �0.005, �0.002, �0.003, and �0.004 for MedI, subgroup

mean, MI and CPI, respectively). For the high impact variable FDG-

PET, MRDs favoring the computationally intensive MI were

observed (MedI: �0.048, MI: �0.005). CPI methods (MRD:

�0.015) may be an alternative to MI because they are less computa-

tionally intensive. MI is the best option when both FEV1 and FDG-

PET were missing (MRD=�0.008; MSE¼0.1252) but is similar to

CPI (MRD=�0.021; MSE¼0.1272).

CONCLUSIONS: Prediction models are important tools used fre-

quently to inform clinical decisions. However, prediction models

cannot be applied when a patient’s clinical data is missing. Using the

population median for missing data is computationally and statisti-

cally efficient for low impact predictors, but high impact predictors

require more sophisticated imputation methods for use in clinical

practice.

Poster Number: M59 Abstract #: 2822Determinants of Health Seeking Behavior inPakistan: A Complex Health Survey Design.

D. S. Rozi, PhD1, D. S. Mahmud, PhD1 andD. G. Lancaster, PhD2

1Aga Khan University, Karachi, Pakistan, 2Lancaster University,Lancashire, United Kingdom

INTRODUCTION: The health care delivery system in Pakistan is

complex in nature and limited resources are available for the health

care sector. Hence it is important to understand the health seeking

behavior of the population and trend of health services utilization in

Pakistan. The study objective is as follow

To investigate the determinants of health seeking behavior in

Pakistan we suggest a multilevel pseudo maximum likelihood

(MPML) approach to estimates model parameters for the complex

survey design.

METHODS: The sampling strategy of the National Health Survey

was stratified two stage cluster sampling. Overall 18,315 subjects

were interviewed. This is three level data with PSUs at the third

level, household at the second level and persons at the first level.

Health care utilization was considered as a binary outcome.

RESULTS: We found age, gender, marital status, household owner-

ship of durable goods, urban/rural status, community development

index, and province as significant predictors of health care utiliza-

tion (P-value <0.05). We also found two significant interactions;

between gender and marital status (P-value <0.005), and between

the community development index and urban/rural status (P-value

<0.045).

The variances of the random intercepts are estimated as 0.135 for

PSU level and 0.224 for HH. The results are significantly different

from zero (P-value <0.05) and indicate considerable heterogeneity

in health care utilization w.r.t to HHs and PSUs.

CONCLUSIONS: The low economic status, illiteracy, lack of

awareness, and cultural and social barriers create obstacles in health

care utilization. It suggests that more health centers should be set up

in rural areas. There is also a need to consider gender sensitive pro-

grams and other determinants which we have highlighted in our

results to bring about significant changes to the health care system

of Pakistan.

Poster Number: M126 Abstract #: 2687Vaccine Safety Monitoring in Pregnant Womenusing Text Messaging.

A. K. Regan, MPH1, C. C. Blyth, MD2, D. Mak, MD3, P. C.Richmond, MD2 and P. V. Effler, MD4

1University of Western Australia, Perth, Australia, 2University of WesternAustralia, Subiaco, Australia, 3Western Australia Department of Health,Shenton Park, Australia, 4Western Australia Department of Health, Perth,

Australia

INTRODUCTION: The World Health Organisation lists pregnant

women as the highest priority for seasonal trivalent influenza vacci-

nation (TIV). Despite the benefits to mother and infant, more than

75% of pregnant women go unvaccinated each season. Safety con-

cerns are commonly cited as a barrier. In 2012, the Western

Australia Department of Health initiated the Follow-up and Active

surveillance of Trivalent influenza vaccine in Mums (FASTMum)

program to monitor vaccine safety in pregnant women annually.


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While successful, this program was time-intensive and costly. In

2013, the use of short message service (SMS) was investigated as a

method for collecting information.

METHODS: Between March and July 2013, 3,446 pregnant

women were surveyed regarding their TIV experience; 3,047

women provided a mobile telephone number and were sent a SMS

query asking if they experienced an adverse event following immu-

nisation; Women who responded ‘yes’ (n¼301) or did not reply,

and women who provided only a home telephone number

(n¼126) were contacted by telephone to ascertain details regard-

ing the event.

RESULTS: Four in five women who agreed to participate in the pro-

gram responded to the query SMS; 8.7% of the women reported a

mild adverse event: 3.5% injection site reaction, 2.7% headache,

2.0% fever, 2.1% fatigue. All other events were rare (<1%). Events

reported by SMS did not differ to events reported by telephone, with

the exception of injection site reaction. Women who responded by

telephone were 10.1 times (95% CI 2.5–44.0) as likely to report

swelling or pain at the injection site compared to women responding

by SMS. The use of SMS resulted in a 7-fold increase in sample size

and 36% reduction in cost.

CONCLUSIONS: Results support the safety of TIV in pregnant

women and suggest mobile phone technology may be useful in

implementing an annual rapid, active monitoring system.

Considering the low level of adverse events reported, these findings

could be useful in promoting vaccine uptake in pregnant women.

Poster Number: M55 Abstract #: 2369Diesel Exhaust Exposure and the Risk of LungCancer—A Review of the EpidemiologicalEvidence.

Y. Sun, MD, F. Bochmann, PhD, A. Nold, MS andM. Mattenklott, PhD

Institute for Occupational Safety and Health of German Social Accident

Insurance (IFA), Sankt Augustin, Germany

INTRODUCTION: Diesel exhaust (DE) emissions are composed of

gases and a particulate phase containing thousands of chemicals. In

June 2012, a working group of the International Agency for

Research on Cancer concluded that there was sufficient evidence for

the carcinogenicity of DE in humans. However, these findings

appear to be based upon selected epidemiological studies with cer-

tain important methodological limitations, particularly in the assess-

ment of confounding effects and the assessment of DE exposures.

To critically evaluate the association between DE exposure and the

risk of lung cancer, we conducted a systematic review of published

epidemiological evidences.

METHODS: To comprehensively identify original studies on the

association between DE exposure and the risk of lung cancer, litera-

ture searches were performed in literature databases for the period

between 1970 and 2013, including bibliographies and cross-

referencing.

RESULTS: In total, 42 cohort studies and 32 case-control studies

were identified in which the association between DE exposures and

lung cancer was examined. In general, previous studies suffer from a

series of methodological limitations, including design, exposure

assessment methods and statistical analysis used. A lack of

objective exposure information appears to be the main problem in

interpreting epidemiological evidence. To facilitate the interpreta-

tion and comparison of previous studies, a job-exposure matrix

(JEM) of DE exposures was created based on around 4000 historical

industrial measurements. The values from the JEM were considered

during interpretation and comparison of previous studies. Overall,

neither cohort nor case-control studies indicate a clear exposure-

response relationship between DE exposure and lung cancer.

CONCLUSIONS: Epidemiological studies published to date do not

allow a valid quantification of the association between DE and lung

cancer.

Poster Number: M102 Abstract #: 2603Visual Impairment and Human Developmentin Brazil.

J. Percio, MPH1, N. H. Medina, DrPH1 and E. A. Luna, DrPH2

1Centro de Vigilancia Epidemiologica ‘Prof. Alexandre Vranjac’, Sao

Paulo, Brazil, 2Instituto de Medicina Tropical de Sao Paulo, USP, Sao

Paulo, Brazil

INTRODUCTION: Sight is responsible for about 80% of the per-

ception of external stimuli. In Brazil, visual impairment was the

most frequent disability reported to the 2010 Census. This study

aims to investigate possible associations between the Human

Development Index (HDI) and its components (income, longevity

and education) to the prevalence of visual impairment.

METHODS: An ecological study that used as territorial base the

twenty-seven Brazilian states. The prevalence of visual impairment

was the dependent variable. The HDI and its component variables

were the independent variables. The analysis was performed in the

free software R. Was used the Pearson correlation test and multiple

linear regressions models, accepting the critical error of 5%.

RESULTS: More than 35 million visually impaired were identified,

of which 506,377 (1.4%) people were blind. The prevalence of vis-

ual impairment was 18.8%, ranging from 15.9% to 22.5% across

states, being higher in the Northeast and lowest in the Southern

region of the country. The HDI ranged from 0.63 to 0.82 among the

states. A significant negative correlation with the prevalence of vis-

ual impairment and HDI (P<0.01 Pearson¼�0.66) was observed.

In the multiple linear regression models, a significant association

between the prevalence of visual impairment and the variables that

make up the HDI was observed. In the triple model longevity was

the variable that presented the strongest association (P¼0.05;

R2¼0.50).

CONCLUSIONS: There is an association between visual impair-

ment and HDI in particular with the longevity variable, which along

with income and education explained 50% of the variation in preva-

lence among Brazilian states.

Poster Number: M209 Abstract #: 2249Discriminatory Experiences and AlcoholConsumption among Undergraduate Studentsfrom Florianopolis, Southern Brazil, 2013.

J. L. Bastos, PhD1, I. Z. Coelho, MS1 and R. K. Celeste, PhD2

1Federal University of Santa Catarina, Florianopolis, Brazil, 2Federal

University of Rio Grande do Sul, Porto Alegre, Brazil

INTRODUCTION: There is a paucity of studies on discrimination

and patterns of alcohol consumption conducted outside the United


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States of America, focusing on the youth population and addressing

different types of discriminatory experiences, in addition to racially

motivated events. This study aimed to investigate the association

between experiences of discrimination and its perceived reasons

with patterns of alcohol consumption among university students

from Southern Brazil.

METHODS: A representative sample (n¼1,264) of undergraduate

students from Southern Brazil answered a self-completed question-

naire on socio-demographic characteristics (age and sex), course

(medicine, engineering etc.), course stage, access to the institution,

mental health outcomes, experiences of discrimination (yes/no),

their reasons (race, social class, sex, etc) and patterns of alcohol con-

sumption. The associations between discrimination and alcohol con-

sumption were adjusted for socio-demographic factors in ordinal

logistic regression models, through which effect modification by

common mental disorders, course stage and age was also explored.

RESULTS: The response rate was 81.0%, 65.8% (95% CI

57.4–73.4) of the students reported that they had been discriminated

against for any reason, and 77.0% (95% CI 77.3–79.7) reported

consuming alcohol. Just over half of the students reported discrimi-

nation for two or more reasons. For the whole sample, there was no

association between discrimination, their reasons, and the pattern of

alcohol consumption. However, the odds of consuming alcohol or

showing alcohol-related problems was statistically significantly

greater among those who reported discrimination (odds ratio [OR]

1.9, 95% CI 1.0–3.4) or multiple reasons for being discriminated

against (OR 2.3, 95% CI 1.3–4.3) during the period of completion

of the undergraduate course, when compared with freshmen not

reporting discrimination.

CONCLUSIONS: These results suggest that the effects of discrimi-

nation on the pattern of alcohol consumption manifest themselves at

a critical period of the university life, specifically during the comple-

tion of the undergraduate studies.

Poster Number: M51 Abstract #: 2410Prenatal Exposure to Perfluorinated Chemicalsand Risk of Congenital Cerebral Palsy in Children.

Z. Liew, MPH1, B. Ritz, PhD1, E. C. Bonefeld-Jørgensen, PhD2,

T. B. Henriksen, PhD2, E. A. Nohr, PhD3, B. H. Bech, PhD2, C.

Fei, PhD4, R. Bossi, PhD2, O. S. von Ehrenstein, PhD5, E. Streja,

PhD1, P. Uldall, PhD6 and J. Olsen, PhD2

1UCLA Fielding School of Public Health, Los Angeles, CA, 2Aarhus

University, Aarhus, Denmark, 3Odense University Hospital, Odense,

Denmark, 4Abbvie Inc, Chicago, IL, 5University of California, Los Angeles,

Fielding School of Public Health, Los Angeles, CA, 6National Institute of

Public Health, Copenhagen, Denmark

INTRODUCTION: Perfluorinated chemicals (PFCs) are persistent

pollutants with widespread human exposure. Research data suggest

that PFCs have endocrine disruptive properties and may affect fetal

brain development. We investigated whether prenatal exposure to

PFCs increases the risk of congenital cerebral palsy (CP), a perma-

nent movement and posture disorder, in children.

METHODS: We studied 83,389 liveborn singleton children and

mothers enrolled in the Danish National Birth Cohort (DNBC) dur-

ing 1996–2002 with an average of 10 years of followed-up. In this

cohort we identified 156 CP cases from the Danish National

Cerebral Palsy Register and randomly selected 550 controls using a

case-cohort design. Fifteen PFCs were measured in maternal plasma

samples collected in early or mid-pregnancy. We used generalized

linear models to estimate Risk Ratios (RRs) for CP.

RESULTS: Eight PFCs were quantifiable in>45% of the measured

samples. We found higher risks of CP in boys with increasing mater-

nal PFC levels (RR¼1.74 (95%CI 1.05–2.88) per one unit (natural-

log ng/mL) increase in perfluorooctane sulfonate (PFOS) and

RR¼1.99 (95% CI 1.15–3.44) per unit increase in perfluoroocta-

noic acid (PFOA)). We also observed a dose-response pattern of CP

risks in boys per PFOS and PFOA quartile (P-trend<0.01). PFC

was associated with both spastic unilateral or bilateral CP sub-phe-

notypes. No association between PFCs and CP was found in girls.

CONCLUSIONS: Prenatal exposures to common PFCs may

increase the risk for CP in boys, but the finding is novel and replica-

tion is needed.

Poster Number: M66 Abstract #: 2730Work-Related Traumatic Injuries OnboardFreezer-Trawlers and Freezer-LonglinersOperating in Alaskan Waters during 2001–12.

D. Lucas, PhD

National Institute for Occupational Safety and Health, Anchorage, AK

INTRODUCTION: Commercial fishing is generally believed to be

the most dangerous occupation worldwide. Workers onboard

freezer-trawl (FT) and freezer-longline (FL) vessels in Alaska may be

at high risk for fatal and non-fatal injuries.

METHODS: Traumatic occupational injuries onboard vessels in the

FT and FL fleets operating in Alaska during 2001–12 were identified

through two government data sources. We estimated the risk of inju-

ries, characterized the etiology of injuries, and suggested injury pre-

vention priorities.

RESULTS: During 2001–12, there were 712 work-related injuries

reported on 24 FT and 42 FL vessels. The annual risk of fatal inju-

ries was 125 per 100,000 FTEs in the FT fleet, and 63 per 100,000

FTEs in the FL fleet. The annual risk of non-fatal injuries was 43 per

1,000 FTEs in the FT fleet and 35 per 1,000 FTEs in the FL fleet.

The majority of injuries in the FT fleet occurred in the factories and

freezer holds, whereas the most common injuries in the FL fleet

occurred on deck while working the fishing gear.

CONCLUSIONS: The findings confirmed that workers in those

fleets were at high risk for work-related injuries. Injury prevention

efforts should focus on the specific work processes injuring the most

workers in each fleet, and concentrate on removing the hazards pro-

ducing the most common and most severe types of injuries.

Poster Number: M206 Abstract #: 2304Prevalence and Spectrum of Adverse DrugReactions in a community Hospital of NorthIndia.

P. K. Singh, MD1, S. S. Agarwal (Late), MD1 and C. M. Pandey,

PhD2

1Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow,

India, 2Sanjay Gandhi Postgraduate Institute of Medical Sciences,

Lucknow, India

INTRODUCTION: Adverse Drug Reaction (ADR), has been identi-

fied as an important cause of morbidity and mortality world-wide.


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However, there is a limited data from India on burden and spectrum

of ADRs. The objective of the present study is to estimate the preva-

lence and spectrum of ADRs in a community hospital of North

India.

METHODS: The study was conducted on more than 1500 patients

attending a community hospital during six months. The information

on each patient was collected prospectively in a structured format.

Patients attending OPDs and wards were included following a clus-

ter sampling procedure. WHO-UMC causality assessment system

was followed for classification of severity and causality. Prevalence

and 90% CI was estimated and presented.

RESULTS: Out of 1501 patients included in the study 139 cases of

ADRs were reported. Overall prevalence of ADR was 9.3% (CI

8.3%–10.4%). ADR rate was higher in females (10.59%) than in

males (8.36%). All the age-groups had almost equal distribution of

ADRs. ADRs were classified in various specialities depending upon

the place of treatment of the patient. In General Medicine preva-

lence was 6.4%, followed by skin 15.2%, psychiatry 16.7% and

oncology 31.5%. The most common organ system involved was

skin (40.3%) followed by metabolic and endocrine manifestations

(15.8%). Most common class of drug implicated was antibiotics

(19.4%) followed by anti-cancer drugs (12.9%), steroids (10.8%),

anti-epileptics (9.4%), anti-Tubercular drugs (8.6%) and anti-

hypertensives including diuretics (7.9%). The causality assessment

of ADRs revealed that 42.4% ADRs were ‘probably/likely’ and

39.6% ‘possible’, rest were of ‘certain’ causality.

CONCLUSION: The estimated prevalence of ADR in this study is

lower than the global estimate based on meta-analysis of Lazarou et

al, which showed 15.1%. There is no gender or age-specific ADRs,

however differentials based on specialty and drug class were

observed in ADRs.

Poster Number: M224 Abstract #: 2352Your Parents’ Wealth is more Important thantheir Education for Your Later Health andWellbeing: Evidence from the Tromsø Study.

M. A. Sheikh, MPH

University of Tromsø, Tromso, Norway

INTRODUCTION: Little evidence is available about the unique

effect of different SES markers in childhood on subjective measures

of health and life satisfaction in adulthood.

METHODS: The Tromsø Study is a prospective cohort study of the

general population in the municipality of Tromsø. With more than

70,000 inhabitants, Tromsø is the largest city in Northern Norway.

It is situated at 69 N, �400km north of the Arctic Circle. Between

1974 and 2007/8, six waves of the Tromsø Study have been con-

ducted (referred to as Tromsø I-VI). The current research is based

on data from the latest wave: 19,762 subjects were invited, and

12,984 (65.7%) attended – 6,054 men and 6,930 women, born

between 1920–1977. The aim was to assess the unique effect of

three indicators of childhood socio-economic status (CSES), child-

hood financial conditions, mothers’ education and fathers’ educa-

tion on the EQ-5D health dimensions (mobility, self-care, usual

activities, pain and discomfort, anxiety and depression), self-rated

health, age-comparative self-rated health, and satisfaction with life.

We observed interaction (P<0.05) between CSES indicators and

the respondents education when regressed on subjective health

measures therefore the data was analyzed with a counterfactual-

based mediation analysis using Stata command Paramed as it allows

exposure-mediator interaction. Logistic regression was used for the

mediator (own education). Log-linear regression was used for the

health and life satisfaction outcomes to estimate the natural direct

effects (NDE), natural indirect effects (NIE) and marginal total

effects (MTE) as risk ratios (RR). Statistically significant interaction

(p<0.05) was observed between the CSES exposures and gender,

regressed on the health and wellbeing outcomes, therefore the analy-

sis was conducted separately for men and women.

RESULTS: Independent of respondents education, childhood finan-

cial conditions was associated (NDE) with all EQ-5D dimensions,

self-rated health, age-comparative self-rated health, and satisfaction

with life. The RRs were not the same for men and women. Men had

a higher risk of being unhealthy on the composite EQ-5D measure

(RR: 1.22, CI 1.14–1.31), and the anxiety/depression dimension

(RR: 1.88, CI 1.57–2.26), but women had a higher risk of being

unhealthy on the dimensions self-care (RR: 1.91, CI 1.23–2.97),

usual activities(RR: 1.68, CI 1.46–1.94), pain/discomfort(RR: 1.13,

CI 1.07–1.21), as well as on SRH(RR: 1.46, CI 1.32–1.61).

Childhood financial conditions had no statistically (P>0.05) signifi-

cant NIE mediated by respondents’ education, on any health meas-

ure. The magnitude of the estimate of NIE was 1.00, though not

statistically significant (P>0.05). While almost all NDEs of paren-

tal education on health outcomes were not statistically significant

(P>0.05), most of the NIEs of parental education were statistically

significant (P<0.05). The exceptions were the increased risk

(NDEs) of being unhealthy on the composite EQ-5D measure(RR:

1.10, CI 1.02–1.19), pain/discomfort(RR: 1.12, CI 1.03–1.22), and

anxiety/depression(RR: 1.38, CI 1.13–1.69), from having low moth-

ers’ education among women.

CONCLUSIONS: Our results show that childhood financial condi-

tions have a strong direct effect on later health and wellbeing, inde-

pendent of respondents’ education, while generally speaking

parental education has an indirect effect on later health mediated by

respondents’ education. This indicates that effect of childhood

financial conditions on later health and wellbeing is long-term and

that there may be other pathways from childhood financial condi-

tions to health, than respondents’ education. However, the effect of

parental education on later health is not independent of the respond-

ents’ education.

Poster Number: M88 Abstract #: 2775Diversity of Carbapenemase Producing P.Aeruginosa Clones Suggests SeriousImplications on Clinical Outcomes andResistance Dissemination.

A. V. Cienfuegos, MS1, J. M. Vanegas, BS1, A. M. Ocampo,BS1, C. A. Vargas, BS1, L. Lopez2, H. del Corral, PhD1 and J. N.Jimenez, PhD1

1University of Antioquia, Medellin, Colombia, 2Grupo MICROBA, Escuela

de Microbiologıa, Universidad de Antioquia UdeA, Medellin, Colombia

INTRODUCTION: Pseudomonas aeruginosa has become a serious

health threat worldwide due to its high rates of multidrug resistance.

However, dissemination of resistance is difficult to assess because

evidence from surveillance systems is limited by unreliable pheno-

typic susceptibility tests. Considering the importance of strengthen-

ing surveillance systems to control antibiotic resistance, this study

aims to describe the molecular epidemiology of carbapenem-


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resistant Pseudomonas aeruginosa (CRP) infections and assess

impact of these infections on clinical outcomes in hospitals in

Medellın-Colombia.

METHODS: A prospective cohort of patients infected with CRP

was enrolled in five tertiary-care level hospitals from Medellın

between June-2012 and May-2013. All subjects were followed until

clinical outcome. Clinical and microbiological information was

retrieved from medical records. Carbapenemases were detected by

PCR and strain typing by PFGE. Bivariate analyses were done using

v2, Fisher’s exact test, risk ratios (RR).

RESULTS: During the study period 146 patients were included.

Carbapenemases blaVIM and blaKPC were detected in 15.1% and

7.5% isolates, respectively. Carbapenemase (C) and non-carbapene-

mase (NC) producing isolates were different regarding predominant

types of infections (P¼0.034). MDR (resistance to �3 antibiotic

families) was higher in C (77.4%) than in NC (27%) isolates

(P<0.001). Mortality was higher in infections caused by C than

NC (RR¼1,47, 95% CI 0.82–2.64). A pseudo outbreak of CRP

harboring blaKPC was detected between August-2012 and January-

2013 in four hospitals but PFGE revealed that isolates were geneti-

cally different.

CONCLUSIONS: In Medellın, the presence of C isolates with

diverse genetic backgrounds has emerged with relevant implications

in patient clinical outcomes. This situation points to antibiotic selec-

tive pressure as a driving force for resistance emergence and a high

potential of carbapenemase dissemination in P. aeruginosa.

Incorporating molecular epidemiology to surveillance activities

should become the mainstay in order to improve understanding of

emergence of resistant clones and effectively control antibiotic resist-

ance in Colombia.

Poster Number: M194 Abstract #: 2288Prevalence of Canine Visceral Leishmaniasis inthe Xakriaba Indigenous Land, Minas GeraisState, Southeast Brazil, 2011.

A. M. S. Rocha, BS1, E. M. de Queiroz, PhD1, I. D. Teixeira1, N.S. Jaques1, A. F. Vieira1, L. S. de Godoy1, E. C. Ferreira, PhD2,V. W. dos Reis, MS1, A. P. Batista, BS1, E. S. Dias, PhD3, H. M.de Andrade, PhD4, J. C. da Silva, BS5, C. C. Marinho, PhD1, J. C.Franca-Silva, PhD4 and G. L. L. Machado-Coelho, PhD1

1Federal University of Ouro Preto, Ouro Preto, Brazil, 2Fiocruz, CampoGrande, Brazil, 3Fiocruz, Belo Horizonte, Brazil, 4Federal University ofMinas Gerais, Belo Horizonte, Brazil, 5SESAI, GovernadorValadares, Brazil

INTRODUCTION: Reports on the epidemiologic surveillance of

leishmaniasis in Brazilian indigenous lands are scarce. Control meas-

ures recommended by the National Health Department are currently

ineffective. One possible reason contributing to the perpetuation of

the zoonosis cycle is the maintenance of canine reservoirs in endemic

areas, either for mistakes in serologic diagnosis (false-negatives or

indeterminate results) or delays in the systematic withdrawal of

seropositive animals. The objectives were to detect the prevalence of

leishmaniasis infection using serologic and molecular methods in

dried blood samples in filter paper (DBS) and to identify the

species of Leishmania sp. in DBS and tissue samples from infected

native canines from 17 of 32 localities in the Xakriaba Indigenous

Land.

METHODS: A canine population of 950 animals was examined.

The immunoenzymatic assay (ELISA) was used as screening and the

indirect immunofluorescence (IFI) was used as confirmatory

(titles>1:40 considered reagent) serologic test. One sample of 24

canines with positive serologic tests was selected for euthanasia and

tissue sampling of: mesenteric lymph nodes, spleen, distal ear border

and bone marrow. Parasite DNA was isolated from DBS and tissue

samples by polymerase chain reaction (PCR-kDNA and PCR-FRLP)

by using the primers A: 50(C/G)(C/G)(G/C) CC(C/A) CTA T(T/A)T

TAC ACC AAC CCC 30 and B: 50 GGG GAG GGG CGT TCT

GCG AA 30. Animals were grouped by serologic profiles: ELISAþ/

IFIþ, ELISAþ/IFI-, indeterminate ELISA/IFIþ, indeterminate

ELISA/IFI-, ELISA-. The proportion of positive diagnosis by the

molecular method was compared between groups.

RESULTS: The prevalence of infection determined by PCR-kDNA

was 13.3% (102/769), by ELISA 33.2% (314/947), and by IFI

13.5% (70/520). L. (L.) infantum was isolated from bone marrow

samples.The percentage of positive diagnoses by molecular method

varied significantly (P<0.001) according to serologic diagnostic cri-

teria: ELISAþ/IFIþ (n¼37; 40.5%); ELISAþ/IFI- (n¼247;

16.6%), indeterminate ELISA/IFIþ (n¼28; 57.1%), indeterminate

ELISA/IFI- (n¼97; 13.4%), ELISA- (n¼356; 4.5%).

CONCLUSIONS: The molecular method evidenced a high fre-

quency of failure of serologic methods at diagnosing canine infec-

tion, hindering the control measures in indigenous lands. In face of

the vulnerability of these populations, the use of molecular methods

is desirable for diagnosing infection in cases with serologic discord-

ant results and to assure the effective control of this zoonosis.

Grants: CNPq 481001/2010-7 and 4747771/2012-0.

Poster Number: M198 Abstract #: 2501‘An Electronic Surveillance System for IntensifiedTB Case Detection in an Adolescent CohortStudy, In Preparation for Future TuberculosisVaccine Trials in Western Kenya’.

J. Opole, MA

KEMRI/CDC, Kisumu, Kenya

INTRODUCTION: The age specific incidence of Tuberculosis (TB)

in developing countries gradually rises in adolescence, making ado-

lescents a good target group for introduction of new TB vaccines.

Phase III TB vaccine trials require solid measurable endpoints. We

therefore sought to do electronic surveillance in addition to sched-

uled active follow ups to maximize TB case finding.

METHODS: The study area is under a continuous Health and

Demographic Surveillance System. After enrolment, passively

detected TB cases listed in TB registers were searched and matched

with Health and Demographic Surveillance System registers to see if

they resided in the same compounds as study participants.TB cases

aged 12 to 18 years were also searched in the study database to ver-

ify whether they were study participants, TB laboratory and chest x

ray records to identify potential TB suspects.

RESULTS: During follow up 8 TB cases were identified, the person

time accumulated by all subjects 5004 as 6002.4 person years. The

corresponding incidence density is 2.0 per 1000 person years with a

corresponding 95% CI (1.14, 3.52) and in addition 5 TB cases were

identified through the surveillance system the total person years

accumulated by surveillance cases is 5.36 years with a corresponding

incidence density of 0.8 95% CI(0.3,2.0) per 1000 person years.

CONCLUSIONS: Identification of Tuberculosis cases through elec-

tronic surveillance indicates this is a useful tool that should be


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further explored. The additional cases yielded by electronic surveil-

lance might help in shortening follow up time if TB cases are found

more quickly.

Poster Number: M62 Abstract #: 2607Does Beverage Type and Drinking ContextMatter in an Alcohol-Related Injury? Evidencefrom Emergency Department Patients in LatinAmerica.

G. Andreuccetti, MS1, H. B. Carvalho, PhD1, Y. Ye, MA2,J. Bond, PhD2, M. Monteiro, PhD3, G. Borges, PhD4 andC. J. Cherpitel, DrPH2

1University of Sao Paulo Medical School, Sao Paulo, Brazil, 2Alcohol

Research Group, Emeryville, CA, 3Pan American Health Organization,Washington, DC, 4Universidad Autonoma Metropolitana, Mexico DF,Mexico

INTRODUCTION: Previous studies have already substantiated

alcohol’s causal role in injuries. Yet the role that alcoholic beverage

preferences and the drinking context play in the risk for injury is still

under-investigated. In this study a cross-national comparison of the

association between alcohol and injury focusing on beverage type

preference and the drinking context is reported.

METHODS: Emergency department injured patients were inter-

viewed in eight countries from the Latin American and Caribbean

(LAC) region. Data on the type of alcoholic beverage, total alcohol

volume, and the place where the injury occurred were obtained from

patients who reported any alcohol consumption within six hours

prior to being injured. Patients who did not drink prior to injury

were also asked about their typical drinking pattern and the injury

place. Differences within- and between-groups were evaluated

regarding patients’ typical drinking and drinking before injury.

RESULTS: Beer was the most prevalent beverage type usually con-

sumed among injured patients across countries, however, patients

who drank before injury had a higher typical consumption of spirits

than those not drinking prior to injury. The total alcohol volume

typically consumed and drinking in public settings were also found

to be positively associated with alcohol-related injury.

CONCLUSIONS: A similar beverage-specific association with alco-

hol-related injury was found across LAC countries, mainly attrib-

uted to beer consumption, and spirits drinkers seem to have a

greater chance of becoming involved in injury events. Future preven-

tion strategies should inform the public about harms from drinking

associated with the context in which drinking takes place.

Poster Number: M157 Abstract #: 2165‘Glycometrics’ – Standardized Metrics forInpatient Glycemic Control Quality PerformanceEvaluation.

P. C. B. Silveira, MD1, R. C. S. Neves, PhD2, C. Souza Jr., BS1,S. S. Moreira, BS2 and E. D. Moreira Jr., PhD1,2,3

1Charitable Works Foundation of Sister Dulce, Salvador, Brazil, 2GoncaloMoniz Research Center, Oswaldo Cruz Foundation, Salvador, Brazil,3McGill University, Montreal, Canada

INTRODUCTION: For patients with diabetes, the quality of outpa-

tient glycemic control is readily assessed by hemoglobin A1c. In con-

trast, standardized measures for assessing the quality of blood

glucose (BG) management in hospitalized patients are lacking. We

sought to evaluate candidate models to measure the quality of inpa-

tient glycemic control.

METHODS: A cross-sectional and nationwide survey was con-

ducted from July/2010 to January/2012. Eligible patients were �18

years old, had a diagnosis of diabetes and hospitalization length of

stay �72 hours. Information on all blood glucose (BG) readings for

a maximum of 20 consecutive days of hospitalization was collected

by chart review. We used three analytical models: patient-day

(grouped BG levels by calendar day for each patient), patient-stay

(each patient’s mean BG level for the entire hospitalization) and

patient-sample (all BG levels individually, without grouping). For

each model we calculated the glycemic average level, the median

BG, the percentage of BG measurements in range, and the percent-

age of hypoglycemic and hyperglycemic events.

RESULTS: Overall, 2,399 patients were surveyed in 24 hospitals

located in 13 cities from all five regions in Brazil. Our dataset con-

tained 71,137 BG measurements. The mean, median and percentage

of BG measurements in range were similar among the three models,

but hypoglycemic and hyperglycemic event rates varied consider-

ably. Although none of the models have shown to be ideal for all

functions, the patient-day model appeared to be the best tool for

analysis of performance measures of the quality of inpatient glyce-

mic control.

CONCLUSIONS: Different models are necessary for evaluating the

quality of inpatients glycemic, as they can contribute to separate

functions. These metrics need to be validated elsewhere to allow

inter-patient and inter-hospital comparison, as well as quality

improvement initiatives results

Poster Number: M207 Abstract #: 2706Education Modifies the Association of Wealthwith Obesity in Women in Middle-Income butnot Low-Income Countries: an Interaction Studyusing Seven National Datasets, 2005–10.

A. Aitsi-Selmi, PhD, R. Bell, PhD, M. J. Shipley, PhD and M. G.Marmot, PhD

University College London, London, United Kingdom

INTRODUCTION: Obesity levels are rising rapidly in low- and

middle-income countries (LMICs). In high-income countries, educa-

tion and wealth have different associations with female obesity but

this is less clear in LMICs. This study examines the separate and

inter-related associations of education and household wealth in rela-

tion to obesity in women in a representative sample of LMICs.

METHODS: The seven largest national surveys were selected from

a list of Demographic and Health Surveys (DHS) ordered by

decreasing sample size which resulted in a range of country income

levels. These were nationally representative data of women aged

15–49 years collected in the period 2005–10. Wealth was derived

from an asset-based index; education was based on the self-reported

highest level of attainment. The separate and joint effects, unad-

justed and adjusted for age group, parity, and urban/rural residence

using a multivariate logistic regression model are presented.

RESULTS: In the four middle-income countries (Colombia, Peru,

Jordan, and Egypt), an interaction was found between education

and wealth on obesity (P-value for interaction <0.001). Among

women with no/primary education the wealth effect was positive

whereas in the group with higher education it was either smaller in


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magnitude or inverted (negative). In the poorer countries (India,

Nigeria, Benin), there was no evidence of an interaction. Instead, the

associations between each of education and wealth with obesity

were independent and positive. There was a statistically significant

difference between the average interaction estimates for the low-

income and middle-income countries (P<0.001).

CONCLUSIONS: These results suggest that, as countries undergo

economic development, education may protect women against the

obesogenic effects of increased household wealth. Further research

could examine this protective pathway including the role of cogni-

tive factors and the food environment.

Poster Number: M1 Abstract #: 1345Effects of Polypharmacy on Adverse Drug

Reactions among Geriatric outpatients at a

Tertiary Care Hospital in Karachi, A prospective

cohort study.

B. Ahmed, MS1, K. Nanji, MS2 and J. Patel, MD3

1The Aga khan University, Karachi, Pakistan, 2The Aga Khan university,

karachi, Pakistan, 3The Aga Khan university, Karachi, Pakistan

INTRODUCTION: The overall aims of the study are to estimate

the ADRs due to poly-pharmacy among the geriatric cohort attend-

ing outpatient clinics at a tertiary care center and to determine the

strength of association of ADRs due to poly-pharmacy in the men-

tioned population.

METHODS: A hospital based prospective cohort study was con-

ducted at ambulatory care clinics of Aga Khan University between

January to December 2012. One thousand geriatrics patients

(age>65 years) visiting clinics were identified. They were divided

on the basis of exposure (poly pharmacy vs no poly pharmacy). We

followed them from the time of their enrollment (day zero) to once

weekly till six weeks. Incidence was calculated and Cox propor-

tional hazard model estimate was used.

RESULTS: The occurrence of poly pharmacy was 68%. The inci-

dence of ADRs with poly pharmacy was 10.5%. Majority (30%)

patients cannot read or write. Use of herbal medicine was reported

by 3.2% and homeopathic by 3%. Our Cox adjusted model shows

that poly pharmacy was 2.3 times more associated with ADRs, con-

current homeopathic use was 7.4 times and those who cannot read

and write was 1.5 times more associated with ADRs.

CONCLUSIONS: The incidence of ADRs due to poly pharmacy is

alarmingly high. The factors associated with ADRs are modifiable.

Policies need be design to strengthen the prescription pattern.

Poster Number: M122 Abstract #: 2286Effect of Reference Period on Survey-Based

Estimates of Newborn Coverage Indicators.

M. K. Munos, PhD and L. C. Mullany, PhD

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

INTRODUCTION: Despite recent interest and investments in

improving neonatal health in low-resource settings, there are few

standard survey questions measuring neonatal interventions, and no

consensus as to the appropriate reference period for such questions.

The objective of this study was to assess the effect of different refer-

ence periods on newborn coverage indicators using data from two

household surveys.

METHODS: Household surveys were conducted in Burkina Faso in

2010 and Ethiopia in 2013, sampling 18,000 and 12,000 house-

holds, respectively. Both surveys included questions about newborn

care practices and careseeking. For each survey, newborn coverage

indicators were estimated using both a 1–2 year reference period

and a one month reference period, and the resulting point estimates

and confidence intervals were compared. In addition, the proportion

of ‘don’t know’ responses for each indicator was regressed on length

of recall, and coverage indicators were regressed on the number of

months of recall to assess whether responses varied systematically

with increasing recall.

RESULTS: In both countries, coverage indicators calculated using a

one month and a 1–2 year reference period were not significantly

different, except for initiation of breastfeeding within one hour of

birth and careseeking in Burkina Faso. In addition, in Burkina Faso,

the number of months of recall was positively associated with care-

seeking for neonatal morbidity (aRR¼1.06, 95% CI 1.01–1.10); in

Ethiopia we saw no such association. The length of the recall period

was not associated with the proportion of ‘don’t know’ responses

for most newborn coverage indicators.

CONCLUSIONS: Using a longer reference period for newborn cov-

erage survey questions, up to at least two years, does not signifi-

cantly change point estimates for most newborn coverage indicators

at population level, and greatly improves the precision of these esti-

mates. A one to two year reference period would therefore be justi-

fied for a newborn survey module.

Poster Number: M8 Abstract #: 1350Association of Apolipoprotein E polymorphismin Alzheimer’s Disease in Indian Population- AMeta-analysis.

C. B. Tripathi, PhD

Institute of Human Beahviour and Allied Sciences, Delhi, India

INTRODUCTION: Alzheimer’s disease (AD) is the most common

form of dementia, estimated to be affecting 4.4% of the population

over 65 years of age. Apo E �4 allele is a known genetic risk factor

for AD which not only predisposes and influences the severity of

pathological changes in the brain, thereby modifying the age at

onset, but also promotes cognitive decline early in non-demented

older people. The objective of study, to review and analyse the pub-

lished evidence on Apo E polymorphism with the susceptibility to

AD and frequency of Apo E �4 genotype and homozygotes among

patients diagnosed with AD as compared to controls in Indian

Population

METHODS: In the present study, MEDLINE was reviewed for

articles published till June, 2013 supplemented by citation analysis

from retrieved articles to select case control studies. A meta-analysis

was performed to demonstrate the association of ApoE gene with

AD by random effects models. The association was assessed by

pooled MH odds ratio with 95% confidence intervals

RESULTS: A total of 07 studies representing data from 417 AD

patients and 651controls in the Indian population were eligible.

ApoE e2/4, e3/4 and e4/4 genotypes (OR¼3.93, 95% CI 1.60–9.68;

OR¼4.18, 95% CI 2.54–6.87; OR¼4.81, 95% CI 1.95–11.86) as

well as ApoE e4 allele (OR¼5.90, 95% CI 3.44–10.13) were associ-

ated with an increased risk AD whereas, ApoE e2/3, e3/3 genotypes


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and ApoE e3 (OR¼0.52, 95% CI 0.32–0.83; OR¼0.28, 95% CI

0.19–0.42; OR¼0.29, 95% CI 0.17–0.50) were found to be signifi-

cant marginal protective factors for AD

CONCLUSIONS: These results indicate that all genotypes of Apo E

e4 allele are associated with an increased risk of AD, whereas geno-

types Apo E e2 allele are protective against AD

Poster Number: M49 Abstract #: 2405Effects of Low Dose Radiation on DNAMethylation in Nuclear Power Plant Workers.

Y. Lee, MPH1, Y. J. Kim, PhD2, Y. J. Choi, PhD1, J. W. Lee, PhD1,S. Lee, MPH1 and H. W. Chung, PhD1

1School of Public Health, Seoul National University, Seoul, South Korea,2Chung-Ang University, Seoul, South Korea

INTRODUCTION: The impact of ionizing radiation on DNA

methylation has received a lot of attention due to its role in carcino-

genesis and the maintenance of genomic stability. Growing evidence

supports that exposure to ionizing radiation could alter DNA meth-

ylation, but few studies were performed on the effect of chronic

exposure to low-dose radiation on DNA methylation. In this study,

we evaluated the association between occupational radiation expo-

sure and DNA methylation level in workers of nuclear power plants.

METHODS: The study population included 170 radiation-exposed

workers and 30 controls. We measured global, long interspersed

nuclear element 1 (LINE-1) and Satellite 2 (Sat2) methylation levels

in blood leukocyte DNA.

RESULTS: Global DNA methylation levels were lower in radiation-

exposed workers than in controls (P<0.05). A significant

dose-response relationship between radiation exposure and global

DNA methylation level was found in nuclear power plant workers.

LINE-1 methylation levels were higher in the workers compared

with controls (P<0.0001), while no difference was found in Sat2

methylation levels (P¼0.090). Multiple linear regression analysis

showed a negative association between recent 1.5 year radiation

exposure and global DNA methylation (b=�0.0089, P<0.05),

whereas no association was found with LINE-1 and Sat2 methyla-

tion levels.

CONCLUSIONS: These findings provide evidence that occupa-

tional exposure to low dose radiation could affect global DNA

methylation level in nuclear power plant workers.

Poster Number: M138 Abstract #: 2550Prevalence of General and Abdominal Obesityand its Association with SocioeconomicVariables in Brazilian Adolescents from Low-Income Region.

M. V. N. Ferreira, MS1,2, A. C. F. de Moraes, PhD3,4, H. B.Carvalho, PhD3, L. A. Moreno, PhD3,4, V. M. M. dos Reis, PhD1

and F. L. Torres-Leal, PhD2

1University of Tras-os-Montes & Alto D’ouro, Vila Real, Portugal,2Federal University of Piauı, Teresina, Brazil, 3School of Medicine of the

University of Sao Paulo, Sao Paulo, Brazil, 4Faculty of Health Sciences of

the University of Zaragoza, Zaragoza, Spain

INTRODUCTION: Studies have shown that obesity is associated

with socioeconomic status (SES) in adolescents and this association

is dependent of the income region level. The objective of this study

was to estimate the prevalence of cardiovascular risk factors and to

verify its associations with socioeconomic variables in adolescents

from low-income region.

METHODS: We performed a cross-sectional study with adolescents

(n¼1014) of 14–19 years old, conducted in Imperatriz (Maranhao,

Brazil), city with Gini Index of 0.56, and selected by stratified sys-

tematic sampling. The outcomes of this study are obesity and over-

weight (measured by BMI), and abdominal obesity (measured waist

circumference). The socioeconomic variables analyzed were: family

socioeconomic status (SES), education level of the family’s head and

nature of school. The analyses were adjusted for confounding varia-

bles: gender, age and physical activity (� 60 min/d). Prevalence esti-

mates were performed and prevalence ratios (PR) were calculated

with confidence intervals of 95%, the associations were verified by

Poisson regression.

RESULTS: The prevalence of obesity was 3.8%, overweight 13.1%

and abdominal obesity 22.7%. In boys, high SES showed positive asso-

ciation with: overweight PR¼5.41 (95% CI 0.75–38.88), obesity

PR¼4.77 (95% CI 0.35–64.56) and abdominal obesity PR¼2,27

(95% CI 0.76–6.78), in comparison with the peers of lower SES. The

other expositions factors were not significant statistics.

CONCLUSIONS: The prevalence of general and abdominal obesity

is high among adolescent residents in low-income region. Boys com-

ing from high SES family, are more prone to present general and

abdominal obesity.

Poster Number: M185 Abstract #: 1351Knowledge, Attitude and Perceptions ofResidents of a Slum Area of Lagos State, Nigeriaon Malaria.

A. Aman-Oloniyo, MPH1 and A. Oduneye, MS2

1Nigeria Field Epidemiology and Laboratory Training Program, Abuja,

Nigeria, 2Lagos State Ministry of Health, Lagos, Nigeria

INTRODUCTION: One-fourth of malaria morbidity in sub-

Saharan Africa occurs in Nigeria. It accounts for about 63% of visits

to public health facilities, 30% of hospital admissions, 29% of child-

hood death, 25% of infant mortality and 11% of maternal mortal-

ity. It is responsible for 70% of outpatient attendance at the

secondary healthcare facilities and over 80% of all tracer diseases

reported by primary healthcare facilities in Lagos State.

METHODS: We administered structured questionnaires to 423 resi-

dents of Makoko slum area of Lagos, to collect demographics, assess

their knowledge about malaria & attitudes that aid the spread,

knowledge concerning Malaria Home management and Malaria

health seeking behaviours.

RESULTS: Sixty-nine percent (69.3%) were females, 18.4% of who

were pregnant. 48.2% of respondents have children<5 years old.

Number of children <5 years in the households ranged from one to

six.

Fifty four percent (54%) have at least one attack of malaria annu-

ally, 37.9% have 2-3 attacks annually. 74.2% had had malaria

within the year, 96.5% of who treated it. Of these, 58.2% used par-

acetamol, 42.3% local herbs, 21.7% chloroquine. Only 10.2% used

(the Government recommended) Artemisinin-based Combination

Therapy (ACTs); 66.5% of those that had malaria were self diag-

nosed while 23.4% went to hospital; 75.3% do not sleep under nets;


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83.7% believe that malaria can be prevented & 82.2% know

malaria has vectors.

Children<5 years old have high rate of malaria attacks (47% have

malaria at least once a year, 43.7% have 2–3 times), yet knowledge

of home management of malaria in children is quite low. Most

(54.9%) take their children to hospital for malaria; 26.5% would

administer paracetamol, 16.7% would tepid sponge. Only 3.4%

would administer ACTs.

CONCLUSIONS: All malaria control strategies including education

should be intensified. Efforts should be directed at improving inter-

vention strategies for those at greatest risk; pregnant women and

children <5 years.

Poster Number: M76 Abstract #: 2201Prevention of diabetes and Obesity in SouthAsians Trial: Lessons for the Future.

R. Bhopal, MD

University of Edinburgh, Edinburgh, Scotland

Raj Bhopal for the Prevention of Diabetes and Obesity in South Asians

(PODOSA) Trial team

INTRODUCTION: People with Indian subcontinent ancestry are

prone to type 2 diabetes particularly when they live overseas or in

urban South Asia. The Prevention of Diabetes and Obesity in South

Asians Trial (PODOSA) started in 2006 and completed in 2013.

METHODS: we tailored existing trial interventions by creating mate-

rials in specific languages, delivering the intervention in the family

home and involving family members to provide support. The trial

aimed to recruit 600 adults with prediabetes but we recruited 171 into

a controlled, family-cluster, randomised trial (86 controls & 85 inter-

vention participants in 156 families). The intervention group received

15, and the control group four, contacts with dietitians over three-

years. This analysis used linear regression models providing mean dif-

ferences (95% CI) in baseline-adjusted weight at three-years.

RESULTS: Recruitment was difficult but retention was excellent as

most participants (97.7%) finished. The primary outcome of the

trial was changed from progression to diabetes to weight change

(continuous outcomes provide more study power). We successfully

tailored prior trials and materials for our populations. The interven-

tion group lost 113 kg, and the control group gained 051 kg, an

adjusted mean difference of 164 (044, 283) kg. In the intervention

group compared to the control group: 33 participants lost �25 kg

compared to 12 (adjusted OR 392 (168, 93)); and the mean 3-year

cost of dietitians, the main additional cost, was £1190 compared to

£575 (95% CI for difference, £561–668).

CONCLUSIONS: The effect was modest but given that multiethnic

societies need to ensure health interventions are equitable across all

their populations, more trials of this kind are required. We will reflect

on how this experience will help in controlling the diabetes epidemic.

Poster Number: M202 Abstract #: 2368Efficacy of HPV Vaccines against Non-Cancer

Lesions: Systematic Review and Meta-Analysis.

R. A. Tejada, MD1, K. G. Vargas, MD1, V. Benites-Zapata, MD1,

E. Mezones-Holguın, MS1,2, A. V. Hernandez, PhD2 and R.

Bolanos, MD1

1Instituto Nacional de Salud, Lima, Peru, 2Universidad Peruana de

Ciencias Aplicadas (UPC), Lima, Peru

INTRODUCTION: Human papillomavirus (HPV) infection has

been associated with cancer and non-cancer lesions such as anogeni-

tal warts (AGW), and respiratory and oral papillomatosis. Vaccines

against HPV could be useful in preventing these diseases. We eval-

uated studies of clinical efficacy of HPV vaccines in the prevention

of non-cancer lesions.

METHODS: A systematic review of randomized trials was con-

ducted. The search was performed in PubMed, Embase, Cochrane

Library, Scopus, LILACS, SciELO and Web of Science from their

inception until August 2013 without language restriction.

References of selected articles, major international scientific sessions

abstracts from 2007 to 2013 and clinical trial registries were also

reviewed. We evaluated three outcomes: AGW, and respiratory and

oral papillomatosis. Tools proposed by the Cochrane Collaboration

for study quality assessment were used, and the I2 statistic was used

to quantify the degree of heterogeneity between studies. Random

effects models were used and effects reported as relative risks (RR)

and their confidence intervals (95% CI) following both intention to

treat (ITT) and per protocol (PP) analyses.

RESULTS: A total of 1598 references were found and five articles

accounting for six studies were included (n¼27 078). We did not

find studies on vaccine efficacy in respiratory or oral papillomatosis,

nor about bivalent vaccine. One study was rated ‘high risk of bias’

due to differences in loss of follow-up. One study could not be

included in the meta-analysis because it combined results on infec-

tion and disease. Quadrivalent vaccine decreased the risk of AGW

by 71% (RR: 0.29; 95% CI 0.18–0.46, I2: 55.1%) in the ITT and by

92% (RR: 0.08, 95% CI 0.03–0.21, I2: 0%) in the PP. Subgroup

analyses of studies in women or with ‘low-risk of bias’ provided sim-

ilar results.

CONCLUSIONS: HPV quadrivalent vaccine is efficacious in pre-

venting AGW. There are no available data on respiratory or oral

papillomatosis.

Poster Number: M222 Abstract #: 1354Fertility History and Cognition in Later Life.

S. Read, PhD1 and E. Grundy, PhD1,2

1London School of Hygiene and Tropical Medicine, London, UnitedKingdom, 2London School of Economics, London, United Kingdom

INTRODUCTION: The accumulation of adverse physiological,

socioeconomic and psychosocial factors over the lifecourse may

have adverse effects on cognitive function in later life. Such chal-

lenges might include stresses resulting from particular fertility path-

ways, but very little is known about this, especially for men. We

investigated the association between fertility history and cognitive

functioning in older men and women.

METHODS: The sample included 6132 women and men aged 50þwho participated in the English Longitudinal Study of Ageing.

Associations between number of children and timing of births with

the level and rate of change of a latent cognitive functioning factor

was assessed at five repeated measurement occasions over an 8-year

time. Models were controlled for age, socioeconomic position,

health, social isolation and control.

RESULTS: Poorer cognitive level was associated with a higher num-

ber of children in both men and women. Decline in cognitive func-

tioning was also faster in women with higher number of children.


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Nulliparity in women and having one child in men compared to two

children were associated with a poorer level of cognitive function-

ing. Early childbirth was associated with poorer cognitive level in

women. Late childbirth was associated with a higher level of cogni-

tive functioning.

CONCLUSIONS: The association between parity and level of cog-

nitive functioning is non-linear so that both high and low parity

compared to average parity are associated with poorer cognitive

functioning in older age. Early childbirth is also a risk factor for

poorer cognitive functioning in older women, whereas those men

and women having children late in life have better cognitive func-

tioning. Although socioeconomic factors played an important role

in the associations, a considerable amount of covariance remained

unexplained. Future studies need to investigate other potential fac-

tors. The pattern of the associations suggests that the underlying

mechanisms could be related to earlier life events and selection.

Poster Number: M108 Abstract #: 2387Efficacy of the Patient Health Questionnaire(PHQ-9) for Screening Depression in theQuilombola Population of Bahia State, Brazil.

S. M. Barroso, MS1, A. P. S. Melo, MD2, M. A. Silva, MS3 andM. D. C. Guimaraes, PhD4

1Universidade Federal do Triangulo Mineiro, Uberaba, Brazil,2Universidade Federal de Sao Joao Del Rei, Divinopolis, Brazil,3Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,4Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

INTRODUCTION: Quilombolas are African descendants with a

high degree of social vulnerability. They descend from slaves, are

extremely poor and live in poor rural areas of Brazil, with limited

access to health services. Incorporating the use of screening tools for

depression among health practices for this population may improve

access to treatment for people who suffer from depression. The

Patient Health Questionnaire (PHQ-9) is a screening scale for Major

Depressive Episode. It has been validated in Brazil and it is one of

the most used tools in the research of depression in the country.

However, there are no studies assessing its validity among rural pop-

ulations in Brazil, including Quilombola communities. This study

aimed at investigating the psychometric properties of the PHQ-9 in

Quilombola communities of Vitoria da Conquista (Bahia State),

Brazil.

METHODS: Cross-sectional population based health survey in five

Quilombola communities. Analysis was carried out by Item

Response Theory and we used the Graded-Response model to assess

depression among the 764 adult residents who answered the PHQ-

9. We estimated the discrimination ability and difficulty of each of

the nine items.

RESULTS: The score on the PHQ-9 ranged from zero to 27 points,

with a mean of 5.68 (SD þ 5.67). All items of the PHQ-9 showed

moderate to very high discrimination ability. The items ‘thoughts

about hurting oneself and death’ and ‘feeling depressed’ showed the

highest and lowest discrimination ability (a¼1.716 and 0.902,

respectively). On the other hand, ‘feeling tired’ and ‘feeling

depressed’ showed the smallest and highest amount of information

about depression (b¼0.744 and 2.570, respectively).

CONCLUSIONS: The PHQ-9 showed good performance in this

Quilombola rural population for assessing depression and this indi-

cates that it can be used as a screening tool for public health profes-

sionals serving this population.

Poster Number: M135 Abstract #: 2656Primary Health Care Data and CardiovascularDisease Risk: A Spatial Analysis.

N. Bagheri, PhD1, B. Gilmour1, I. McRae, PhD1, P. Konings,MS1, P. Dawda, MD1, P. Del Fante, MD2 and C. Van Weel, MD1

1Australian National University, Canberra, Australia, 2HealthfirstNetwork, Adelaide, Australia

INTRODUCTION: Cardiovascular disease (CVD) continues to be

a leading cause of morbidity and mortality among adults worldwide.

The objective of this study was to calculate a cardiovascular disease

risk score from General Practice clinical records for a sample popu-

lation and assess spatial variations in the distribution of CVD risk to

identify areas with high and low prevalence levels of CVD risk.

METHODS: We used GP practice data for 4,748 men and women

aged 30 to 74 years with no history of CVD. A 10 year absolute

CVD risk score was separately developed for men and women based

on the standard Framingham Risk Equation (FRE). The individual

risk scores were aggregated by statistical area level one (SA-1) to

predict area level CVD risk, and then the pattern of high and low

CVD risk was visualised in the study area.

RESULTS: The overall ten year risk of CVD in our sample popula-

tion was 14.6% (95% CI 14.29–14.94). Of the 4,748 patients in

our study, 26.7% were at high risk, 29.8% were at moderate risk

and 43.5% were at low risk for CVD over ten years. On the whole

men had a much higher CVD risk score (20.2%) than women

(10.6%). The geographic visualisation approach highlighted that the

prevalence of CVD risk was substantially higher in the areas with

lower socio-economic status.

CONCLUSIONS: The most immediate outcomes of this study are

greater empowerment of participating practices and general practi-

tioners in their use of clinical data and identification of hotspot

areas of future CVD risk. The geospatial analyses of CVD risk iden-

tified areas with high levels of unmet need for CVD care which will

enable policy makers to apply geographic targeting of effective pre-

ventive interventions to the right place, at the right time, to the right

people.

Poster Number: M90 Abstract #: 2538Elimination of Trachoma as cause of blindness inItapevi, State of Sao Paulo, Brazil.

V. H. Joseph, MD1, N. H. Medina, PhD2, J. L. Moreira, MD1, M.L. Silva, MS1, S. Nishimura, MD3 and M. R. Cardoso, DrPH4

1Secretaria de Higiene e Saude de Itapevi, SP, Itapevi, SP, Brazil,2Secretaria de Estado da Saude de Sao Paulo, Sao Paulo, Brazil,3Secretaria de Estado da Saude de Sao Paulo, Osasco, SP, Brazil,4Universidade de Sao Paulo, Sao Paulo, Brazil

INTRODUCTION: Trachoma is a chronic inflammatory disease

that affects the eye’s conjunctive and cornea, with recurrent evolu-

tion. Its etiological agent is the bacteria Chlamydia trachomatis. The

World Health Organization (WHO) has set the year 2020 as the

target for global elimination of trachoma as a public health

problem. To reach this target, the SAFE strategy (Surgery for trichia-

sis, Antibiotics to treat the infection, Facial cleanliness and

Environmental improvement to reduce transmission. This study

was carried out to assess the extension and distribution of

trachoma in Itapevi, SP in order to get the trachoma elimination

certification.


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METHODS: Itapevi is a city of 205,877 inhabitants and is located

in the greater Sao Paulo, state of Sao Paulo. A representative sample

of children one to nine years old was selected in census areas where

there were houses with a per capita income average of 1=4 of the

Brazilian minimal wage, using a probabilistic household sampling

procedure. The external ocular examination with a 2.5X magnifying

glass, according to WHO criteria was performed in the households

with children one to nine years old and their relatives. A variety of

socioeconomic and hygiene variables were studied in order to deter-

mine the risk factors for active trachoma in a household.

RESULTS: A total of 7.221 people and 2.354 children one to nine

years old were examined. The trachoma prevalence was 1%, being

98.6% of inflammatory follicular trachoma (TF) and 1.4% of cica-

tricial trachoma (TS) and no trachomatous trichiasis were found.

CONCLUSIONS: The prevalence of active trachoma was less than

5% in children one to nine years old, showing that trachoma is not a

cause of blindness and is not a public health problem in Itapevi, SP,

Brazil.

Poster Number: M223 Abstract #: 1357Physical Activity Moderates the Association

between Fertility History and Later Life Health.

S. Read, PhD1 and E. Grundy, PhD1,2

1London School of Hygiene and Tropical Medicine, London, United

Kingdom, 2London School of Economics, London, United Kingdom

INTRODUCTION: High parity and early child birth have been

associated with adverse health outcomes in old age. We examined

whether physical activity moderates later life health disadvantages

related to high parity and early child birth.

METHODS: A sample of men and women from five waves between

2002–10 (n ¼11,233 in wave 1) of the English Longitudinal Study

of ageing was used. Latent growth curves were used to analyze the

level and rate of change in disability. The models included physical

activity, fertility history (parity and early childbirth), age and quali-

fication in wave 1, and being married, wealth quintile, current

smoking, social support and depressive symptoms as time-varying

covariates. The interaction terms physical activity*parity and physi-

cal activity*early childbirth were tested in the models.

RESULTS: Among those who were physically active, disability

remained at a considerably lower level and high parity and early

child birth were not associated with a poorer level of health. Among

those who were physically less active, disability was initially at a

higher level and showed a faster increase over time. High parity and

early child birth were associated with a poorer level of health among

those who were physically less active.

CONCLUSIONS: Physical activity moderates the extent of health

disadvantage related to high parity and early age at entry to parent-

hood. This suggests a need to test whether interventions to promote

physical activity are of value in offsetting disadvantages associated

with fertility and other trajectories earlier in the life course.

Poster Number: M233 Abstract #: 2567Environmental Exposure to Phthalates may

Affect Bone Mineral Density in Older Women.

K. Min, PhD1 and J. Min, PhD2

1Ajou University School of Medicine, Suwon, South Korea, 2SeoulNational University, Seoul, South Korea

INTRODUCTION: Phthalates are mainly used as plasticizers or a

large variety of products. Phthalates, as endocrine disruptors with

estrogenic activity, have the potential to affect bone metabolism.

Experimental studies have demonstrated that some phthalates inter-

feres with skeletal formation and balance of bone homeostasis; there

is no evidence on the relationship of phthalates with bone health in

human. The purpose of this study was to examine the association of

bone mineral density (BMD) or osteoporosis with concentrations of

phthalate metabolites in older women.

METHODS: We conducted a cross-sectional study of 556 women

adults (�50 years) who participated in the 2005–06 and 2007–08

National Health and Nutrition Examination Survey. Eleven phtha-

lates (LOD>60%) were included in the present analysis. The total

hip BMD was measured using dual-energy X-ray absorptiometry,

and the status of osteoporosis was based on the World Health

Organization WHO definitions.

RESULTS: Women with higher levels of mono-n-butyl phthalate

(MnBP), mono-(3-carboxypropyl) phthalate (MCPP), monoethyl

phthalate (MEP), and monobenzyl phthalate (MBzP) were associated

with significant decreases in the total hip BMD, after adjusting for

potential confounders. Compared with women in the lowest quartile,

women in the highest quartile for the sum of three di(2-ethylhexyl)

phthalate (DEHP), MCPP, mono(2-ethyl-5-carboxypentyl) phthalate

(MECPP) had a four- to seven- fold greater risk for osteoporosis

[OR¼6.7 (95% CI 2.3, 19.2) for DEHP, OR¼4.6 (95% CI 1.6, 13.6)

for MCPP, and OR¼3.5 (95% CI 1.0, 12.0) for MECPP, respectively].

CONCLUSIONS: Our findings suggest that specific phthalate

metabolites may continue a risk factor for low bone mass and osteo-

porosis in older women. Future studies are needed to confirm the

effect of phthalates on bone health in human.

Poster Number: M188 Abstract #: 2625Prognostic Factors and Scoring System for Deathfrom Visceral Leishmaniasis: A Historical CohortStudy in Brazil.

M. Carneiro, PhD1, W. Coura-Vital, PhD1, V. E. M. Araujo, PhD2,I. A. Reis, PhD1, F. F. Amancio, MD1, A. B. Reis, PhD3 and A.Rabello, PhD4

1Federal University of Minas Gerais, Belo Horizonte, Brazil, 2MunicipalityHealth Service, Belo Horizonte, Brazil, 3Federal University of Ouro Preto,Ouro Preto, Brazil, 4Oswaldo Cruz Foundation, Belo Horizonte, Brazil

INTRODUCTION: In Brazil, case-fatality rates from visceral leish-

maniasis (VL) are high and knowledge regarding the risk factors

associate with death may contribute to lower mortality. The goals

were to build and to validate a scoring system for prognosis of death

from VL using cases reported in Brazil from 2007 to 2011.

METHODS: This historical cohort study analyzed 18,501 VL cases;

of these 17,345 were cured and 1,156 died from VL. The database

was provided by Brazilian Ministry of Health. The database was

divided into two series: primary (2/3 of cases) to develop the prog-

nostic score system; and secondary (1/3 of cases) to validate the scor-

ing system. Multivariate logistic regression models were performed

to identify factors associated with death from VL, and these were

included in prognostic scoring system.

RESULTS: The prognostic factors associated with death from VL

were: bleeding (OR¼3.8; score 3), hepatomegaly (OR¼1.5; score


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1), edema (OR¼1.8; score 1), weakness (OR¼1.7; score 1), jaundice

(OR¼1.6; score 1), Leishmania-HIV co-infection (OR¼1.6; score

1), bacterial infection (OR¼1.9; score 1) and age (� 0.5 years

[OR¼8.3; score 5];>0.5 and �1 years [OR¼2.8; score 2];>19 and

�50 (OR¼2.4; score 2),>50 and <65 [OR¼3.9; score 3]; 365

[OR¼9.5; score 5]). The scoring system performance showed an area

of 0.77 (good performance) under the receiver operating characteristic

curve. It was observed that patients with score of 11 have the proba-

bility of death of 26.9% and from this point, the prognosis worsens.

CONCLUSIONS: Knowledge the factors associated with death can

contribute to improve the surveillance system, the clinical manage-

ment of the severe cases and to reduce the case-fatality rates from

VL. Patients classified according to their prognosis may assist deci-

sion-making as their transfer to hospital care and admission to the

intensive care unit.

Poster Number: M117 Abstract #: 2482Epidemic of Charcoal Burning Suicide in Japan.

E. Yoshioka, MD1, S. J. Hanley, PhD2, Y. Kawanishi, MD1 and Y.Saijo, MD1

1Asahikawa Medical University, Asahikawa, Japan, 2HokkaidoUniversity, Sapporo, Japan

INTRODUCTION: There has been an epidemic of suicide by the

charcoal burning method since the late ’90s in Hong Kong and

Taiwan, and since 2003 in Japan. While the epidemics in Hong Kong

and Taiwan have been well documented, little is known about the sit-

uation in Japan. We aim to evaluate the impact of the emergence of

charcoal burning on overall suicide rates in Japan, and assess any sign

of substitution effect from the charcoal burning method.

METHODS: Data was obtained from the Vital Statistics of Japan.

We grouped suicide methods into charcoal burning and other meth-

ods, and age into 15–24, 25–44, 45–64 and 65þ. The period

1998–2002 was taken as the pre-epidemic period, while 2003–07 as

the epidemic period. To examine the influence of charcoal burning

method on overall and method-specific suicides, Negative Binomial

regression analyses were performed by using the number of suicides

per year and the age groups as the outcome variables.

RESULTS: In the 15–24 and 25–44yr age groups of both males and

females, substantial increases in the APCs (average percentage

change between the pre-epidemic and epidemic periods) of overall

suicides were observed, while significant decreases in the APCs of

other method suicide were not observed after adjustment for time

trend. However, in the other age groups, similar trends in the APCs

of overall and other method suicides were not observed.

CONCLUSIONS: Our results suggest that, in the 15–24 and

25–44yr age-groups of both males and females, the charcoal burning

method appealed to individuals who might not have used other

available lethal methods and this therefore lead to an increase in

overall suicide rates during the epidemic period in Japan.

Poster Number: M165 Abstract #: 2594Prospective Cohort Study on Television ViewingTime and Chronic Obstructive PulmonaryDisease Mortality: Findings from the JapanCollaborative Cohort Study.

S. Ukawa, PhD1, A. Tamakoshi, PhD2, H. Yatsuya, PhD3, K.Yamagishi, PhD4, M. Ando, PhD5 and H. Iso, PhD6

1Hokkaido University, Sapporo, Japan, 2Hokkaido University Graduate

School of Medicine, Sapporo, Japan, 3Fujita Health University, Toyoake,

Japan, 4University of Tsukuba, Tsukuba, Japan, 5Nagoya UniversityHospital, Nagoya, Japan, 6Osaka University, Suita, Japan

INTRODUCTION: Sedentary behaviors including watching televi-

sion (TV) increase the risk of cardiovascular disease and several can-

cers. However, the link between sedentary behaviors and chronic

obstructive pulmonary disease (COPD) is unclear. We tested the

association of daily television viewing time with COPD mortality in

Japanese adults in a large-scale nationwide cohort study.

METHODS: A total of 72,702 adults (31,200 males and 41,502

females) aged 40 to 79 years without a history of stroke, myocardial

infarction, cancer, and tuberculosis, who were followed for a

median of 17.3 years, were studied. Participants who died or were

censored within five years from the baseline were not included. The

Cox proportional hazards model was used to calculate hazard ratios

(HRs) and 95% confidence intervals (CIs) for COPD (J41 to J44

and J47 by the International Classification of Diseases 10th revision)

mortality adjusted for study area, age, smoking status (never smok-

ers exposure to environmental tobacco smoke at home or in public

places almost every day, less or unknown, former smokers time since

quitting �10 or <10 years or unknown, and current smokers with

�20 or <20 pack years or unknown), body mass index

(BMI<18.5, 18.5–24.9, �25.0, unknown), educational level

(school up to age 15, 15–18, �19 years, unknown), marital status

(single, married, divorced/widowed, unknown), and alcohol con-

sumption (never, former, current alcohol drinker, unknown).

RESULTS: During the study period, 254 (223 males and 31 females)

participants died of COPD. The HR of male participants who

watched TV for more than four hours daily was 1.68 (95% CI

1.04–2.74) compared to those with the habit less than two hours per

day. No association was found among women (HR, 0.75; 95% CI

0.25–2.28).

CONCLUSIONS: Our findings suggest that reducing the amount of

time spent watching TV may be beneficial for preventing death from

COPD.

Poster Number: M69 Abstract #: 1364Estimating the Risk of Child Maltreatment byAge Two among Children Born to Mothers with aPrior History of IPV.

J. W. Parrish, MS1,2, M. Shanahan, PhD1 and K. Perham-Hester, MS2

1University of North Carolina at Chapel Hill, Chapel Hill, NC, 2Alaska

Division of Public Health, Anchorage, AK

INTRODUCTION: Children living in homes with intimate partner

violence (IPV) have an increased risk of child abuse; the nature of

this association remains ambiguous. While literature on the co-

occurrence has been documented, the risk of child maltreatment

among children born to mothers with a prior history of IPV is

unknown. This study describes a retrospective cohort study con-

ducted in Alaska to understand any potential etiologic link.

METHODS: Since 1990 the Alaska Division of Public Health has

surveyed approximately 17% of all birthmothers each year using the

Pregnancy Risk Assessment Monitoring Survey (PRAMS). The

2009–10 PRAMS respondents (n¼2,393) were linked to child pro-

tection services (CPS) reports occurring between 2009–12, to exam-

ine the risk of child maltreatment by age two among children born

to mothers with a prior history of IPV. Unadjusted incidence odds


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ratios (IOR) and 95% confidence intervals were calculated using a

median unbiased approach to account for small numbers and logis-

tic regression was used to calculate adjusted IOR to approximate

the total effects incidence risk ratio.

RESULTS: Among the 2,393 PRAMS respondents, 217 (9.0%) self-

reported a history of intimate partner violence and 228 (8.1%) of

the PRAMS children experienced a maltreatment report. Comparing

respondents with an IPV history to those without, the unadjusted

incidence odds ratio (IOR) of a maltreatment report was 4.70 (95%

CI 3.00, 7.23). After adjusting for income status, marital status,

Alaska Native, maternal education, smoking during pregnancy, and

maternal age, the adjusted IOR was 2.58 (95% CI 1.60, 4.10).

CONCLUSIONS: This study suggests an increased risk of maltreat-

ment for children born to mothers with a history of IPV. More sensi-

tive familial violence screenings are needed during prenatal care

through birth when physicians and other health professionals poten-

tially have high impact contact with high risk populations.

Poster Number: M189 Abstract #: 2340Public Awareness and Information Sources ofHealth Publicity for Three Major InfectiousDiseases in Rural Zhejiang Province, China.

K. Chen, PhD

Zhejiang University, Hangzhou, China

INTRODUCTION: Our study aimed to investigate the level of

awareness and the information sources of health publicity of major

infectious diseases in Zhejiang Province, southeast of China, and to

examine the association between sociodemographic characteristics

and the sources of health publicity for major infectious diseases.

METHODS: This cross-sectional study was carried out in Zhejiang

province between December 2010 and April 2011. Participants were

recruited from 36 villages and interviewed by doctors from the com-

munity health service using a structured questionnaire. Chi-square

test and t-test were used for analytical evaluation.

RESULTS: The study sample consisted of 36,377 subjects aged 15 to

80 years old. It showed that knowledge of human immunodeficiency

virus (HIV) was adequate in 44.21% of rural residents; knowledge of

tuberculosis (TB) was adequate in 52.66% of respondents; and knowl-

edge of hepatitis B virus (HBV) was adequate in 60.18% of respond-

ents. The percentage of participants having been exposed to health

publicity related to HIV, TB and HBV over the past year was 87.89%,

88.71%, and 90.81%, respectively. Subjects with above senior high

school education chose ‘newspapers or magazines’ and ‘internet’ most.

Farmers were more likely to choose ‘television’, ‘posters or billboards’,

and ‘broadcasts’. Subjects who were aware of knowledge for three

infectious diseases tended to choose ‘television’, ‘posters or billboards’,

‘free publicity materials or handbills’, ‘newspapers or magazines’, and

‘internet’, but not ‘relatives or friends’ and ‘broadcasts’.

CONCLUSIONS: The level of public awareness of HIV, TB and

HBV is still low among rural residents. The government could invest

selectively on the information sources of health publicity which have

greater potentials to inform audiences.

Poster Number: M82 Abstract #: 2568Epidemiologic Features of Human Prion Diseasesin Japan: A Prospective 14-year Surveillance.

R. Ae, MD1, T. Kojo, PhD1, S. Tsuboi, PhD1, Y. Aoyama, PhD1,K. Kotani, PhD1, H. Takamura, PhD1, E. O. Tsogzolbaatar,

MPH1, M. Yamada, PhD2, H. Mizusawa, PhD3 and

Y. Nakamura, MPH1

1Jichi Medical University, Shimotsuke, Japan, 2Kanazawa University

Graduate School of Medical Science, Kanazawa, Japan, 3Tokyo Medical

and Dental University Graduate School of Medical and Dental Sciences,

Tokyo, Japan

INTRODUCTION: The nationwide prospective surveillance for

human prion diseases in Japan has been conducted since 1999. This

study aimed to reveal epidemiologic features of human prion dis-

eases in Japan by using the surveillance data.

METHODS: Information about patients suspected to have human

prion diseases was obtained from three sources: (1) registries to the

Intractable Disease Treatment Research Program, (2) notifications

based on the Infectious Diseases Control Law, and (3) requests for

genetic or CSF analysis by physicians to the members of the Creutzfeldt-

Jakob disease (CJD) Surveillance Committee. We analyzed the data

obtained from all the patients suspected of human prion diseases who

were registered by the CJD Surveillance Committee between April 1999

and October 2013. All the referrals were assessed according to the

World Health Organization case definition.

RESULTS: During the surveillance period, 4281 suspected patients

were identified, and 2162 patients were confirmed as having prion dis-

eases: definite (n¼245, 11%) and probable (n¼1668, 77%) cases.

Diseases included sporadic CJD (n¼1655, 77%), genetic CJD

(n¼415, 19%, including familial CJD [n¼325, 15%], Gerstmann-

Straussler-Scheinker syndrome [GSS, n¼85, 4%], and fatal familial

insomnia [n¼3]), dura mater graft-associated CJD (dCJD, n¼84,

4%), variant CJD (n¼1), and unclassified CJD (n¼7). The age-specific

incidence rates of human prion diseases in 2011 (per one million popu-

lations) were higher with age (40–49 years: 0.3, 50–59 years: 1.7,

60–69 years: 2.8, and 70–79 years: 6.3). During 1999–2011, annual

incidence rates increased only in older groups. A total of 1622 deaths

were reported; the mean duration from disease onset to death was 18

months, ranging from 16 months in sporadic CJD to 61 months in GSS.

CONCLUSIONS: In Japan, the proportions of dCJD and genetic

CJD were relatively higher than other countries. Particularly, the

number of dCJD was markedly higher.

Poster Number: M204 Abstract #: 2243Quantifying the Impact of Surgical Treatment onTemporo-Mandibular Joint Ankylosis: aSystematic Review and Meta-analysis.

N. De Roo, MS1, L. Van Doorne, MD1, A. Troch, MS1, H.

Vermeersch, PhD1 and N. Brusselaers, PhD2

1Ghent University, Ghent, Belgium, 2Karolinska Institutet, Stockholm,

Sweden

INTRODUCTION: Temporo-mandibular joint ankylosis (TMJA)

results in a restricted mouth-opening due to fibrous or bony (non-

neoplastic) union of the mandibular head to glenoid fossa. TMJA

causes speech disorders, oral hygiene and breathing problems, and

disturbances of facial and mandibular growth in children. Early sur-

gical treatment is recommended, but the ideal surgical technique is

still debated. The objective of this study is to assess and quantify the

effect on maximal mouth-opening of the different surgical interven-

tions reported in the literature.

METHODS: The systematic literature search (1960–2013) was

based on PubMed, Web of Science and Cochrane. A random-effects


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meta-analysis was performed to analyse the pooled mean difference

between pre-and postoperative maximal interincisal mouth-opening

(in millimetres, presented with 95% confidence intervals). The surgi-

cal interventions were grouped according to increasing complexity:

gap arthroplasty (GA), interposition arthroplasty (IA) and recon-

struction arthroplasty (RA). IA and RA were performed with autog-

enous (auto-) or allogenous (allo-) materials.

RESULTS: Thirty-eight articles were identified (1993–2013), includ-

ing 787 operated patients (50% male, 20% bilateral). Mean age of

onset varied between 5-18 years, with on average nine years (65.2y)

delay of treatment; 81% was caused by trauma and 11% by infection.

GA (n¼140), auto-IA (n¼311), allo-IA (n¼79), auto-RA (n¼217)

and allo-RA (n¼37) resulted in an improvement in mouth-opening

of, respectively 25.2 (CI 21.5–29.02), 26.7 (CI 24.8–28.7), 23.3 (CI

18.5–28.1), 28.5 (CI 26.4–30.6) and 29.9 (CI 25.1–34.6) mm, or a

pooled average of 26.9 (CI 25.6–28.2) mm. However, the mean

pooled postoperative mouth-opening was similar in all groups (33.7-

35.3 mm). The mean difference was similar in children and adults,

respectively 27.3 (CI 24.3–30.3) and 26.2 (CI 20.6–31.8) mm.

Complication and recurrence rates could not be compared.

CONCLUSIONS: Improvement of mouth-opening was largest after

RA, and smallest after GA. However, the post-operative mouth-

opening was similar for all techniques.

Poster Number: M91 Abstract #: 2505Epidemiological and Clinical Characteristics ofStevens-Johnson Syndrome and Toxic EpidermalNecrolysis in Japan: Finding from a Database ofPatients Receiving Financial Aid for Treatment.

M. Kurosawa, PhD1, Y. Kano, MD2, T. Shiohara, MD2 and K.Yokoyama, PhD1

1Juntendo University Faculty of Medicine, Tokyo, Japan, 2Kyorin

University School of Medicine, Tokyo, Japan

INTRODUCTION: In 2003, the Ministry of Health, Labour and

Welfare (MHLW) of Japan launched an online registration system

for 45 intractable diseases. Stevens-Johnson syndrome (SJS) and

Toxic epidermal necrolysis (TEN) were added to the system in

2009. The study aimed to explore the epidemiological and clinical

characteristics of SJS and TEN in Japan using this clinical database.

METHODS: We obtained clinical records for SJS and TEN from the

MHLW between 2009 and 2012. Eighteen duplicate cases were

excluded from the analysis and clinical data from 241 patients (SJS:

161 cases, TEN: 75 cases, Unknown disease type: 5 cases) including

sex, age, activity in daily life, symptoms, and treatments were

included in the final analysis.

RESULTS: The sex ratio (male/female) of the subjects was 1.06 for

SJS and 0.70 for TEN. TEN most frequently afflicted patients in the

60–69 years age group, whereas SJS were widely distributed across

the age groups. A total of 72.7% of patients with SJS and 53.3% of

patients with TEN could perform daily activities almost independ-

ently, whereas 18.6% of patients with SJS and 37.3% of patients

with TEN needed some assistance. A total of 92.5% of patients with

SJS received corticosteroids (76.5% efficacy rate), 50.9% received

steroid pulse therapy(75.6% efficacy rate), 17.8% received intrave-

nous immunoglobulin (IVIG) therapy(58.8% efficacy rate), and

1.9% received plasma exchange therapy (66.7% efficacy rate). Of

the patients with TEN, 88.0% received corticosteroids (60.6% effi-

cacy rate), 82.7% received steroid pulse therapy (64.5% efficacy

rate), 45.3% received IVIG therapy(58.8% efficacy rate), and

22.7% received plasma exchange therapy (64.7% efficacy rate).

CONCLUSIONS: Using a clinical database, we clarified the clinical

and epidemiological features of SJS and TEN in Japan.

ACKNOWLEDGEMENTS: This work was partly supported by the

Health and Labour Sciences Research Grants ‘Research on

Intractable Diseases’ from the MHLW of Japan.

Poster Number: M127 Abstract #: 1382The Application of Sociomapping inEpidemiological Research.

J. Spilkova, PhD1, R. Bahbouh, PhD2 and D. Dzurova, PhD1

1Faculty of Science, Prague 2, Czech Republic, 2Faculty of Arts, Prague,Czech Republic

INTRODUCTION: The aim of the presentation is to contribute to

the evaluation of health risk perception and the prevalence of sub-

stance use among European students and examine the possibilities

of the use of new visual methods—sociomapping.

METHODS: For our study we use a total of the 71,287 European stu-

dent respondents (the European School Survey Project on Alcohol and

Other Drugs 2007) from 23 countries (boys 49% and 51% of girls).

Sociomapping is a new method for analyzing socio-economic systems

that reveals hidden structures within complex systems and monitors

their dynamics. The process allows for the systematic interpretation of

data that is not possible using more traditional methods making it a val-

uable new tool for use in team development.

RESULTS: Based on the multi-level statistical models which

included 9 independent variables, we can state that the students who

don’t perceive smoking of one or more packets of cigarettes per day

as a great risk, are 1.74 times more likely to become daily smokers

than those who recognize the risk. In heavy episodic drinking, those

who do not see the risk in drinking one or two drinks nearly every

day tend to become heavy drinkers 1.23 times more likely than the

control group and those who do not think that the occasional use of

marijuana is risky, use this drug almost seven times more likely than

the students who are aware of its risk.

CONCLUSIONS: The European countries where students are aware

of the risks presented by smoking, drinking of alcohol and mari-

juana use, tend to show lower prevalence of these risk behaviors.

Sociomaps represent a very efficient tool for analysis because they

enable swift orientation and comprehension of data even in the anal-

ysis of complex systems.

Poster Number: M68 Abstract #: 2265Radiation Risk of Mortality of Cancer andNoncancer Diseases in the Atomic-bombSurvivors.

K. Ozasa, PhD1, Y. Shimizu, PhD1, T. M. Pham, PhD1, E. J.Grant, PhD1, R. Sakata, PhD1, H. Sugiyama, PhD1, A. Sadakane,PhD1, M. Soda, MD2 and K. Kodama, PhD1

1Radiation Effects Research Foundation, Hiroshima, Japan, 2RadiationEffects Research Foundation, Nagasaki, Japan

INTRODUCTION: Late health effects of atomic-bomb radiation

have been evaluated by long-term cohort studies.

METHODS: The Life Span Study (LSS) is a cohort of 120,321

atomic bomb survivors, who have been followed up for mortality


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since 1950. Individual radiation doses were estimated as weighted

absorbed doses (Gy), gamma dose þ neutron dose x 10, based on

location and shielding at the time of the bombing. Excess relative

risk per unit dose (ERR) has been calculated.

RESULTS: A significantly increased risk of radiation for solid can-

cer mortality was estimated at doses �0.20 Gy (ERR/Gy¼0.42 at

age 70 years after exposure at age 30) based on a linear model,

which was the best fitting model. The ERR/Gy was 0.17 for all non-

cancer respiratory diseases (NCRD), 63% of which consisted of

pneumonia/influenza. The dose response of NCRD was more con-

cave in the early period of observation and became linear in the late

period. In addition, adjustments for indications of cancer and/or car-

diovascular disease decreased the risk estimates of all NCRD by

35% from 0.17 to 0.11.

CONCLUSIONS: The long-term risk of radiation for cancers is well

established. However, the apparent association between NCRD and

radiation exposure may, in part, be attributed to coincident cancer

and/or other diseases that were associated with radiation risks. The

different shapes of the dose response by observed period suggests

different mechanisms of radiation risks.

REFERENCE

Ozasa K, et al. Studies of the Mortality of Atomic Bomb Survivors,

Report 14, 1950–2003. Radiat Res 2012;177:229–43.

Pham TM, et al. Radiation exposure and the risk of mortality from

noncancer respiratory diseases in the Life Span Study, 1950–2005.

Radiat Res 2013;180:539–45.

Poster Number: M159 Abstract #: 1385Sex, Age and other EpidemiologicalCharacteristics of Aplastic Anemia Patients inJapan.

M. Nagai, MD1, A. Ohta, MD1, M. Nishina, BS1, N. Shimada,

MD2, S. Nakao, MD3 and M. Kurokawa, MD4

1Saitama Medical University, Moroyamamachi, Japan, 2International

University of Health and Welfare, Tochigi, Japan, 3Kanazawa University

Graduate School of Medical Science, Kanazawa, Japan, 4Graduate

School of Medicine, The University of Tokyo, Tokyo, Japan

INTRODUCTION: We describe the epidemiological characteristics

of aplastic anemia patients in Japan based on data from a nation-

wide registration system.

METHODS: An effective nationwide registration system for patients

with intractable diseases including aplastic anemia has been estab-

lished in Japan and is administrated by the Japanese government. We

used data from the system that had been converted to electronic form

between 2003 and 2010 for analysis. The data included information

on patients’ age, sex, age at onset, disease type [primary (idiopathic),

secondary, and other], and severity of aplastic anemia. As patients

who want to receive financial assistance for treatment register with

the system, the registered patients are considered to be representative

of patients across Japan. Although only 70 to 80% of the data have

been converted to electronic form, the data are considered to

adequately represent the characteristics of all registered patients.

RESULTS: Between 2003 and 2010, approximately 9000 patients

were registered, which means that the prevalence is 7.2 per 100,000

population. Analysis of the 7,505 cases that were electronically con-

verted in 2009 revealed the following epidemiological characteristics:

the sex ratio (female/male) is 1.46; the age distribution shows two

peaks in the thirties and sixties; age at onset also has two peaks at

approximately ten years prior to each peak in the current age; age at

onset is higher in females than males; approximately 90% of patients

are primary (idiopathic) type; 50% of patients who are within one

year since onset have a severe or very severe (stage 4 or 5) condition;

and patients with longer suffering time have a less severe condition.

CONCLUSIONS: This report provides fundamental epidemiologi-

cal information on aplastic anemia in Japan.

ACKNOWLEDGEMENTS: This study was supported by a Grant-

in-Aid for Research Committee on the Idiopathic Disorders of

Hematopoietic Organs from the Ministry of Health, Labour and

Welfare of Japan.

Poster Number: M99 Abstract #: 2518Reasons for Encounters and Diagnoses of NewOutpatients at a Small Community Hospital inJapan: an Observational Study.

T. Takeshima, MD1, M. Kumada, PhD1,2, J. Mise, MD1, Y.Ishikawa, PhD2, H. Yoshizawa, MD2, T. Nakamura, PhD1,2, M.Okayama, PhD1 and E. Kajii, PhD1

1Jichi Medical University, Center for Community Medicine, Tochigi,

Japan, 2Chikusei City Hospital, Ibaraki, Japan

INTRODUCTION: The registration of primary care-based reasons

for encounters (RFEs) and diagnoses are essential for teaching gen-

eral practice methods. However, there are few reports on this topic

from small hospitals (200 beds or less). Therefore, we investigated

RFEs and diagnoses of new outpatients at a small hospital.

METHODS: We reviewed data of new outpatients seen in the

department of general internal medicine at a small hospital between

May 6, 2010 and March 11, 2011. We classified RFEs and diagno-

ses according to Component 1, ‘Symptoms/Complaints,’ and

Component 7, ‘Diagnosis/Diseases,’ of the International

Classification of Primary Care, 2ndedition (ICPC-2). Furthermore,

we evaluated the differences between observed RFEs and common

symptoms from the guidelines, ‘Model Core Curriculum for

Medical Students’ and ‘Goals of Clinical Clerkship.’

RESULTS: We analyzed the data of 1515 outpatients whose age

(mean 6 standard deviation) was 52.9 6 19.9. There were 2252

RFEs (1.49 per encounter) and 170 ICPC-2 codes. The top 30 RFE

codes accounted for 80% of all RFEs and the top 55 codes

accounted for 90%. There were 1727 diagnoses and 192 ICPC-2

codes. The top 50 diagnosis codes accounted for 80% of all diagno-

ses, and the top 90 codes accounted for 90%. Of the 2252 RFEs,

1408 included at least one of the 36 symptoms listed in the Model

Core Curriculum and 1443 included at least one of the 35 symptoms

in the Goals of Clinical Clerkship. On the other hand, ‘A91

Abnormal result investigation,’ ‘R21 Throat symptom/complaint,’

and ‘R07 Sneezing/nasal congestion,’ which were among the top 10

RFEs, were not included in these two guidelines.

CONCLUSIONS: We identified the common RFEs and diagnoses

and revealed the gaps in between the RFEs observed and common

symptoms listed in various guidelines. Our findings can be useful in

improving the medical education curricula for general practice.

Poster Number: M77 Abstract #: 2818Epidemiology of the use of Complementary andAlternative Medicine in Central Area of Sao Paulo.

B. Castro and O. Simoes


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Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Sao Paulo,

Brazil

INTRODUCTION: Establish the profile of Sao Paulo citizen

regarding alternative practices, based on the literature and on the

assumption that the use of CAM (Complementary and Alternative

Medicine) is mediated by factors such as socioeconomic status, gen-

der and dissatisfaction with official medicine. Also, determining the

usage, frequency, amount, types, costs and reasons. Furthermore, it

aims to contribute to the health actions of the local Health Unit.

METHODS: Cross-sectional study, population-based, through inter-

views with adults above 18 years old, living in Barra Funda in the

influence area of the Health Centre, which was selected from a sys-

tematic sample, by homogeneous cluster, in areas covered by the PSF

(Programa Saude da Famılia). Were excluded from the sample those

who could not respond to the interview, otherwise we requested the

help of other family member. The sample contains 380 individuals

considering the frequency of use, the difference found between the

proportions of users or not, according to personal characteristics. The

sample size considered the effect of the study design, losses due to

refusal, lack of locals (after two visits to residences), failure in filling

the questionnaire. The analysis was made with the chi-square test.

RESULTS: It was determined the frequency, motivation and costs of

these therapies used by respondents. The use of CAM was more

prevalent in people with income greater than the median household

income of the sample. Furthermore, individuals with college degrees

use complementary therapies more than others. It was also found

that women use more than men. Finally, we had acupuncture,

prayer and tea as known and used by most respondents.

CONCLUSIONS: These findings allow us to identify the need for

greater closeness between health professionals and alternative thera-

pies. Also, it was found the need to expand the use of complemen-

tary therapies to assist in the restoration of health problems, and on

preventive health.

Poster Number: M211 Abstract #: 1386Impact of ‘Maria da Penha Law’ on FemaleMortality due to Aggression in Brazil, 2001–11.

L. P. Garcia, PhD1, L. R. Freitas, MD2 and D. A. Hofelmann, PhD3

1Institute for Applied Economic Research, Brasilia, Brazil, 2University ofBrasilia, Brasilia, Brazil, 3Brazilian Ministry of Health, Brasilia, Brazil

INTRODUCTION: In Brazil, the Law n. 11.340, enacted in 2006,

known as ‘Maria da Penha Law’, created mechanisms to prevent

domestic and family violence against women, including integrated

measures of prevention, assistance to women victims of violence and

protective measures applied to the aggressor. This study aims to

evaluate the impact of the ‘Maria da Penha’ Law on the female mor-

tality due to aggression.

METHODS: A time series study with before-and-after design was con-

ducted with data from the period 2001–11, from the Mortality

Information System of the Brazilian Ministry of Health. The number of

deaths was corrected through proportional redistribution of the events

of undetermined intent. Corrected mortality rates were calculated. The

Autoregressive Integrated Moving Average (ARIMA) model was used.

RESULTS: 54,107 deaths of women due to aggression were esti-

mated for the period 2001–11. The deaths were concentrated in the

age group 20–39 years (52.5%) among black women (55.0%) and

lower education (45.4% with up to seven years of study, highlight-

ing that there were 36 6% of missing information for this variable).

The main causes were injury by firearms (52.0%) and injury by

sharp instrument, sharp or blunt (30.0%), followed by suffocation

(5.7%). More than a third of the deaths occurred during the week-

ends (35.5%), and nearly a third of the deaths occurred at home

(27.0%). The corrected mortality rates were 5.28 and 5.22 per

100,000 women in the periods 2001–06 and 2007–11, respectively,

before and after the enactment of the law. Comparing these periods,

there was no reduction in annual female mortality rates due to

aggression (P¼0.846).

CONCLUSIONS: The Law that created mechanisms to prevent

domestic and family violence against women had no impact on the

female mortality due to aggression. The mortality profile is largely

consistent with the occurrence of domestic violence against women.

Poster Number: M228 Abstract #: 1827Breast Cancer: Cross Sectional Study ofKnowledge, Attitude and Practice RegardingBreast Self Examination among Female MedicalStudents in Taif.

D. Nemenqani, PhD1 and S. Abdelmaqsoud, DrPH2

1Taif University; Faculty of Medicine, Taif, Saudi Arabia, 2Taif University

Faculty of Medicine, Taif, Saudi Arabia

INTRODUCTION: Breast cancer is the most common of all female

cancers in Kingdom of Saudi Arabia. Different studies conducted in

the kingdom have shown that knowledge of females regarding

breast cancer is poor. Aim of the study was to determine knowledge,

attitude and practice among Saudi female medical university stu-

dents towards Breast Self Examination (BSE) and also to explore

their knowledge about breast cancer.

METHODS: An observational cross–sectional study was conducted

at faculty of Medicine; Taif University during October 2013. Sample

size was 378 with mean age of 19.961.5. A self administrated ques-

tionnaire was used to obtain data about knowledge, attitude and prac-

tice towards BSE and knowledge about breast cancer. Data were

collected and fed to SPSS version 16. Shape of distribution for numeri-

cal data was tested using one sample Kolmogorov-Smirnov test. Chi-

Square test & Fissure Exact Test (FET) was used for testing relation

between categorical variable while correlation analysis was used to

test the strength of relation between numeric variables.

RESULTS: The study revealed that only 8.2% of participants had

good overall knowledge about breast cancer and BSE. Although

66% of the study sample had positive attitude towards BSE; only

17% reported that they practice BSE monthly. A significant positive

moderate correlation was found between overall knowledge score

and attitude towards BSE. (r¼0.449 & P¼0.000). The same was

for the frequency of BSE practice but it was found to be in a weak

magnitude, (r¼0.223 & P¼0.000)

CONCLUSIONS: Although there was lack of knowledge about

breast cancer and BSE yet positive attitude towards BSE was encour-

aging. Most female medical students in our sample did not perform

BSE or perform it irregularly.

Poster Number: M54 Abstract #: 2203Reduction of Occupational Accidents: Evidencebased Prevention and the Prevention Index (PITOP).

F. Bochmann, PhD1, M. Arning, PhD2, Y. Sun, MD1 and

A. Nold, MS1


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1Institute for Occupational Safety and Health of German Social AccidentInsurance (IFA), Sankt Augustin, Germany, 2German Social AccidentInsurance Institution for the Woodworking and Metalworking Industrie,Hannover, Germany

INTRODUCTION: Prevention Index (PITOP) is a practical measure-

ment tool which is currently used by the German Social Accident

Insurance Institution for the Woodworking and Metalworking

Industries to monitor injury prevention activities at workplaces.

This 12-item scoring system has three subscales rating technical,

organizational and personnel-related internal safety conditions of a

company. Each item of the score has a rating value ranging from

1–9, with higher values indicating higher level of safety conditions.

The reliability and validity of this instrument were evaluated in a

cross-sectional survey in the German metal industry during the time

between December 2011 and May 2012.

METHODS: In the first step the inter-rater-reliability of this instru-

ment was examined by two trained supervisors of the German

Social Accident Insurance Institution for the Woodworking and

Metalworking Industries in 128 companies. The agreement of the

double ratings was quantified by interclass correlation coefficient

(ICC) and absolute agreement of the rating values. In the next step

the construct validity of the score was examined by principle compo-

nent analysis (factor analysis) while content validity was evaluated

by quantifying the association between PITOP-values and five-years

injury rates of 35,000 companies. Poisson regression analysis was

performed to assess the strength of the association adjusted for com-

pany size and related industrial sectors.

RESULTS: Our analysis indicate a moderate to good inter-rater-reli-

ability (ICC¼0.46–0.75) of PITOP-values with an absolute agree-

ment between 72% and 81%. Factor analysis identified three

component subscales which meet exactly the structural measure

theory behind the score. The Poisson regression analysis demon-

strates that PITOP-values �7 in the T-, O- and P-subscales are associ-

ated with a decrease of injury rates.

CONCLUSIONS: Because this analysis indicates that PITOP is a

valid and reliable instrument, it will be used to monitor safety condi-

tions at workplaces in a longitudinal practical approach.

Poster Number: M17 Abstract #: 2829Estimation of HIV Incidence in Brazil, 2005–11.

C. L. Szwarcwald, PhD and P. R. Souza Jr, PhD

Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil

INTRODUCTION: The HIV incidence is nowadays the most valua-

ble indicator of epidemiologic surveillance, both to guide prevention

activities and to monitor ongoing interventions. However, the inci-

dence estimates are still limited to a few countries. This paper

addresses a method to estimate the HIV incidence in Brazil in recent

years.

METHODS: As the information source, we used the national lab

information system (SISCEL) created to monitor CD4/CD8 count

and viral load among HIV infected people. The proposed method is

based on a statistical model that relates the first CD4 count to time

of HIV seroconversion. For each treatment-naıve HIV infected case

reported in SISCEL aged 15 years or older, we estimated the time

lag between HIV infection and the date the case was reported. The

HIV incidence was estimated as the sum of the cases reported in the

same year of infection, one year after infection, and so on until 20

years after infection.

RESULTS: The average time from HIV infection to date of first

CD4 count was five years. The proportion of cases reported to

SISCEL in the same year of HIV infection increased from 30%, in

2005, to 36%, in 2011.The HIV incidence was estimated as 38968

(95% CI 36805–41130) in 2011, representing approximately 5% of

the HIV prevalence. The analysis by gender showed that the HIV

incidence increased among men and decreased among women in the

period 2005–11. The male-female incidence ratio was 1.45 in 2005

but increased to 1.96 in 2011.

CONCLUSIONS: In the context of expansion of antiretroviral

treatment to HIV-infected individuals, and improved survival, it is

increasingly difficult to interpret HIV prevalence data, making it

essential to have estimates of HIV incidence for a better understand-

ing of the epidemic. The results here depicted suggest that interven-

tions in Brazil should be focused on young adult men.

Poster Number: M63 Abstract #: 1388Motorcycle Accidents Mortality in theMunicipality of Belo Horizonte, Brazil: FactorsAssociated with using of Alcohol and Drugs.

E. Drumond, DrPH1, D. M. X. Abreu, PhD2, H. N. F. Souza, BS2

and T. Hang-Costa, BS2

1City Department of Health and Welfare of Belo Horizonte, BeloHorizonte, Brazil, 2Federal University of Minas Gerais, Belo Horizonte,Brazil

INTRODUCTION: Statistics have shown an increase in motorcycle

accidents in the large number of traffic accidents in Brazil and there-

fore deserve further analysis. Importantly, in our country toxicology

tests are not done routinely by traffic officers.

OBJECTIVE: To verify the frequency of positive post mortem blood

of legal (alcohol) and illegal drugs (crack/cocaine, marijuana) con-

centration (BADC) among motorcyclists dead between 2008 and

2012 in Belo Horizonte and to examine associated factors in a cross-

sectional study.

METHODS: Characteristics of motorcycle deaths in 1,220 occurred

in the period analyzed. Multivariate logistic regression was used to

evaluate associated factors. It was not given the time elapsed

between death and completion of toxicology.

RESULTS: The victims are men (93%),>25 years old (55%), non

married (82%), black (63%),>8 years of schooling (94%).The

prevalence of positive BADC was 21%. The multivariate analysis

showed that only death in the street (OR¼5.2; 95% CI 3.8–7.0)

was a factor associated with BADC. Protection factors are age <25

years (OR¼0,6; 95% CI 0.4–0.7), be married (OR¼0.4; 95% CI

0.2–0.6). Sex, schooling and race were not significantly associated

with post mortem blood alcohol and drugs (crack/cocaine, mari-

juana) concentration (BADC) among motorcyclists.

CONCLUSIONS: This study findings suggest that the complexity of

the association between the use of legal and illegal drugs and traffic

accidents among motorcyclists, serious public health problems in

Brazil. It puts on the agenda the need to debates based on reliable

information. Results can help to inform drinking/drugs using and

driving policy and preventive approaches. SUPPORT: FAPEMIG

APQ-01511-79.


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Poster Number: M120 Abstract #: 2634Estimation of Provincial Tobacco Use in ThailandUsing Multilevel Small Area Estimation from aNational Probability Sample.

J. Hsia, PhD1, X. Zhang, PhD1 and H. Puckcharern, MS2

1US Centers for Disease Control and Prevention, Atlanta, GA, 2National

Statistical Office of Thailand, Bangkok, Thailand

INTRODUCTION: Monitoring tobacco use is one of the key

tobacco control strategies proposed by World Health Organization

to assess implementation of the Framework Convention on Tobacco

Control. In Thailand, tobacco use surveillance is based on repeated

nationally representative cross sectional surveys. While these surveys

provide national estimates of tobacco use, they do not provide pro-

vincial level estimates because they were not designed with adequate

provincial sample sizes. Provincial estimates of tobacco use are nec-

essary for assessing local tobacco control policies. We used small

area estimation (SAE) to estimate prevalence of current tobacco use

in 76 provinces in Thailand with information from a national proba-

bility sample and census information.

METHODS: Multilevel logistic regression models with a provincial-

level random effect were first estimated based on the Global Adult

Tobacco Survey in Thailand and then applied to 2010 Thailand cen-

sus to make predictions of current tobacco use for all target popula-

tion groups in each province. The multilevel model provincial-level

estimates were evaluated and validated by comparison to their direct

survey estimates.

RESULTS: Prevalence of current tobacco use (defined as all forms

of tobacco use) at the provincial level varied by province. For men,

the range was from 35.2% in Lamphun to 60.6% in Ranong

(median¼45.6%). For women, the range was from 2.0% in

Narathiwat to 20.0% in Buri Ram (median¼7.25%). The standard

deviation of the prevalence ranged from 0.02% to 0.06%

(median¼0.04%) for men and from 0.01% to 0.05%

(median¼0.03%) for women. The correlation between estimated

prevalence using SAE and direct estimation was 0.966 and 0.919 for

men and women, respectively.

CONCLUSIONS: Application of SAE to a Thailand nationally rep-

resentative sample can be used for reliable estimation of prevalence

of current tobacco use for all 76 provinces in Thailand.

Poster Number: M237 Abstract #: 2804Relationship between LBW Infant Rate byPrefecture and Biological Socio-EconomicFactors in Japan: An Ecological Study.

K. Serizawa, MS and A. Ogihara, PhD

Waseda University, Tokorozawa, Japan

INTRODUCTION: In Japan, the low birth weight (LBW) rate has

been increasing in recent years. LBW infants are at increased risk for

a number of diseases later in life, but the risk factors is not clear.

METHODS: We therefore conducted a systematic review of the fac-

tors associated with a higher incidence of LBW and selected 28 bio-

logical socio-economic factors. We used 44 indexes that linked to 28

biological socio-economic factors from ‘Population Survey Report

2009’ as an objective variable. In addition, ‘number of infants under

2500 g (LBW infants) rate by prefecture’ was used as an

explanatory variable. Two analyses were conducted in this study.

We first performed a multiple correlation analysis between 28 bio-

logical socioeconomic factors and LBW rate, and then conducted a

multiple regression analysis using the factors that were significantly

correlated with LBW.

RESULTS: The results were as follows. The Gini coefficient

(b¼0.458, P<0.001) that we obtained was R2¼0.192. However,

since the effect of the Gini coefficient was so large, we conducted

another multiple regression analysis excluding the Gini coefficient

from the independent variable. The result of the reanalysis was

R2¼0.245, and the factors used were birth rate of 40–44-year-old

mothers (b = 0.535, P<0.001), rate of college/graduate school grad-

uates (b¼�0.670, P¼0.004), and women’s average sleeping time

(b¼�0.463, P¼0.034).

CONCLUSIONS: The present findings suggest that regional differ-

ences in LBW rate are due to economic differentiation. It was

expected that the mother’s household income or educational back-

ground would correlate with LBW rate, but we could not make it

clear in this study. The possible reason for this is because our subject

in this research/study was each prefecture, which is relatively large.

Future studies should examine the factors affecting LBW rate in

municipalities

Poster Number: M24 Abstract #: 1392Investigation of Hepatocellular Cancer Epidemicin an Island Community, Korea.

S. S. Kweon, MD1,2, M. H. Shin, MD1, J. S. Choi, MD1, J. A.Rhee, MD1, H. R. Ahn, MPH2 and I. J. Chung, MD1

1Chonnam National University Medical School, Gwangju, South Korea,2Chonnam National University Hwasun Hospital, Jeollanam-do, South

Korea

INTRODUCTION: South Korea has the highest incidence of hepa-

tocellular carcinoma worldwide. The high prevalence of hepatitis B

virus (HBV) infection rather than hepatitis C virus (HCV) might

play a dominant role in HCC development in Korea because of the

low HCV seroprevalence, generally about 1%. HCC epidemic in an

island community was detected, age-standardised incidence with

WHO population (/100,000) were 71.7 and 17.3, in men and

women, respectively, between 1999 and 2008. Age-standardised

incidence ratios based on Korean national data were 2.2 (95% con-

fidence interval [CI] 1.9–2.5) and 2.2 (95% CI 1.8–2.7) in men and

women, respectively, was noted. Our aim was to investigate the

causal associations of the HCC epidemic in the study area.

METHODS: To identify the potential causality, we conducted epi-

demiologic surveys for the risk factors for HCC and hepatitis. Total

of 2,153 and 1,887 randomly selected residents (age �19 years), liv-

ing in study and control area, respectively, were participated on the

investigation. Distribution of the risk factors in previous HCC cases

were also compared.

RESULTS: We found an approximately four-fold higher HCV sero-

prevalence in the study area (5.1% vs 1.4%). HBV seroprevalence

was also higher in HCC epidemic area (5.1% vs 3.1%). Significant

differences in the exposure to acupuncture and tattoo between areas

were identified

CONCLUSIONS: The excessive HCC burden in the study commun-

ity may be caused by HCV epidemic and frequent exposure to acu-

puncture and tattoo might be associated with the HCV epidemic in


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this community. HCV epidemic confined in a community is rare

because of its transmission mode.

Poster Number: M112 Abstract #: 2330Relationship between Life Style and Mortalityamong Atomic Bomb Survivors.

M. Mine, PhD1, K. Yokota, PhD1 and Y. Shibata, PhD2

1Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan,2Fukushima Medical University, Fukushima, Japan

INTRODUCTION: We examined the effects of lifestyle on the mor-

tality in Nagasaki A-bomb survivors on the basis of the mail-survey

results collected from 35,035 Nagasaki A-bomb survivors in 2003.

METHODS: Items in the questionnaire included distance of the

exposed place from the hypocenter, smoking, drinking, exercise,

health checkup and mental health conditions. We dichotomized the

distance from the hypocenter: less than 2 km, and 2 km or over.

Mental health conditions were assessed by 12-item version of General

Health Questionnaire. In 13,048 survivors finally remained for the

analysis, 3448 died from 1 April 2003 through 31 March 2012; 1138

died from cancer, 899 from circulatory system diseases and 1351

from other diseases. We analyzed the effects of smoking, drinking,

exercise, health checkup and mental health conditions on mortality

separately using Cox proportional hazard model after adjusting for

sex, age and the dichotomized distance from the hypocenter.

RESULTS: In the comparison of survivors without and with exer-

cise, the hazard of death from cancer in the former group was 1.24-

fold of that in the latter group (95% confidence interval:

1.10–1.40), the hazard of death from circulatory system in the for-

mer group was 1.50-fold of that in the latter group (1.30–1.72), and

the hazard of death from other causes in the former group was 1.53-

fold of that in the latter group (1.37–1.72).Similarly, in the compari-

son of survivors without and with health checkup, the hazard of

death from cancer in the former group was 1.16-fold of that in the

latter group (0.96–1.41), the hazard of death from circulatory sys-

tem in the former group was 1.50-fold of that in the latter group

(1.25–1.82), and the hazard of death from other causes in the former

group was 1.37-fold of that in the latter group (1.17–1.60).

CONCLUSIONS: More detailed survey is needed to confirm the

present results.

Poster Number: M226 Abstract #: 2407A Disease Map of Male Suicide in Japan and itsAssociation with Socioeconomic Factors.

S. Tsuboi, PhD, K. Kotani, PhD, Y. Aoyama, PhD, R. Ae, MD, T.Kojo, PhD, E. O. Tsogzolbaatar, MPH, H. Takamura, PhD and Y.Nakamura, MPH

Jichi Medical University, Shimotsuke, Japan

INTRODUCTION: Suicide is well known as a major social prob-

lem in Japan, and the male suicide rate has been particularly high

for many years. The present study shows a disease map of male sui-

cides in Japan and explores associated factors that might prove use-

ful for determining public health strategies in consideration of

locality.

METHODS: We conducted an ecological study referring to govern-

ment statistics, including vital statistics, municipality tax records,

and a national census. The study population comprised Japanese

men living in Japan in 2010. Relative risk of death from suicide in

each municipality was used as an outcome variable, calculated from

conditional autoregressive models. Trend analysis was also con-

ducted to explore associated factors and examine the direction of

association (i.e. negative or positive).

RESULTS: Hot spots of suicide were detected in the north and south

of Japan. Income, local finance, proportion of doctors to local popu-

lation and proportion of doctors to local gross area showed negative

trends for relative risk of suicide. Unemployment rate and primary

industry worker rate in area of residence showed positive trends for

relative risk of suicide (all P-values <0.01).

CONCLUSIONS: Although the present study was designed as an

ecological study and our findings need more precise investigation

based on individual data, disparities in socioeconomic factors may

help explain regional differences in suicide risk. Arrangement of

doctors who can deal with mental health difficulties in hot spots of

suicide may be warranted.

Poster Number: M89 Abstract #: 2417Review of 103 Swedish Healthcare QualityRegisters.

L. Emilsson, PhD1, B. Lindahl, PhD2, M. Koster, PhD3, M.Lambe, PhD4 and J. F. Ludvigsson, PhD4

1Primary care research unit, Varmlands Nysater, Sweden, 2Departmentof Medical Sciences, Uppsala Clinical Research Center, Uppsala,Sweden, 3National Board of Health and Welfare, Stockholm, Sweden,4Karolinska Institutet, Stockholm, Sweden

INTRODUCTION: In the past two decades an increasing number

of nationwide, mostly physicianinitiated, Healthcare Quality

Registries (QRs) focusing on specific disorders have been developed.

This article describes the purpose, organisation, variables, coverage,

completeness, and quality of 103 Swedish QRs.

METHODS: In March-September 2013, we examined the 2012

applications of 103 QRs to the Swedish Association of Local

Authorities and Regions (SALAR), as well as studying annual

reports from the same QRs. After an initial data abstraction, the

coordinator of each QR was contacted at least twice in June-

October 2013 and asked to confirm the veracity of the data retrieved

from the applications and reports.

RESULTS: About 60% of the QRs covered �80% of their target

population (completeness). Data recorded in Swedish QRs include

aspects of management (means of diagnosis, clinical characteristics

of the disease, treatment, and lead times). In addition, some QRs

retrieve data on selfreported quality of life (EQ5D, SF-36, and dis-

ease-specific measures), lifestyle (smoking) and general health status

(WHO performance status, body mass index, and blood pressure).

CONCLUSIONS: In conclusion, most Swedish QRs have a high

completeness. The detailed clinical data available in the QRs com-

plement information from government-administered registries and

provide an important source not only for assessment and develop-

ment of quality of care but also for research studies.

Poster Number: M174 Abstract #: 1394Different Trends in Dietary Intakes of Foods andNutrients across Psychological Stress Levelamong Middle-Aged Japanese Women with orwithout Habitual Exercise.

K. Endoh, PhD, K. Kuriki, PhD and T. Goda, PhD

University of Shizuoka, Shizuoka, Japan


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INTRODUCTION: Mental illness is increasing globally. Well bal-

anced diet is not only base of physical health but also mental health.

However, relationship between psychological stress and dietary

intakes of foods and nutrients has not been fully clarified. To deter-

mine the relationships, we conducted a large-scale cross-sectional

study.

METHODS: A total of 2,718 middle-aged (30–60 years old)

Japanese women who underwent annual health checkup between

2005 and 2007. The subjects were divided into habitual exercisers

and non-exercisers. Self-reported psychological stress (SRPS) was

estimated by s brief questionnaire and classified into three levels

(low, moderate or high). For each SRPS level in two habitual exer-

cise groups, multivariate-adjusted means of dietary intakes of foods

and nutrients, respectively, were calculated by a general linear

model.

RESULTS: Proportions of habitual exercisers and non-exercisers

were 45.4% and 54.6%, respectively. Among exercisers, SRPS was

positively associated with western confectionaries, ‘sembei’

(Japanese-style confectionaries) and coke and negatively with green

leafy vegetables, tomatoes, ‘raw lettuce and cabbage’, whisky,

mayonnaise, insoluble dietary fiber, total dietary fiber and folate

(P for trend <0.05 for all). Among non-exercisers, SRPS was posi-

tively associated with wine, western confectionaries and saturated

fatty acids, and negatively with tomatoes, seaweeds, beer (P for

trend <0.05 for all). Interactions between SRPS and habitual exer-

cise were found for ‘raw lettuce and cabbage’ and juice (P for inter-

action <0.05 for both).

CONCLUSIONS: Among middle aged Japanese women with or

without habitual exercise, different associations were found between

SPRS and dietary intakes of foods and nutrients. The authors thank

a member of SBS Shizuoka Health Promotion Center.

Poster Number: M129 Abstract #: 2740Review of Partial and Point Identification ResultsUsing Instrumental Variable Type Assumptions.

S. A. Swanson, MS, J. Robins and M. A. Hernan, MD

Harvard School of Public Health, Boston, MA

INTRODUCTION: Studies using instrumental variable (IV) meth-

ods rely on strong assumptions to present a point estimate for the

average treatment effect (ATE), yet epidemiologists may be unaware

of how combinations of IV-type assumptions lead to partial or point

identification.

METHODS: We reviewed the identification results under IV-type

assumptions presented in the statistical, epidemiological, and econo-

metric identification literature, and synthesized the results into a

common notation and description of underlying assumptions. We

primarily considered identification of the ATE for dichotomous

treatments and outcomes.

RESULTS: Without data or assumptions, we know nothing about

the ATE (bounds: [�1, 1]). With no assumptions, observed data cuts

the width of these bounds in half. Under the exclusion restriction

and independence assumptions (i.e. the IV-type assumptions), the

identification region may be smaller. Assuming marginal versus joint

independence results in different expressions for the bounds,

although in practice the bounds may often be equal. Bounds under

the IV-type assumptions may be quite wide; combining these with

further assumptions will be discussed. In particular, further assum-

ing additive or multiplicative effect homogeneity leads to point iden-

tification, although the point estimates will differ when the effect is

non-null. Examples of bounds and point estimates for the ATE

under these various sets of assumptions will be presented, with dis-

cussion of when these assumptions may be more or less reasonable

in practice.

CONCLUSIONS: Causal inference relies on a trade-off between

making strong, untestable assumptions, and making more conserva-

tive assumptions that may not readily inform public health practice.

Estimating the ATE under several sets of IV-type assumptions makes

clear how much our conclusions rest upon the assumptions being

made.

Poster Number: M19 Abstract #: 3047Cancer-Related Risk Factor Prevalence andScreening Participation in Ontario Off-ReserveFirst Nations and Metis Adults.

A. Amartey, MPH1, D. R. Withrow, MS1,2 and L. D. Marrett,PhD1,2

1Cancer Care Ontario, Toronto, ON, Canada, 2University of Toronto,Toronto, ON, Canada

INTRODUCTION: Increasing evidence surrounding the rising bur-

den of cancer among Canadian Aboriginal subpopulations suggests

the important need for current data on cancer risk factor prevalence

and screening uptake in this population. Several population-based

surveys have included Aboriginal respondents over the years, how-

ever their use for studying Aboriginal health specifically, has proved

challenging. Despite the small sample of Aboriginal respondents in

national population-based surveys, the extensive array of health-

related indicators within the Canadian Community Health Survey

(CCHS) provides the most comprehensive look at cancer-related

risk factors and screening behaviour among Aboriginal

subpopulations.

METHODS: CCHS surveys from 2007 to 2011 were combined to

increase the sample of Ontario’s off-reserve First Nations and Metis

respondents, in order to estimate the prevalence of smoking, obesity,

alcohol consumption, physical activity, diet, and colorectal, breast,

and cervical screening uptake. Odds ratios adjusted for socioeco-

nomic factors (SES) were obtained, and non-Aboriginal Ontarians

were analyzed for comparison.

RESULTS: Significantly higher rates of smoking and obesity were

found in both the First Nations and Metis population compared to

non-Aboriginal Ontarians. Significantly heavier alcohol consump-

tion was reported among First Nations and Metis males, while inad-

equate fruit and vegetable consumption was more reported among

First Nations. Accounting for SES however, resulted in a no longer

significant difference in alcohol consumption and fruit and vegetable

intake among Metis males and First Nations males, respectively,

compared to non-Aboriginal males. First Nations women were more

likely to report having had a colorectal cancer screening test in the

past two years than non-Aboriginal women.

CONCLUSIONS: Understanding how the prevalence of these risk

factors varies in subgroups is essential to informing cancer preven-

tion and control programs tailored to the specific needs of these

groups, and to monitor equity. Analyses such as these should be


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repeated over time to monitor trends and track progress toward tar-

gets for improvement.

Poster Number: M216 Abstract #: 1403Long Term Effects of Abuse in Early Life onDepression and Anxiety over the Life Course.

J. Lindert, PhD1,2 and O. S. von Ehrenstein, PhD3

1University of Emden, Emden, Germany, 2Brandeis University, Waltham,

MA, 3University of California, Los Angeles, Fielding School of Public

Health, Los Angeles, CA

INTRODUCTION: Long term impact of abuse on early life is

still under discussion. We aimed to systematically assess

epidemiological and clinical evidence on the relation of abuse in

early life abuse and depression and anxiety based on community

samples, worldwide.

METHODS: We performed a systematic search of the electronic

databases (from August 2011–October 2011, all age groups, any

language, any population) of three databases: PUBMED, EMBASE

and PSYCHINFO. Data were extracted after consideration of exclu-

sion criteria and quality assessment, and then compiled into sum-

mary tables. To quantify the association of abuse with depression

and anxiety we performed a meta-analysis and calculated pooled

odds ratios (ORs) with respective 95% confidence intervals (CI).

The I2 statistic was used to assess heterogeneity.

RESULTS: The search yielded 29 eligible studies with 139,625 par-

ticipants. There was a statistically significant association between

abuse and lifetime psychiatric symptoms of depression (sexual

abuse: OR¼2.16; 95% CI 1.62–2.87; physical abuse: OR¼1.71;

95% CI 1.39–2.09) and anxiety (sexual abuse: OR¼2.42; 95% CI

1.96–2.99; physical abuse: OR¼1.90; 95% CI 1.13–3.20).

CONCLUSIONS: Associations persisted over the life course with

peaks in younger and older age groups (age 18–30, over age 60).

Poster Number: M232 Abstract #: 2628A Study on Body Image and Eating Habits ofFemale Students Taking a Child Education

Course at a Japanese Junior College.

W. Ikeda, PhD1, Y. Inaba, PhD2, S. Yamaguchi, PhD3, A.

Shinohara, PhD2,4, M. Nagayoshi5 and N. Morikawa, PhD6

1Shukutoku Junior College, Tokyo, Japan, 2Juntendo University, Tokyo,

Japan, 3Ibaraki Prefectural University of Health Sciences, Ibaraki,

Japan, 4Seisen University, Tokyo, Japan, 5Tokyo Medical and Dental

University, Tokyo, Japan, 6Jissen Women’s University, Tokyo, Japan

INTRODUCTION: The ratio of low birth weight children in Japan

is increasing. Hypoalimentation in childhood is associated with

adulthood diseases, such as arteriosclerosis, diabetes, and hyperten-

sion, and much focus has been placed on how these diseases relate

to the health and dietary habits of young women. The establishment

of dietary habits, health education, and enlightenment are important

for maintaining women’s health in the teens and twenties.

Accordingly, attention has been placed on those who provide care

for children, such as teachers and childcare staff, who can communi-

cate with parents regarding proper dietary habits. The study aimed

to clarify the body image and eating habits of female students taking

a child education course at a Japanese junior college.

METHODS: This cross-sectional study involved 434 female stu-

dents (first year, 233; second year, 201) attending a child education

course at a Japanese junior college in July 2013. Two self-adminis-

tered questionnaires were distributed: a custom-made questionnaire

consisting of 15 items on knowledge, attitudes, and practices related

to health and dietary habits, and the ‘Brief-type Self-administered

Diet History Questionnaire (BDHQ)’ developed by EBNJAPAN.

The chi-square test and t-test were used to assess associations with

each questionnaire item. P<0.05 was considered significant. All

statistical analyses were performed with HALBAU7 and

SPSSVer.16.0.

RESULTS: The average age was 18.961.3 years, height

157.665.4cm, weight 50.466.4kg, BMI 20.362.4, and energy

intake 1578.16876.8kcal/day. First year students weren’t more

knowledgeable regarding own BMI than second year students

(58.0%, P¼0.01). Of all, 75.1% felt their nutritional balance was

poor. Among the four body images presented, students picked the

slender type, regardless of own BMI. No significant relationship was

found between first and second year students.

CONCLUSIONS: Our findings clarify the body image and eating

habits of female students taking a child education course at a

Japanese junior college.

Poster Number: M217 Abstract #: 1404Indicators of Genocide.

J. Lindert, PhD

University of Emden, Emden, Germany; Brandeis University, Waltham,

MA

INTRODUCTION: Genocide and war were the ranking causes of

preventable death in the 20th century. Research has shown that

organised violence develops in stages from the first stage (loss of

opportunities for the persecuted group) to the last stages (loss of

existence, loss of memory). Several concepts of stages exist. Until

now data are scattered and remain often un-catalogued within coun-

tries. Accurate empirical estimates of the burden of organised vio-

lence are necessary for anticipatory planning of prevention. We

intend to provide a comprehensive set of early indicators and to

introduce epidemiological tools for describing and understanding

the historical and spatial organisation of organised violence.

METHODS: Because each stage of organised violence has its own

indicators, stages can be assessed with standardised measures by

measuring specific indicators like i.e. percentage of weapons in a

country and number of riots. We present geographical information

systems (GIS) combined with sociological and psychological meth-

ods as a new interdisciplinary violence surveillance system to map

and analyse rates and distributions of genocide indicators.

RESULTS: Historical examples i.e. from Germany, from the Soviet

Union, from Kampuchea show the utility of this method. Other

actual examples will be given in the presentation and countries will

be analysed with the standardised set of indicators.

CONCLUSIONS: Case studies show GIS systems can be useful for

scoring profiles of risk, based on a priory defined quantitative crite-

ria. But there is a need for safeguards against abuse, stereotyping,

using models for hating up situations. Genocide and violence control


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programmes could operate within this framework for mapping

organised violence at early stages collecting in a standardised way

data to prevent violence and to identify settings at risk.

Poster Number: M81 Abstract #: 2184A Study on the Living and Health Status of theElderly who Fail to Pay Premiums of the Long-Term Care Insurance in Japan.

K. Takahashi, MA and A. Ogihara, PhD

Waseda University, Tokorozawa, Japan

INTRODUCTION: To conduct study on the living and health sta-

tus of the elderly who fail to pay premiums of the long-term care

insurance (LTCI).

METHODS: A mail-in survey using questionnaire to all 1750 local

governments in Japan.

RESULTS: The number of effective replies was 567(The response

rate: 32.4%). The government staff in charge of LTCI conveyed that

the elderly in the nonpayment category are restricted to medical

service for economic reason, and in poor health status, when initial

care-need certification.

Also, it was suggested that their risks of restriction on LTCI benefits

for economic reason and receipt a livelihood protection were higher

than those of the elderly in the payment category. These facts are

influenced in proportion to the population and wealth of the local

governments.

CONCLUSIONS: The elderly in the nonpayment category were

affected by economic inequality in Japan. The results indicated an

association between economic inequality and health. Because of eco-

nomic inequality, people in the lower economic class would face

various health risks.

Poster Number: M78 Abstract #: 2593Risk of Mother-to-Child Transmission of HIVamong Women on Triple Antiretroviral Drugs inSub-Saharan Africa: Systematic Review ofObservational Studies and Explorative Meta-Analysis.

A. Nikuze, MPH1, A. M. Ekstrom, MD2,3 and J. Monarrez-Espino, PhD3

1University of Stellenbosch, Tygerberg, South Africa, 2Karolinska

University Hospital, Stockholm, Sweden, 3Karolinska Institutet,

Stockholm, Sweden

INTRODUCTION: Monitoring the elimination of mother-to-child

HIV transmission (MTCT) requires measuring the transmission

rate; however, in the era of triple antiretroviral drugs (ARVs) for

prevention of MTCT, evaluators use different methodological

approaches to measure it. This work revised programme evaluation

studies between 2000–13 to determine the effect of triple ARVs on

MTCT rate in Sub-Sahara Africa (SSA)

METHODS: A systematic review and explorative meta-analysis was

undertaken. PUBMED and EMBASE were searched using relevant

terms. Inclusion criteria were as followed: population, HIV-exposed

infants and their mothers; intervention, triple ARVs treatment/

prophylaxis; outcome, MTCT rate (proportion); and study design,

observational studies. The New-Castle Ottawa scale was used to

assess the methodological quality. Random-effect modelling was

used to combine individual MTCT rates. Forest plots were used to

summarize the results, and funnel plot was used to assess publica-

tion bias

RESULTS: Thirty studies were reviewed. Most were facility-based

or child-testing data of intermediate quality. They were relatively

similar in terms of exposure, but the outcome, sample size

(10–5141), and type/number of covariates reported varied consider-

ably. Competing risk such as weaning and bias due to loss to follow-

up were not usually considered in individual studies, leading to an

incorrect estimation of transmission rate. Twelve studies were

included in the meta-analysis leading to a pooled estimate of 4%

(95% CI 1.6-7.3) with large variations in individual MTCT rates

(0.9-11.9%); heterogeneity was high (Q-statistic P<0.000; I2-index

95% CI 92.9–96.5), and the funnel plot was asymmetric. Subgroup

analyses by infants’ age at testing showed no differences, but the

prophylaxis group had a slightly lower pooled estimate than the

treatment group (3.7 vs 4.9%)

CONCLUSIONS: The preventive effect of triple ARVs in SSA is

context specific. MTCT rate estimation in individual studies need to

be improved. Major methodological differences prevent meaningful

comparisons, and limit the value of the pooled estimates

Poster Number: M50 Abstract #: 2667Exposure to Metals and Congenital Anomalies: ABiomonitoring Pilot Study in Bedouin Women inSouthern Israel.

I. Karakis, PhD1, D. Landau, MD2, M. Yitshak-Sade, MPH3, D.

Dukler, MD2, R. Hershkovitz, MD2, M. Rotenberg, MD4, B.Sarov, PhD3, I. Grotto, MD1 and L. Novack, PhD3

1Ministry of Health, Jerusalem, Israel, 2Soroka University Medical

Center, Beer-Sheva, Israel, 3Ben-Gurion University of the Negev, Beer-

Sheva, Israel, 4Sheba Medical Center, Tel Hashomer, Israel

INTRODUCTION: Bedouin-Arab population in Israel is of low

socio-economic status, characterized by frequent smoking among

males and consanguineous marriages. Previous study showed ele-

vated rates of major malformations within Bedouin population

residing near an industrial park (IP) compared to remote localities.

High ambient values of Arsenic (As) and Nickel (Ni) were detected

in the area. Exposure to metals has been related to birth defects. We

estimated the extent of exposure to metals in pregnant Bedouin-

Arab women in relation to congenital malformations.

METHODS: We enrolled 140 Bedouin women upon their admis-

sion to delivery room of a local hospital. Maternal urine samples

were collected and maintained at �20C till tested in Clinical

Toxicology lab in Tel-HaShomer. The information on pregnancy,

consanguineous marriages, and parental exposures was collected.

RESULTS: Aluminum (Al) was detected in 34 out of 140 women

(24.3%), Cadmium – in two women (1.4%), As— in 10 women

(7.1%) and Ni—in 1 (0.7%), amounting to 40 women (30%) posi-

tive to any of the 4 metals. Cd exposure rate was low, in spite of

above 92% prevalence of smoking among Bedouin males, which

might be explained by a low maternal passive-smoking exposure.

Mothers exposed to metals frequently complained on transport

(PV<0.001), reported cooking on open fire (PV¼0.018), usage of

stove or open fire for heating (PV¼0.020) and had a tendency of

living closer to IP (PV¼0.082). Exposure to metals was not affected

by maternal age or consanguineous marriage. Twelve fetuses had


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minor anomalies, another 12 were diagnosed with major anomalies

and two fetuses died in-utero. Ten fetuses to mothers exposed to

metals (23.8%) had anomalies or died in-utero compared to 16.3%

in the unexposed group. Fetuses to exposed to metals were born at a

lower weight (PV¼0.023).

CONCLUSIONS: Our findings urge for further screening for metals

in susceptible populations in Israel.

Poster Number: M162 Abstract #: 1406Incidence of Aplastic Anemia in Japan: Analysisof Data from a Nationwide Registration System.

A. Ohta, MD1, M. Nagai, MD1, M. Nishina, BS1, N. Shimada,MD2, S. Nakao, MD3 and M. Kurokawa, MD4

1Saitama Medical University, Moroyamamachi, Japan, 2International

University of Health and Welfare, Tochigi, Japan, 3Kanazawa University

Graduate School of Medical Science, Kanazawa, Japan, 4Graduate

School of Medicine, The University of Tokyo, Tokyo, Japan

INTRODUCTION: Aplastic anemia is a rare and intractable dis-

ease with an incidence that varies considerably worldwide. This

study aimed to estimate the incidence of aplastic anemia in Japan,

utilizing data from a nationwide registration system.

METHODS: The Japanese government has established a nationwide

registration system for patients with intractable diseases including

aplastic anemia. We utilized data converted to electronic form

between 2004 and 2012 for analysis. The data include information

on patients’ sex, birth year and onset year. However, only 70 to

80% of all registered patients’ data have been converted to elec-

tronic form. We calculated the electronic data entry rate as the num-

ber of patients whose data were converted into electronic form

divided by the total number of patients enrolled in the registration

system for each year. The estimated total number of incident cases

in each year was calculated as the sum of the number of incident

cases registered in the following years, divided by the entry rate of

the registered year.

RESULTS: During the nine years from 2004 to 2012, the estimated

total number of incident cases of aplastic anemia was 9455. The

incidence was estimated as 8.2 per 1,000,000 person-years. The

male and female incidences were 7.6 and 8.8 per 1,000,000 person-

years, respectively. The sex ratio (female/male) was 1.16. The age-

specific incidence showed peaks at age 10–20 years and 70–80 years,

with a larger peak observed at 70–80 years.

CONCLUSIONS: This is the first report of the incidence of aplastic

anemia at the nationwide population level in Japan. It was found

that the incidence in Japan is higher than in western populations.

ACKNOWLEDGEMENTS: This study was supported by a Grant-

in-Aid for Research Committee on the Idiopathic Disorders of

Hematopoietic Organs from the Ministry of Health, Labour and

Welfare of Japan.

Poster Number: M67 Abstract #: 2334Risk Prediction of the Effects of Severe WinterDisasters (dzud) on Nomadic Health and Societyin Mongolia with regard to Loss of Livestock.

S. Otani, PhD1, H. Mu, PhD1, K. Onishi, PhD1, Y. Kurozawa,PhD1 and M. Shinoda, PhD2

1Tottori University, Yonago, Japan, 2Tottori University, Tottori, Japan

INTRODUCTION: Dzud is a Mongolian term for a winter weather

disaster in which deep snow, severe cold, or other conditions render

forage unavailable or inaccessible that leads to high livestock mor-

tality. In the winter of 2009–10, Mongolia experienced the most

severe dzud since the consecutive dzud winters of 1999–2002.

However, it is obviously difficult to accurately predict the risk pre-

diction of the effects of dzud on human lives and public health. This

study aimed to evaluate the nomadic public health risks of dzud

from the point of the view of livestock loss.

METHODS: The analysis covered all 21 aimags (provinces of

Mongolia) in Mongolia and compared the following parameters: the

declining rate of population (2009–10), infant mortality in 2010,

and the decline in the numbers of livestock, which includes horses,

cattle, camels, sheep, and goats (2009–10) in each aimag. These

parameters were based on the data from the National Statistical

Office of Mongolia. For statistical analysis, Spearman’s rank-corre-

lation coefficient was used to determine any correlation between the

parameters with a significance level of 5%.

RESULTS: The decline in the population was significantly positively

correlated with the declining numbers of horses, cattle, and camels

(r¼0.58, P¼0.005; r¼0.57, P¼0.006; r¼0.59, P¼0.004,

respectively). Infant mortality was significantly negatively correlated

with the rate of decrease in the numbers of camels (r¼0.44,

P¼0.038).

CONCLUSIONS: Declining numbers of large livestock such as horses,

cattle, and camels are associated with the mentioned public health

parameters. Loss of large livestock may cause economic loss and deteri-

oration of the nutritional status among the herders; thus, it may be one

of the predictive factors of the effects of dzud on the nomadic health.

Poster Number: M132 Abstract #: 2696Factors Associated with Quality of Life ofDiabetic Patients Treated in a Reference Serviceof the Federal University of Minas Gerais, Brazil.

A. R. Mata, MS, M. Ruberson, BS, A. Borges, L. M. Diniz, PhD,

A. Guerra Jr, PhD, J. Alvares, PhD and F. A. Acurcio, PhD

Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

INTRODUCTION: Diabetes Mellitus (DM) is a serious public

health problem and studding its impact on patients’ quality of life

(QoL) has become increasingly important. The aim of this study was

to evaluate the QoL of diabetic patients and its associated factors.

METHODS: Patients over 18 years with DM treated at the Federal

University of Minas Gerais (UFMG) reference service were inter-

viewed about sociodemographic, clinical and QoL aspects during the

period of September to December 2013. QoL was measured by the

EuroQol questionnaire (Eq5D). Descriptive analysis, correlation, lin-

ear regression, univariate and multivariate analyzes were performed.

RESULTS: We interviewed 228 patients. Of these, 66% were

women, 74% nonwhite and 49% were married or living together,

61% had type 2 DM and 39% type 1. Regarding education, 43%

had more than eight years of study. About 70% belonged to social

classes C and D. About the treatment type, 71% used insulin, alone

or in combination with oral hypoglycemics. The mean QoL of dia-

betic patients was 0.74 (SD¼0.19), lower than the general popula-

tion of Minas Gerais. Multivariate analysis showed that being non-

white race, having ‘diabetic foot’, nephropathy, neuropathy, depres-

sion and cancer (P<0.05) significantly decrease the QoL of


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patients. The greater the number of medications the lower the QoL

(P¼0.001).

CONCLUSIONS: The most common comorbidities associated with

DM negatively impacted the QoL of these patients, which points to

the need for better disease control, monitoring and more educational

activities that effectively contribute to the self-care.

Poster Number: M113 Abstract #: 2424Females have Higher Rates of Depression amongConflict-Affected Internally Displaced Persons inPakistan.

K. Shafique, PhD1 and F. Tareen, MPH2

1Dow University of Health Sciences, Karachi, Pakistan, 2Government ofPakistan, Quetta, Pakistan

INTRODUCTION: Counter-terrorism and counter-insurgency

operations and violent clashes between non-state armed groups con-

tinue to lead to major, rapid movements of internally displaced peo-

ple (IDPs) in Pakistan’s volatile north-west. Beside other problems,

conflict-affected IDPs also face financial and mental constraints.

However, there is limited evidence available on mental health status

of IDPs, therefore, this study aimed to examine the prevalence of

depression conflict-affected IDPs.

METHODS: This cross-sectional study was conducted in Khyber

Pakhtoonkha province of Pakistan. Camps of conflict-affected IDPs

were identified and a sample of 623 individuals was recruited

through a simple random sampling using the official registration

lists in the year 2010 and 2011. We used Hamilton Rating Scale for

Depression (HRSD) to assess the depression. Logistic regression

models were used to examine the determinants of depression.

RESULTS: Of 623 individuals, 332 (53.3%) were males and 291

females (47.7%), with a mean age of 39.3612.9 and a mean depres-

sion score of 17.6611.2. Females had a higher prevalence (P-value

<0.01) compared with males (20.6% vs 20.5%), (24.7% vs 16.0%)

and (30.2% vs 25.6%) for mild, mild to moderate and moderate to

severe depression, respectively. Financial constraints (OR 2.91,

95% CI 1.49–5.66) among males and loss of a blood relative (OR

3.51, 95% CI 2.10–4.95) among females were significantly associ-

ated with severe depression.

CONCLUSIONS: This study suggests that females have higher rates

of depression among conflict-affected IDPs. Differential determinants

of depression indicate the need for further research to identify high-

risk groups to reduce the risk of deleterious effects of depression.

Poster Number: M153 Abstract #: 2713Secondhand Smoke Exposure and IntermittentClaudication: A Scotland-Wide Study.

L. Lu, PhD, D. Mackay, PhD and J. Pell, MD

Institute of Health and Wellbeing, University of Glasgow, Glasgow,United Kingdom

INTRODUCTION: Active smoking is an important risk factor for

peripheral arterial disease. In contrast, published evidence on the

association with secondhand smoke (SHS) is very limited. The aim

of this study was to examine the association between SHS exposure

and intermittent claudication (IC) among middle-aged non-smokers.

METHODS: We conducted a cross-sectional study using the

Scottish Health Surveys undertaken between 1998 and 2010.

Inclusion was restricted to participants aged>45 years.

Multivariate logistic regression analyses were used to adjust for

potential confounders.

RESULTS: Of the 4,231 confirmed non-smokers (self-reported non-

smokers with salivary cotinine concentrations <15 ng/mL), 134

(3.2%) had IC based on the Edinburgh Claudication Questionnaire.

There was evidence of a dose relationship, whereby the risk of IC

increased with increasing cotinine concentration. Following adjust-

ment for potential confounders, participants with a cotinine concen-

tration �2.7 ng/mL were still significantly more likely to have IC

(OR 1.76, 95% CI 1.04– 3.00, P¼0.036) compared with

those with a cotinine concentration <0.7 mg/mL. Among non-

smokers, 5.6% (95% CI �0.8% to �11.7%) of cases of IC were

attributable to cotinine concentrations �2.7 ng/mL and a further

3.6% (95% CI �6.6% to �12.8%) to cotinine concentrations of

0.7–2.6 ng/mL.

CONCLUSIONS: As with coronary heart disease and stroke, SHS

exposure was independently associated with IC. Our findings add to

the published evidence in support of protecting the general public

from SHS exposure.

Poster Number: M31 Abstract #: 1413To Assess the Effectiveness of IFA-DOT (Iron Folicacid –Directly Observed Therapy) on Prevalenceof Anaemia in Adolescent School going Girls inShimla District.

A. Gupta, MD

IG Medical College Shimla, Shmla, India

INTRODUCTION: India is home to about 20 per cent of the

world’s adolescent population. The prevalence of anaemia among

adolescent girls is nearly 90%. Such high prevalence justifies the

urgency of the implementation of interventions among anaemic ado-

lescent girls

METHODS: The study was carried out in Shimla district of a hilly

state of North India from March 2011 to Oct 2012. A baseline sur-

vey was done among 1596 adolescent girls in nine schools of Shimla

district. The screened anaemic students (n¼331) were then were

randomly allocated to either of the three intervention groups. School

teachers administered iron folic acid tablets. The biweekly group,

once weekly and daily regimen group had 112, 108 and 111 study

participants, respectively. The haemoglobin and serum ferritin con-

centration was measured at baseline and at the end of the interven-

tion period. Data collected was analysed using the Epi Info software

(version 6.04). Two tailed t-test was used for comparing the means.

RESULTS: The intermittent and daily iron folic acid supplementa-

tion resulted in a significant increase in haemoglobin concentration

and reduction of the prevalence of anaemia. Intermittent IFA

regimes were comparable to daily regimen as regards impact on Hb

and serum ferritin. Compliance to iron tablets was more in intermit-

tent regimen as compared to daily regimen group

CONCLUSIONS: Administration of IFA at intermittent intervals is

potential alternatives to daily dosing for the treatment of mild and

moderate anaemia among adolescent girls. Considering the benefits


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of intermittent regimes it is recommended that state government

takes its up as an option to decrease the prevalence of adolescent

anemia in the hilly state of Himachal Pradesh.

Poster Number: M124 Abstract #: 2386Fetal and Infant Mortality in Alaska, 2004–11.

C. B. Prince, PhD1, M. B. Young, MPH1 andW. M. Sappenfield, MD2

1Alaska Division of Public Health, Anchorage, AK, 2College of PublicHealth University of South Florida, Tampa, FL

INTRODUCTION: The Alaska infant mortality rate (IMR) has

been gradually declining since 2007. A dramatic drop in IMR for

2010 and 2011 has led to speculation about what might be associ-

ated with this unprecedented reduction.

METHODS: To pinpoint changes in IMR, an approach known as

Perinatal Periods of Risk was used to assign Alaska fetal and infant

deaths into four categories according to weight at birth and age at

death. Categories included very low birth weight (VLBW 500-1,499

grams), and low to normal birth weight (>1500 grams) sub-divided

by age: late fetal (>23 weeks gestation), neonatal, and postneona-

tal. To determine excess mortality, comparisons were made with

rates previously calculated for a national low risk reference popula-

tion. Alaska data were aggregated into three time periods. Fetal and

infant mortality rates (FIMR) per 1,000 live births and fetal deaths

were calculated for each category and compared by maternal race

and residency. The study was conducted for 251 fetal and infant

deaths in 2004–06, 265 deaths in 2007–09, and 129 deaths in

2010–11.

RESULTS: Alaska’s total excess deaths decreased from 94 in

2004–06 to 16 in 2010–11. During all three study time periods, the

largest FIMR disparities between Alaska and the national reference

group were observed for the postneonatal mortality rate (PNMR) of

non-VLBW infants. The PNMR for larger Alaska Native infants liv-

ing in rural areas decreased significantly (p¼0.004) between

2007–09 and 2010–11. During the three time periods, no significant

changes to the PNMR were identified for infants born to White

urban or rural women, or Native urban women.

CONCLUSIONS: The decline in the IMR since 2007 appears to be

due to a decrease in the PNMR among rural Alaska Native infants.

In most other mortality categories examined, Alaska’s births do as

well or better than the national reference group’s.

Poster Number: M60 Abstract #: 2769Self-Rated Health and Health Service Utilization:A Systematic Review.

F. Xu, MPH1 and J. M. Johnston, PhD2

1University of Hong Kong, Hong Kong, Hong Kong, 2The University ofHong Kong, Hong Kong, Hong Kong

INTRODUCTION: Self-rated health (SRH) is a widely used predic-

tor of health service utilization. In the international literature, no

recent systematic review exists that helps synthesizes findings on the

validity of using SRH to predict health service utilization. Therefore,

this study systematically reviewed the published evidence on the

association between SRH and health service utilization.

METHODS: Literature was searched using MEDLINE and

ProQuest up to September 2013 and supplemented by hand search

of publication reference lists. Two key components were searched:

self rated health and health service utilization. The eligibility criteria

were: English or Chinese language, quantitative observational stud-

ies, pre-defined definition of SRH and health service utilization,

derived from the general population, used single item measure of

SRH, assessed the association between SRH and health service uti-

lization, used health service utilization as outcome and SRH as inde-

pendent variable, used multivariate analysis. Quality of included

studies was determined using a 16-item checklist. A narrative syn-

thesis was undertaken.

RESULTS: Twenty-seven articles were identified; twelve were of

high quality. Three types of SRH were identified. General SRH was

most frequently used, whereas few studies used age-comparative

SRH and even fewer used time-comparative SRH. Most of the stud-

ies found poorer general SRH significantly associated with increased

hospitalization and outpatient care in elderly populations. Eleven

studies suggested a linear trend between different SRH levels and

outpatient service utilization. Middle-aged or younger age groups

were under-examined. Health service utilization could be underesti-

mated due to self-report nature. Studies in non-Western populations

were under-represented in the SRH literature.

CONCLUSIONS: Findings suggested that general SRH may be

helpful in identifying elderly populations at higher risk of health

service use. Further research is needed to test the validity of SRH in

different populations and age groups, as well as the change in SRH

and health care utilization over time.

Poster Number: M80 Abstract #: 1417Countdown to 2015: An Analytical Tracking of

Millennium Development Goals for Maternal andChild Mortality in India.

R. K. Soni, PhD

Dayanand Medical College and Hospital, Ludhiana, India

INTRODUCTION: Millennium Development Goals (MDGs) are a

set of numerical and time bound targets to measure achievement in

human and social development. Of 8 MDGs, U5MR, IMR and

MMR are of paramount importance in respect of different aspects

of human development. In view of policy initiatives and investments

made since 2000 in India, the analytical tracking of MDG 4 and 5,

which calls for 2/3rdreduction of under-five child mortality and three

quarter reduction in maternal mortality ratio, respectively between

1990 and 2015 is required so as to monitor the progress.

METHODS: The data for the present study was taken from

Ministry of Statistics and Programme Implementations, Govt of

India. The analysis of progress towards MDGs 4 and 5 was carried

out by using statistical tools.

RESULTS: The U5MR which was 125 in 1990 declined to 59 in

year 2010 (with 66 in rural and 38 in urban areas) against a target

of 42 by 2015. Over the time the observed decline is more for male

child than the female child, being 55 and 64 in 2010, respectively.

The infant mortality rate which was 80 in 1990 declined by 33

points in last 20 years at annual average decline of 1.65 points

against the MDG target of 27 in 2015. IMR for infant girls

remained consistently higher than IMR of infant boys over the last

two decades. The relative decline in IMR (males) during 1990 to

2010 has been about 41% in comparison to 39.5% IMR (females).


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The rural urban gap in IMR signifies a drop of 35 points in rural

against 19 points in urban.

CONCLUSIONS: Though the 2015 deadline for MDGs is fast

approaching, India is set to miss its maternal and child mortality

targets.

Poster Number: M145 Abstract #: 2228Adiponectin, but neither Leptin nor C-reactiveprotein, Mediates the Association betweenSmoking and Diabetes.

E. H. Hilawe, MPH1, H. Yatsuya, PhD1,2, Y. Li, PhD1,

M. Uemura, MS1, C. Wang, MS1, C. Chiang, PhD1, H.

Toyoshima, PhD3, K. Tamakoshi, PhD4, Y. Zhang, MS1 and

A. Aoyama, PhD1

1Nagoya University Graduate School of Medicine, Nagoya, Japan, 2Fujita

Health University School of Medicine, Toyoake-shi, Aichi-prefecture,

Japan, 3Anjo Kosei Hospital, Anjo-shi, Aichi-prefecture, Japan, 4Nagoya

University School of Health Science, Nagoya, Japan

INTRODUCTION: Although the association between cigarette

smoking and risk of type 2 diabetes is well established, its mecha-

nisms are yet to be clarified. As levels of adiponectin, leptin, and

high-sensitivity C-reactive protein (hs-CRP) are reportedly associ-

ated with both smoking and diabetes incidence, we hypothesized

that the smoking-diabetes association could potentially be mediated

by serum levels of these biomarkers.

METHODS: We followed 3338 Japanese workers aged 35–66

years, in the Aichi workers’ cohort between 2002 and 2011. We

examined the association between smoking status and risk of diabe-

tes using multivariable adjusted Cox proportional hazards regres-

sion models. Ordinary-least squares or logistic regressions were used

to estimate path coefficients in a multiple mediation model.

Significance of the indirect effects of smoking on diabetes incidence

through adiponectin, leptin and hs-CRP in the model was assessed

with bootstrapping procedure.

RESULTS: Compared with that for never smokers, the risk for dia-

betes was significantly elevated in current smokers (hazard

ratio¼1.75, 95% confidence interval: 1.25, 2.46) and ex-smokers

(hazard ratio¼1.54, 95% confidence interval: 1.07, 2.22). Of the

three biomarkers, only adiponectin was independently associated

with diabetes incidence (b (standard error (SE))¼�0.992 (0.381),

P¼0.009); it also appeared to mediate the smoking-diabetes associ-

ation: bias-corrected bootstrap 95% confidence intervals (BC 95%

CI) based on 10,000 bootstrap samples for the indirect effects on

diabetes of being a light (point estimate ¼0.033, BC 95% CI 0.005,

0.082), moderate (point estimate ¼0.044, BC 95% CI 0.010,

0.094) or heavy smoker (point estimate ¼0.054, BC 95% CI 0.013,

0.113), relative to never smokers, were statistically significant.

CONCLUSIONS: Adiponectin appeared to partially mediate the

association between smoking and diabetes while leptin and hs-CRP

did not.

Poster Number: M196 Abstract #: 2549Seroepidemiological Survey of Tularaemia inWestern Iran.

E. Mostafavi, PhD1, M. M. Gooya, PhD2, S. Esmaeili, MS1, M. R.

Shirzadi, PhD2, F. B. Amiri, MS1 and O. Banafshi, MS3

1Pasteur institute of Iran, Tehran, Iran, 2Ministry of Health, Tehran, Iran,3Kurdistan University of Medical Sciences, Sanandaj, Iran, Sanadaj, Iran

INTRODUCTION: Tularaemia is a zoonotic disease caused by

Francisella tularensis. The first human case of tularaemia (glandular

tularaemia) in Iran was reported in Marivan city, southwest

Kurdistan (western Iran) in 1980. There have been no subsequent

reports of tularaemia in Iran. The aim of this study was to carry out

a survey of tularaemia among high risk groups in the province of

Kurdistan.

METHODS: This study was carried out between 2011–12 among

hunters and their families, butchers, health care workers and those

referred to medical diagnostic laboratories in the south and south-

west of Kurdistan province. 250 sera samples were collected from

these groups with a questionnaire containing personal and behav-

ioural information. Sera were tested using ELISA kit to detect spe-

cific IgG antibodies against F. tularensis.

RESULTS: Of a total of 250 sera, 14.40% of samples had anti-tular-

aemia antibodies and 13.20% were borderline. The highest and the

lowest seroprevalence was in hunters (18%) and health care workers

(12%), respectively. Age had a significant positive association with

tularaemia seroprevalence (P<0.001). The seroprevalence of tular-

aemia in those exposed to foxes (hunting or eating its meat) (25%)

was significantly higher than in others (8.65%) (P¼0.01).

CONCLUSIONS: This study showed a high anti-tularaemia anti-

body seroprevalence among a high risk population in the west of

Iran. It is suggested that physicians and health care workers are

informed of bacteria circulating in this area. Similar studies in other

parts of the country and on domestic and wild animals will clarify

epidemiological aspects of tularaemia in Iran.

Poster Number: M106 Abstract #: 2719Genome-Wide Association Study (GWAS) andGenome-Environment Wide Interaction Study(GEWIS) of Late-Life Depressive Symptoms inWomen.

E. C. Dunn1, A. Wiste, MD1, F. Radmanesh, MD1, K. C. Koenen,

PhD2, S. Purcell, PhD1, M. Cornelis, PhD3, J. Rosand, MD1, P.

Kraft, PhD3, S. Wassertheil-Smoller, PhD4 and J. Smoller, MD1

1Massachusetts General Hospital, Boston, MA, 2Columbia University,

New York, NY, 3Harvard School of Public Health, Boston, MA, 4Albert

Einstein College of Medicine, Bronx, MA

INTRODUCTION: Depression is a common mental health problem

among women. Although the role of environmental exposures is

well-established for depression, little progress has been made in

identifying specific genes that increase risk. We undertook a

genome-wide association study (GWAS) and genome-environment

wide interaction study (GEWIS) of depressive symptoms using data

from the Women’s Health Initiative, a large population-based, lon-

gitudinal study of post-menopausal women.

METHODS: We examined the joint effect of common genetic var-

iants (e.g. single nucleotide polymorphisms; SNPs) with two envi-

ronmental exposures, stressful life events and social support. We

used data from African American (n¼8,565) and Hispanic

(n¼3,709) women, making this the first large-scale GWAS of

depression in these groups. Women were ages 50–79 at baseline.

Participants were genotyped using the Affymetrix 6.0 chip; addi-

tional SNPs were imputed using the 1000 Genomes reference panel.


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Depressive symptoms were assessed using six items from the Center

for Epidemiological Studies of Depression Scale.

RESULTS: No SNPs achieved genome-wide significance

(P<5�10�8) in either sample. The strongest association signal in

African Americans was for rs73531535 (P¼5.75�10�8), an

imputed SNP located 20kb from GPR139 (G protein-coupled recep-

tor 139) and in Hispanics, for the intronic SNP rs4542757

(P¼7.31�10�7) in DCC (deleted in colorectal cancer). Stressful life

events were positively associated with depressive symptoms (African

American: b¼1.42; P<0.001; r2¼0.06; Hispanic: b¼1.62;

P<0.001; r2¼0.06); social support was inversely associated

(African American: b¼1.46; P<0.001; r2¼0.06; Hispanic:

b¼2.12; P<0.001; r2¼0.09). After Bonferroni correction for mul-

tiple testing of the top 1% of GWAS hits (P<2.47�10�6 African

American; P<3.71�10�6 Hispanics), there were 8 statistically sig-

nificant SNPs in the GEWIS of social support in African Americans

and 5 significant SNPs in Hispanics.

CONCLUSIONS: Social support may be an important buffer of

genetic factors associated with depression. GEWIS appears to be a

promising and unbiased approach to identify novel loci associated

with depression. The results await replication.

Poster Number: M221 Abstract #: 2305Sex Differences in Smoking Habit by Educationaland Marital Status in a Representative JapanesePopulation: the NIPPON DATA2010.

N. Nishi, MD1, N. Okuda, MD1, T. Hayakawa, PhD2, A.Fujiyoshi, MD3, A. Kadota, MD4, T. Ohkubo, MD5, Y. Nakamura,MD6, K. Sakata, MD7, T. Okamura, MD8, H. Ueshima, MD3, A.Okayama, MD9 and K. Miura, MD3

1National Institute of Health and Nutrition, Tokyo, Japan, 2FukushimaMedical University, Fukushima, Japan, 3Shiga University of MedicalScience, Otsu, Japan, 4Osaka Kyoiku University, Kashiwara, Japan,5Teikyo University, Tokyo, Japan, 6Kyoto Women’s University, Kyoto,Japan, 7Iwate Medical University, Iwate, Japan, 8Keio University, Tokyo,Japan, 9Japan Anti-Tuberculosis Association, Tokyo, Japan

INTRODUCTION: In recent years, smoking prevalence of the

Japanese men is decreasing, but is still over 40% for middle-aged

men. In women, it is unchanged, but is around 15% in their 30’s.

This study aimed to examine socioeconomic differences in smoking

habit in a representative Japanese population.

METHODS: Subjects were aged 20 years and older, and a part of the

participants of the National Health and Nutrition Survey of Japan in

2010, who agreed to take supplementary examinations on circulatory

disorders (the NIPPON DATA2010). Smoking habit and educational

and marital status were asked by questionnaire. Respondents, who

reported smoking at least 100 cigarettes or for six months or more in

their lifetime and who, at the time of survey, smoked either every day

or some days were defined as current smoker. Educational status was

divided into three categories: junior high school (nine years), high

school (12 years), and college or university (14 years or more).

Marital status was either single or married. A total of 2,855 subjects

without missing observations, 1,215 men and 1,640 women, were

analyzed. Logistic regression model was used and odds ratios (OR)

with 95% confidence intervals (CI) were calculated.

RESULTS: In multivariate models, educational status in men and

educational and marital status in women were inversely associated

with current smoking. Compared with college or university gradu-

ates, OR (95% CI) of being a current smoker for junior high school

and high school graduates were 2.55 (1.72–3.77) and 1.66

(1.21–2.28) in men and 5.84 (2.99–11.4) and 2.51 (1.52–4.15) in

women, respectively. OR (95% CI) of being a current smoker for

being a single was 2.23 (1.39–3.59) in women.

CONCLUSIONS: Educational status was strongly associated with

being a current smoker both in men and women, but being a single

was associated with current smoking only in women.

Poster Number: M142 Abstract #: 2390Growth Trajectories in Early Childhood: what isthe Relative Importance of Antenatal andPostnatal Factors?

L. C. Giles, PhD, M. J. Whitrow, PhD, A. R. Rumbold, PhD, C. E.Davies, BS, M. J. Davies, PhD and V. M. Moore, PhD

University of Adelaide, Adelaide, Australia

INTRODUCTION: Childhood obesity frequently persists into

adulthood, so that obese children carry greatly increased risks of

cardiovascular disease and other conditions into their adult lives.

Identifying and better understanding differences between patterns of

growth in children in early life may give important insights into the

roots of childhood obesity.

METHODS: As part of an ongoing longitudinal study of 557 fami-

lies, children’s heights and weights were measured at birth, 6, 9, 12

months, 2, and 31=2 years. Standardized body mass indices (BMI)

were derived at each time, and latent class growth models used to

identify groups of children with different growth trajectories. We

investigated the relationship between distinct growth trajectory

groups and a range of antenatal and postnatal exposures.

RESULTS: We identified four growth trajectory groups across early

childhood, corresponding to low, medium, high, and accelerating

growth. Compared to children in the medium growth trajectory

group, those in the accelerating group were more likely to have a

mother with BMI>30 in early pregnancy (Odds Ratio¼4.5; 95%

confidence interval 1.4–14.4) than a mother of normal weight.

Parity was also significantly associated with accelerating growth tra-

jectory. Neither breastfeeding nor timing of introduction to solids

were significantly associated with growth trajectories.

CONCLUSIONS: Of the antenatal and postnatal exposures that we

considered, the most important factor that differentiated

between the growth trajectory groups was maternal BMI in early

pregnancy. Initiatives to address intergenerational transmission of

obesity and its consequences are vital for the health of Australian

families.

Poster Number: M215 Abstract #: 2391Adjusting for Spatial Autocorrelation inAssessing Access to Fast Food Outlets byNeighbourhood Deprivation.

K. E. Lamb, PhD, L. E. Thornton, PhD and K. Ball, PhD

Deakin University, Melbourne, Australia

INTRODUCTION: Higher rates of obesity have been observed in

more socially disadvantaged neighbourhoods, possibly due to

increased exposure to outlets serving energy dense food. Studies

worldwide have examined access to fast food outlets by neighbour-

hood deprivation, with inconsistent findings. However, there exist


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differences in the analytical approaches used, with correlation

between observations often ignored. The need to take spatial

autocorrelation into account is increasingly emphasised among

neighbourhood and health researchers but little is known about the

impact of adjusting for spatial autocorrelation or the implications of

failing to do so in studies of equitable access to neighbourhood

resources. Our study examined access to fast food outlets by neigh-

bourhood deprivation in Victoria, Australia, investigating the

importance of adjustment for spatial autocorrelation.

METHODS: Major chain fast food outlets (e.g. McDonald’s, KFC)

were identified using company websites and mapped to obtain a

count within each neighbourhood in Victoria (n¼422). Data were

linked to Australian Bureau of Statistics data on neighbourhood

deprivation and population size. We examined associations

between fast food outlet availability and deprivation using Poisson

regression, adjusting for population size. A neighbourhood adja-

cency matrix was created, defining areas sharing a common boun-

dary as neighbours. Spatial autocorrelation was assessed using

Moran’s I.

RESULTS: There was little spatial autocorrelation between fast

food outlets (q¼0.06, P¼0.02). We found evidence of differences

in fast food outlets by deprivation; fewer in least deprived neigh-

bourhoods compared to most deprived (incidence rate ratio

(IRR)¼0.27, 95% confidence interval (CI) (0.12, 0.61)) and second

most deprived (IRR¼0.27, 95% CI (0.13, 0.60)). There was no

residual spatial autocorrelation (P¼0.39).

CONCLUSIONS: Results suggest that spatial regression models are

not necessarily required in examining neighbourhood deprivation

and fast food access. Further research should examine spatial auto-

correlation in the analysis of neighbourhood effects on individual

health outcomes in order to in order to ensure correct inferences are

made.

Poster Number: M178 Abstract #: 2481Sex of the Offspring Influences the Relationshipsbetween Infant Feeding, Preeclampsia Statusand Early Pubertal Hormonal Levels.

J. M. Schraw, BS1, B. Øglænd, PhD2, Y. Q. Dong, MS1, S. T.Nilsen, PhD3, L. J. Vatten, PhD4 and M. Forman, PhD1

1University of Texas at Austin, Austin, TX, 2Oslo University Hospital, Oslo,Norway, 3Stavanger University Hospital, Stavanger, Norway, 4NorwegianUniversity of Science and Technology, Trondheim, Norway

INTRODUCTION: Cord blood insulin like growth factor-1

(IGF-1) levels are lower in preeclamptic (PE) than in normotensive

(NT) pregnancies. Early childhood IGF-1 levels are lower in

breastfed than formula fed infants. The aims of this study are to

examine: 1) the association between infant feeding practices and

childhood IGF-1 levels in offspring of NT and PE pregnancies and

2) the association between pubertal status and hormones by PE sta-

tus and sex of the offspring.

METHODS: A cohort of 565 Norwegian offspring of PE (37%)

and NT pregnancies born 1993–95 was followed through

puberty. Medical record linked data from prenatal and childhood

exposures through 10.8 years in girls and 11.8 years in boys were

abstracted. During clinical visits through puberty anthropometrics,

Tanner staging and maternal-reported diet through the life course were

collected; biospecimens were collected and analyzed for serum hor-

mones and IGF-1.

RESULTS: The percent exclusively breastfed was 75.5%, 27% and

1.4% at<3, 3-6 and 6-9 months in PE and NT. In linear regression

models, duration of exclusive breastfeeding was positively related to

IGF-1 levels in boys but not girls after adjustment for formula feeding,

age introduced to solids, childhood diet, weight, height, Tanner Stage

and PE status (P<0.05) (R2¼0.31). Compared to NT offspring of

the same sex and pubertal (Tanner 2þ) stage, PE boys had higher

mean serum IGF-1 and testosterone (T) levels (P¼0.01); PE girls had

higher dehydroepiandrostenedione sulfate (DHEAS). In contrast pre-

pubertal (Tanner stage 1) PE boys had lower DHEAS and higher T

(P<0.05); PE girls had higher DHEAS and lower T levels (P<

0.001).

CONCLUSIONS: Sex-specific associations were observed: Duration

of exclusive breast feeding and PE status in puberty was associated

with IGF-1 levels in boys. PE status was associated with DHEAS

and T levels in girls.

Poster Number: M130 Abstract #: 2487An Improved Method for Assessing Costs forPatients Admitted for Treatment usingNeighborhood Rough Set and Artificial NeuralNetwork (ANN).

Z. Wang, PhD1, Q. Du, PhD1, K. Nie, PhD1, S. Liang, PhD2 andF. Ren, PhD1

1Wuhan University, Wuhan, China, 2Health and Family Planning

Commission of Shenzhen Municipality, Shenzhen, China

INTRODUCTION: Assessing costs for patients admitted for treat-

ment is considerably important in hospital system; however, the

relationship between this outcome and its related factors is complex

and high-dimensional. In medical science, ANN models are success-

fully applied in many fields. However, ANN models are considered

as a black box model that has some disadvantages including heavy

computational burden, proneness to overtraining, and the empirical

nature of model selection. Thus, we developed a hybrid method to

overcome these problems. Classic rough set can extract knowledge

from the raw data, but it cannot handle the numerical variables

directly. Neighborhood rough set can compute attribute reduction

from nominal variables, numerical variables and their mixtures

when multi-variety data is available. The mean square error and

other homogeneous criterions are commonly used to evaluate the

ANN’s performance, but these criteria are correlated to model’s

architecture and sample size. Therefore, we applied an information

based criterion, the Akaike information criterion (AIC) to evaluate

the ANN’s performance.

METHODS: Sample data set was obtained from the records of 798

patients admitted for treatment of myocardial infarction, containing

24 condition attributes and one decision attribute (treatment costs).

The superfluous factors were eliminated by the method of neighbor-

hood rough set. Then, a three-layer back-propagation neural net-

work (BPNN) was used to assess the treatment costs. The AIC was

used to evaluate the performance of the proposed method.

RESULTS: Based on neighborhood rough set, 12 factors were

selected as input variables for the ANN to assess the treatment costs.

The corresponding AIC is �5.20, which is lower comparing to the

AIC (�4.32) of using ANN only.

CONCLUSIONS: Neighborhood rough set can efficiently eliminate

superfluous factors without loss of information. The proposed


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hybrid method based on neighborhood rough set and ANN outper-

formed the traditional ANN methods in estimating treatment costs,

which can be applied in hospital system.

Poster Number: M236 Abstract #: 2745Health and Work in Adult Women: Population-Based Study in Campinas, Sao Paulo, Brazil.

C. Senicato, MS1 and M. Barros, PhD2

1State University of Campinas/UNICAMP, Piracicaba, Brazil, 2State

University of Campinas—UNICAMP, Campinas, Brazil

INTRODUCTION: Little is known about the relationship between

employment status and socioeconomic status on the health of

Brazilian women.This study assessed social inequality in health

among housewives and employed women between 18 and 64 years

of age according to level of schooling (<9 and 9þ years of study).

METHODS: A population-based cross-sectional study was carried

out with conglomerate sampling. 668 women were analyzed from a

health survey carried out in Campinas, Sao Paulo, Brazil in 2008.

Were analysed: health status (self-assessment health, limiting long-

standing illness, chronic conditions, self-reported health problems

and mental health) and health related behaviours (leisure-time phys-

ical activity, hours of sleeping, smoking, alcohol abuse and con-

sumption of fruits and vegetables). Prevalence values were estimated

and prevalence ratios were adjusted using Poisson regression and

considering weights related to the sampling design.

RESULTS: The proportion of housewives was higher among women

of low level of schooling, 44.6% versus 19.9%. After adjusting for

age, housewives of low educational level had greater prevalence val-

ues for a worse self-assessment of health (PR¼2.69) and non-daily

consumption fruits or vegetables (PR¼1.15). No differences were

found for self-assessment health among women of high educational

level, but found higher prevalence of common mental disorders

(PR¼2.49), and lower prevalence of smoking (PR¼0.92) and non-

daily consumption fruits or vegetables (PR¼0.79) among house-

wives with a high level of schooling.

CONCLUSIONS: Among the indicators analyzed, we highlight the

differences in mental health and health related behaviors between

housewives and workers. Housewives of high level of schooling

have more common mental disorder compared the employed

women. However, the health related behaviours were less unfavour-

able for housewives of high educational level. These results empha-

size the need to consider the interaction between the level of

schooling and insertion in the production process in the develop-

ment of policies to promote the women’s health.

Poster Number: M168 Abstract #: 1427Betel Chewing and Risk of Metabolic Disease,Cardiovascular Disease, and All-Cause Mortality:A Meta-Analysis.

T. Yamada, MD, K. Hara, MD and T. Kadowaki, MD

University of Tokyo, Tokyo, Japan

INTRODUCTION: Asia already has 60% of the world’s diabetic

population and diabetes is increasing more rapidly in Asia than any-

where else. Betel nut (Areca nut) is the fruit of the Areca catechu

tree. Approximately 600 million individuals regularly chew it

in Asia and it is thought to be the fourth most commonly used

psychoactive substance in the world. Betel quid (BQ) is a known

risk factor for oral cancer and esophageal cancer. Several recent

studies have shown that chewing BQ is associated with the risk of

various systemic diseases. We performed a meta-analysis to confirm

the influence of chewing BQ on metabolic disease, cardiovascular

disease, and all-cause mortality.

METHODS: We searched Medline, Cochrane Library, Web of

Science, and Science Direct for pertinent articles published by 2013.

The adjusted relative risk (RR) and 95% confidence interval were

calculated using the random effect model. Sex was used as an inde-

pendent category for comparison.

RESULTS: Of 675 potentially relevant studies, 21 studies from Asia

(5 cohort studies and 16 case-control studies) covering 434,423 sub-

jects were selected. Seven studies (n¼121,585) showed significant

dose-response relationships between betel quid consumption and the

risk of events. According to pooled analysis, the adjusted RR of betel

quid chewers vs non-chewers was 1.47 (P<0.001) for obesity, 1.51

(P¼0.01) for metabolic syndrome, 1.47 (P<0.001) for diabetes,

1.45 (P¼0.06) for hypertension, 1.63 (P¼0.04) for hypertriglyceri-

demia, 1.55 (P¼0.004) for chronic kidney disease, 1.2 (P¼0.02)

for cardiovascular disease, and 1.21 (P¼0.02) for all-cause

mortality.

CONCLUSIONS: BQ chewing is associated with an increased risk

of metabolic disease, cardiovascular disease, and all-cause mortality.

In addition to preventing oral cancer, stopping BQ use would be

beneficial in view of the rapidly increasing prevalence of metabolic

diseases in South-East Asia and the Western Pacific.

Poster Number: M137 Abstract #: 2235Ankle-Brachial Index and the Risk ofCardiovascular Disease: The Circulatory Risk inCommunities Study.

R. Cui, PhD1, K. Yamagishi, PhD2, H. Imano, PhD1, T. Ohira,PhD3, T. Tanigawa, PhD4, M. Kiyama, PhD5, T. Okada, PhD6, A.Kitamura, PhD5 and H. Iso, PhD1

1Osaka University, Suita, Japan, 2University of Taukuba, Taukuba, Japan,3Fukushima Medical University, Fukushima, Japan, 4Ehime University,Ehime, Japan, 5Osaka Center for Cancer and Cardiovascular DiseasesPrevention, Osaka, Japan, 6Osaka Center for Cancer and CardiovascularDisease Prevention, Osaka, Japan

INTRODUCTION: Peripheral artery disease (PAD) is recognized as

a risk factor for coronary heart disease and ischemic stroke in

Western populations. However, evidence for the risk in Asian popu-

lations is limited.

METHODS: This study examined 939 Japanese men aged 60–74

years. None of the subjects had a history of clinical PAD or cardio-

vascular disease. The ankle brachial blood pressure index (ABI) pro-

vided a surrogate measure of PAD.

RESULTS: Age-adjusted risks of coronary heart disease, ischemic

stroke, and ischemic cardiovascular disease were higher in men who

measured in the lowest ABI tertile compared with those in the high-

est tertile. These associations did not change substantially after

adjusting for cardiovascular risk factors. The respective multivari-

able hazard ratios (HRs; 95% CI) for the three conditions were:

2.48 (1.08–5.71), p for trend¼0.03; 1.95 (0.94–4.02), p for

trend¼0.04; and 2.16 (1.25–3.72), P for trend¼0.004. These

results did not vary with comparison of the three ABI categories:

�0.90, 0.91–1.10, and>1.10. The multivariable HRs (95% CI) for


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an ABI �0.90 versus>1.10 were: 2.04 (0.67–6.20), P for

trend¼0.14 for coronary heart disease; 3.39 (1.10–10.5), P for

trend¼0.006 for ischemic stroke; and 2.61 (1.19–5.76), P for

trend¼0.003 for ischemic cardiovascular disease. There was no

association between ABI and the risk of hemorrhagic stroke.

CONCLUSIONS: Low ABI is associated with the risks of coronary

heart disease, ischemic stroke, and ischemic cardiovascular disease

in elderly Japanese men.

Poster Number: M235 Abstract #: 2561Health Related Quality of Life (SF-36) amongWomen: A Comparative Study betweenHousewives and Workers in Campinas, SaoPaulo, Brazil.

C. Senicato, MS1, M. G. Lima, PhD2 and M. Barros, PhD3

1State University of Campinas/UNICAMP, Piracicaba, Brazil, 2StateUniversity of Campinas, UNICAMP, Campinas, Brazil, 3State University ofCampinas—UNICAMP, Campinas, Brazil

INTRODUCTION: The conditions of women in the job market

and the traditional female roles in the family may distinctly influ-

ence the health and quality of life. This study assessed health related

quality of life (HRQL) of women between 18 and 64 years of age

according to insertion in the production process and schooling

(housewives and paid workers with<9 and>9 years of study).


out with conglomerate sampling. 668 women were analyzed from a

health survey carried out in Campinas, Sao Paulo, Brazil in 2008

(ISACAMP 2008). The HRQL was assessed using The Medical

Outcomes Study Instrument SF-36 – Item Short Form Health

Survey. The dependent variables were the eight scales of the SF-36.

Independent variables were the condition insertion in the production

process and the level of schooling. Analyses were performed by lin-

ear regression models, simple and multiple. Adjustment variables

were age and number of chronic diseases.

RESULTS: Among the workers paid the SF-36 mean scores were

similar in both level of schooling, with the exception of general

health (b=�6.5). Comparing housewives with higher level of school-

ing with paid female workers, the lowest scores among the house-

wives were observed in the scales: vitality (b=�9.6), role-emotional

(b=�4.7), social functioning (b=�4.1) and mental health (b¼�9.8).

The study also pointed out the lower scores in housewives with low

level of schooling in all scales of the SF-36, except pain. The largest

associations were found in: general health (b= �13.7), role-physical

(b= �11.2) and mental health (b= �10.9).

CONCLUSIONS: There was inequality in HRQL according to inser-

tion in the production process. Paid employment is positively associ-

ated with better health and quality of life in women. Housewives with

up to nine years of schooling exhibited a worse quality of life.

Poster Number: M240 Abstract #: 2681Sexual Risk Taking among Married or CohabitingWomen and its Implications for SexuallyTransmitted Infections in Mahikeng,South Africa.

G. Osuafor, MPH

North West University, Mafikeng, South Africa

INTRODUCTION: Risky sexual behaviour continues to propel

sexually transmitted infections (STIs) in South Africa. However,

there is dearth of research on sexual risk taking in South Africa, par-

ticularly in Mafikeng. Therefore this study was designed to examine

sexual risk taking and its implication for STIs among married

women in Mahikeng.

METHODS: The study cross-examined 568 women of age 18–49

years selected using a multistage random sampling technique from

the clusters carved from census 2011 enumeration areas in

Mahikeng. Data analyses were conducted using descriptive statis-

tics, chi-square and logistic regression model (a¼0.05).

RESULTS: The data show that the mean 6SD age of the women

was 34.568.0. Fifty-nine percent has good safer sex attitude if

woman had STI whereas 86.1% has good safer sex attitude if hus-

band/partner had STI. The identified predictors of sexual risk taking

are having at least primary education, being a student, belonging to

Methodist faith based, acceptance of condom, spousal discussion

about sex and engaging in sex for health enhancement. Women

whose union have lasted less than 5 years, partners are farmers or

drivers, and engage in sex for childbearing were more likely to have

risky sexual intercourse. Those who have experienced forced sex

and believe that husband/partner’s has right to sex were more likely

to engage risky sexual escapade. Furthermore, uncertainty about

being at risk of contracting STIs, and misconceptions on HIV trans-

mission were found to be significant predictors of sexual risk taking.

CONCLUSIONS: The findings of the study suggest that there are

socio-cultural, structural and individual factors that are salient in wom-

en’s sexual risk taking. It appeals for more work at individual and cou-

ple level to allay women’s vulnerability to sexual risk taking. Given

that risk perception varies among women and their husband/partners

influence intensify the risky behaviour. Intervention that focuses on

educating women on their basic sexual rights, improving spousal com-

munication about sex as well as streamlined information on STIs mis-

conceptions is needed for women’s sexual health in Mahikeng.

Poster Number: M175 Abstract #: 1430A Longitudinal Study of Dietary Supplement Usein Community-living Middle Age and ElderlyJapanese.

T. Imai, PhD1,2, R. Otsuka, PhD2, Y. Kato, PhD3, F. Ando, MD4

and H. Shimokata, PhD5

1Doshisha Women’s College of Liberal Arts, Kyoto, Japan, 2National

Center for Geriatrics and Gerontology, Obu, Japan, 3National Center for

Gerontology and Social Science, Obu, Japan, 4Aichi Shukutoku

University, Nagakute, Japan, 5Nagoya University of Arts and Sciences,

Nissin, Japan

INTRODUCTION: There are few studies about dietary supplement

use in Japan. The purpose of this study is to clarify the dietary sup-

plement use in the community-living Japanese population.

METHODS: Dietary supplements were grouped into 10 major cate-

gories. Some categories were further classified into sub-categories.

To collect information on dietary supplement use in the previous

year we conducted an original self-administered dietary supplement

frequency questionnaire. The subjects were participated in the

National Institute for Longevity Sciences Longitudinal Study of

Aging (NILS-LSA) from baseline (2000–02, males; n¼1,152,

females; n¼1,107) to seventh (2010–12; males; n¼1,178, females;

n¼1,152). The prevalence of dietary supplement uses and trend of


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them according to waves were examined by Cochran-Mantel-

Haenszel test controlled by age.

RESULTS: At the baseline, 59% of males and 67% of females con-

sumed any dietary supplements. Females were more likely to take

them than males in all waves (P<0.01). In major category, the prev-

alence of Vitamin intakes was 10% in males and 14% in females,

liquid type dietary supplements (Drink type) was 23% in both sexes,

and other type of supplement including efficient ingredients for

health except nutrients (Others) was 9% in males and 14% in

females at the baseline. The users of Drink type (both sexes,

P<0.01) and Vitamin (females, P¼0.02) tended to decrease with

wave. In Vitamin sub-categories, Vitamin E and C users in females

decreased with wave (P<0.01). However, Others tended to increase

with wave in both sexes (P<0.01), especially, anthocyanin, green

leaves juice and dietary supplements for Joints such as chitosan and

chondroitin-sulfate and supplements for beauty such as CoQ10 and

collagen increased with wave in both sexes (P<0.01).

CONCLUSIONS: More than a half of the community-living popu-

lation used dietary supplements in Japan. The purpose of dietary

supplement intakes shifted from compensating for lack of nutrients

to taking efficient ingredients for health.

Poster Number: M11 Abstract #: 2519Antiretroviral Therapy at Public Health CareFacilities in Brazil: HIV/AIDS Cohort-Brazil.

M. M. L. Escuder, MS1, A. M. Grangeiro, MS2, A. J. F.Cassenote, MS3, A. O. Kalichman, MS4, R. A. Souza, MD5, U.Tupinamba, PhD6, V. Veloso, PhD7, N. Barcellos, PhD8, B.Grinsztejn, PhD7 and E. A. Castilho, PhD3

1Institute of Health of Sao Paulo, Sao Paulo, Brazil, 2School of Medicineof Sao Paulo University, Sao Paulo, Brazil, 3University of Sao PauloSchool of Medicine, Sao Paulo, Brazil, 4Centro de Referencia eTreinamento DST e Aids, Sao Paulo, Brazil, 5Centro de Referencia eTreinamento de DST e Aids, Sao Paulo, Brazil, 6Medicin School—UFMG,Belo Horizonte, Brazil, 7Fundacao Oswaldo Cruz, Instituto de PesquisaClinica Evandro Chagas—IPEC, Rio de Janeiro, Brazil, 8HospitalSanatorio Partenon, Porto Alegre, Brazil

INTRODUCTION: Results from the use of combination antiretro-

viral therapy (cART) in daily practice of health services remain rela-

tively unknown in countries of low and middle-income, despite their

accounting for around 90% of the AIDS epidemic worldwide. In

order to minimize this limitation we developed the HIV/AIDS

Cohort- Brazil, which has as main objective to analyse the effective-

ness of the antiretroviral and the impact of that treatment on mor-

bidity, quality of life and mortality of people HIV-infected in Brazil.

METHODS: Since 2003, the HIV/AIDS Cohort-Brazil project has

been following 6109 HIV-infected adults receiving cART in 26 pub-

lic health care facilities in Brazil, using as sources of information

data from routine health services and self-reported quality of life

questionnaires. When not otherwise available, data related to demo-

graphics, laboratory tests and mortality are obtained from national

information systems. The main outcomes of interest are diseases

related or unrelated to HIV; suppression of viral replication; adverse

events; virological, clinical and immunological failures; change in

the cART; and mortality.

RESULTS: When antiretroviral treatment was started, approxi-

mately 60% of the patients presented severe immunodeficiency

(CD4þT-cell counts of �200 cells/mm3) or diseases related to HIV

infection. In addition, in 1/3 of these cases, antiretroviral therapy

was not started until more than six months after clinical follow-up

had begun. The medications most often used in the various

treatment regimens were efavirenz (in 59.7%), lopinavir/ritonavir

(in 18.2%) and atazanavir/ritonavir (5.6%). Of the NRTI back-

bones prescribed, 86.2% contained zidovudine or lamivudine; teno-

fovir was used in 4.5%. By 36 months after the beginning of

therapy, the initial regimen had been changed in 29.9% of the cases,

translating to a probability of change for the period of 35.6%. The

average duration of treatment prior to the change being 30.4

months

CONCLUSIONS: Results from cART use, in the daily practice of

health services, remain relatively unknown in countries of low- and

middle-income and studies with the characteristics of Cohort-Brazil

contribute to minimize these shortcomings, given its scope and a

patient profile similar to that of the AIDS epidemic in the country.

Poster Number: M164 Abstract #: 2746Heart Rate Variability, Insulin Resistance andInsulin Sensitivity in Japanese Adults: The ToonHealth Study.

I. Saito, PhD1, K. Maruyama, PhD1, W. Nishida, PhD1, E.Eguchi, PhD1, T. Kato, PhD2, S. Hitsumoto, PhD3, R. Kawamura,PhD1, Y. Takata, PhD1, H. Onuma, PhD1, H. Osawa, PhD1 and T.Tanigawa, PhD1

1Ehime University Graduate School of Medicine, Toon, Japan, 2EhimeUniversity, Matsuyama, Japan, 3Ehime University Hospital, Toon, Japan

INTRODUCTION: Varied genetic backgrounds due to ethnicity

are implicated in the pathogenesis of diabetes. Although abnormal

cardiac autonomic function is associated with increased risk of dia-

betes in Caucasians, evidence is limited in Asian populations with

lower body weight.

METHODS: The Toon Health Study recruited 1,899 individuals

without medication for diabetes, ages 30–79 years during 2009–12.

A 75-g oral glucose tolerance test was used to diagnose diabetes,

and fasting and 2h-postload glucose and insulin concentrations were

measured. We assessed homeostasis model assessment index for

insulin resistance (HOMA-IR) and Gutt’s insulin sensitivity index

(ISI). Pulse was recorded for 5 min and time-domain heart rate vari-

ability (HRV) measures were assessed: standard deviation of all nor-

mal-to-normal RR intervals (SDNN), and square root of mean

squared differences of NN intervals (RMSSD). Power spectral analy-

sis provided high frequency (HF) power, low frequency (LF) power

and LF/HF, as frequency domain measures of HRV.

RESULTS: Decreased SDNN, RMSSD and HF, and increased LF/

HF ratio were significantly associated with increased HOMA-IR or

decreased ISI in multivariable-adjusted logistic regression models.

When stratified by overweight status, associations of RMSSD, HF

and LF/HF ratio with decreased ISI were also apparent in non-over-

weight individuals. An interaction of LF/HF ratio for decreased ISI

with overweight conditions was significant, and the odds ratio for

decreased ISI in highest quartile of LF/HF ratio in non-overweight

was 2.09 (95% confidence interval, 1.41–3.10).

CONCLUSIONS: HRV was associated positively with insulin resist-

ance, and inversely with insulin sensitivity. Reduced ISI was associ-

ated with decreased parasympathetic function, primarily in non-

overweight individuals.


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Poster Number: M230 Abstract #: 2544Social Inequality in the Prevalence of Smokingamong Adult Women: Population-Based Study inCampinas, Sao Paulo, Brazil.

C. P. Batalha1, C. Senicato, MS2 and M. Barros, PhD3

1State University of Campinas/UNICAMP, Itu, Brazil, 2State University ofCampinas/UNICAMP, Piracicaba, Brazil, 3State University of Campinas—UNICAMP, Campinas, Brazil

INTRODUCTION: Despite of the stability rates of smoking in

women population, the regression index is low and still more dan-

gerous in countries under development due to the tendency of femi-

nization, poverty and addiction among young people. The present

study assessed the prevalence of smoking, degree of dependence and

socioeconomic and demographic factors associated with smoking

among adult women between 20 and 59 years of age.


out with conglomerate sampling. Five hundred eight women were

analyzed from a home survey carried out in Campinas, SP, Brazil in

2008. Prevalence values were estimated and prevalence ratios were

adjusted using Poisson regression and considering weights related to

the sampling design.

RESULTS: The prevalence in smoker women in Campinas was 16.7%

(95% CI 12.8–20.6) and in ex-smoker was 10.8% (95% CI 6.8–14.9).

About the nicotine dependence level, evaluated by the Fagerstrom Test,

the category of low was more relevant with 31.0% (95% CI

20.2–41.8). After the age adjustment, the prevalence of smokers was

higher among women between 50 and 59 years (PR¼1.91), with

brown skin (PR¼1.75), living with partner (PR¼2.25), with three or

more children (PR¼1.98), without religion (PR¼1.96) and those

women till eight years of study (PR¼2.07). The protestant women

had lower tobacco prevalence (PR¼0.36) when compared to the cath-

olic ones. The women who live in a family with three or four people

smoke less than those who live alone (PR¼0.47).

CONCLUSIONS: The smoking in adult women is associated with

the social inequality. Identifying vulnerabilities and inequalities in

health generates information for public policies to promote social

equity and the risks of falling ill and dying.

Poster Number: M52 Abstract #: 2836Higher Prevalence of Active Asthma among15–17 Year-Old Greek-Cypriots in Socio-Economically Deprived Communities in theVicinity of Power Plants: Results of a NationwideSurvey in Cyprus.

N. Middleton, PhD1, O. Kolokotroni, MD1,2, D. Lamnisos, PhD1,E. Papathanassoglou, PhD1, C. Nicolaou, BS1, P. Koutrakis,PhD3 and P. Yiallouros, PhD4

1Cyprus University of Technology, Limassol, Cyprus, 2University ofNicosia, Nicosia, Cyprus, 3Harvard School of Public Health, Boston, MA,4Cyprus International Institute for Environmental and Public Health,Cyprus University of Technology, Limassol, Cyprus

INTRODUCTION: In contrast to the large body of literature on

traffic pollution, there is only a handful of studies on the respiratory

health of children in the vicinity of power plants, even though the

energy industry is the main contributor to outdoor air pollution.

METHODS: Based on responses to the ISAAC questionnaire

of 5,817 15–17 year-old participants in a nationwide survey, we

investigated: active asthma (i.e. report of asthma and wheeze and/or

night time cough unrelated to colds in the past 12 months), inactive

asthma and respiratory symptoms without a diagnosis in the vicinity

of power plants in relation to the rest of the island. Associations in

terms of GIS-calculated distance of the participants’ community to

any of the three power plants were investigated in logistic models

before and after adjusting for potential confounders.

RESULTS: At 7.4% (95% CI 4.5,11.3), the prevalence of active

asthma at 5km from power plants appeared elevated compared to

national levels, but any effect appeared restricted to the 5km-zone.

Compared to>30 km away, those in the vicinity of power plants

were nearly twice as likely to report active asthma with an adjusted

OR of 1.83 95% CI (1.03, 3.24). No clear pattern was observed for

inactive asthma while the OR of respiratory symptoms in the absence

of diagnosis was 0.76 (95% CI 0.58, 1.01), suggesting, if not diagnos-

tic or reporting bias, an increased likelihood for symptomatic children

to receive a diagnosis after more frequent or severe attacks.

CONCLUSIONS: Higher prevalence of active asthma was observed

in the vicinity of power plants, with no evidence of a distance-

response relationship. Due to the small size of these communities,

this corresponds to a small fraction of active asthma attributable to

plant emissions but raises questions about environmental justice

since the most affected communities are also socio-economically

disadvantaged.

Poster Number: M22 Abstract #: 2239Hormone Replacement Therapy and OralContraceptives and Risk of OesophagealAdenocarcinoma: A Systematic Review andMeta-analysis.

K. Lagergren1, J. Lagergren, PhD1,2 and N. Brusselaers, PhD1

1Karolinska Institutet, Stockholm, Sweden, 2Kings’s College, London,

United Kingdom

INTRODUCTION: There is an unexplained strong male predomi-

nance in the aetiology of oesophageal adenocarcinoma (OAC). A

potential protective influence of exogenous oestrogen exposure, i.e.

hormone replacement therapy (HRT) and oral contraceptives (OC)

has been addressed only in studies of limited statistical power, and

the individual studies have not provided conclusive results.

METHODS: We conducted a systematic literature search and meta-

analysis on HRT and OC and the risk of OAC. We used the data-

bases PubMed and the Web of Science (1960–2013). Pooled odds

ratios (ORs) and 95% confidence intervals (CIs), estimated by the

Mantel-Haenszel random-effect method. Statistical heterogeneity

was assessed by the I-square test.

RESULTS: The search identified 463 articles, of which 5 eligible

studies published between 2006–11, including a total of 451 women

with OAC and 367,033 female controls. Two studies were cohort

studies, and 3 were case-control studies. All studies addressed HRT

exposure, while three studies also presented data on OC exposure.

Compared to never users, ever users of HRT had a statistically sig-

nificantly decreased risk of OAC (pooled OR¼0.75; 95% CI

0.58–0.98) and ever users of OC had a borderline significantly

decreased risk of this cancer (pooled OR¼0.76; 95% CI

0.57–1.00). Statistical heterogeneity was low (I2¼0%).

CONCLUSIONS: This study suggests that use of HRT, and possibly

also OC, decreases the risk of OAC, thus providing support for the

hypothesis that exogenous oestrogen exposure counteracts OAC in


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women. These findings require more research before any causal asso-

ciation can be established. This meta-analysis was limited by the low

number of studies, and there was insufficient data to allow sub-group

analysis of duration, type or dosage of HRT and OC use, or adjust for

potential confounding. The rough categorisation into ever or never

use should, however, dilute true effects rather than enhance them

since potential misclassification was likely to be non-differential.

Poster Number: M32 Abstract #: 2507Association between Allergic Diseases andMental Distress in Danish Adolescents.

L. Hammer-Helmich, MS1, A. Linneberg, PhD1, S. F. Thomsen,PhD2, C. Obel, PhD3 and C. Glumer, PhD1

1Capital Region of Denmark, Glostrup, Denmark, 2Bispebjerg Hospital,

Copenhagen NV, Denmark, 3University of Aarhus, Aarhus C, Denmark

INTRODUCTION: Children with allergic diseases often experience

physical, psychological and social impairment, including emotional

distress and social isolation. However, only few studies address ado-

lescence and few use self-report instead of parent report. Most studies

focus on patients alone, while the public health perspective including

socioeconomic disparities is less frequently addressed. Our aim was to

examine the association between allergic symptoms, self-rated health

and mental distress in a general child population and to assess if this

association was modified by parental socioeconomic position.

METHODS: A cross-sectional health survey of two complete birth-

cohorts in the municipality of the Danish capital Copenhagen was

conducted. Children aged 11 and 15 years completed questionnaires

on mental health and symptoms of atopic eczema, asthma and aller-

gic rhinitis. Data were linked to national registers on parental socio-

economic position. In total, 3784 children responded (46.6%).

RESULTS: Current allergic symptoms were associated with increased

risk of poor self-rated health (OR¼1.70, 95% CI¼1.31–2.19 for

symptoms of one vs no diseases; OR¼2.53, 95% CI¼1.79–3.57 for

symptoms of two/three vs no diseases) and emotional problems

(OR¼1.74, 95% CI¼1.43–2.11 for symptoms of one vs no diseases;

OR¼2.10, 95% CI¼1.58–2.79 for symptoms of two/three vs no dis-

eases). The risk was highest among children experiencing symptoms

of two or three allergic diseases. Current allergic symptoms were also

associated with increased risk of feeling lonely, but not with peer

problems or problems with prosocial behaviour. Socioeconomic posi-

tion did not significantly modify the association between current aller-

gic symptoms and each mental distress indicator. However, low

compared to high socioeconomic position added to the total mental

distress burden by increasing the risk of peer problems and problems

with prosocial behaviour.

CONCLUSIONS: Children experiencing allergic symptoms were at

higher risk of rating their health as poor and suffering from

emotional problems or loneliness than children without allergic

symptoms, regardless of their socioeconomic position.

Poster Number: M191 Abstract #: 2733Socio-Economic Factors Associated with CholeraOutbreak in Southern Ghana, 2012: ACase-Control Study.

B. B. K. Davies-Teye, MPH1,2, L. Vanotoo, MPH3, J. B. Yabani,MPH3 and C. Kwaakye-Maclean, MPH3

1Ghana College of Physicians and Surgeons, Accra, Ghana, 2Accra

Metropolitan Health Directorate, Accra, Ghana, 3Ghana Health Services,Accra, Ghana

INTRODUCTION: Cholera, a key social development indicator

remains an acute global public health threat (Dunkle, 2011

Penguele, 2011). Ghana has seen recurrent epidemics in recent years,

posing health system challenge. This study aimed to describe, iden-

tify the cause and socio-economic factors associated with 2012 chol-

era outbreak in Osu-Klottey district for policy recommendations.

METHODS: We conducted descriptive and unmatched 1:2 case-

control study. Cholera case-patient was person with acute diarrhea

with/without vomiting in the district from 1st March to 30th

November 2012. We interviewed participants on socio-economic,

household hygiene, food, water exposures with structured question-

naires and mapped their residence geospatially. Data was managed

and analyzed in Stata 11/SE.

RESULTS: Index case, 23 year old male Nima resident reported at

Ridge hospital on 9th March 2012 after eating street-vendors

‘Waakye’. The outbreak caused by Vibrio cholerae O1 El-Tor bio-

type, serotype ogawa had two peaks with total of 494 cases with

three mortalities (Attack rate; 383/100,000 populations, 0.61%

fatality). Age ranged 2-83; mean and median 31þ/-14.4 and 27

years, respectively. Majority of cases were from Ayawaso and Osu-

Klottey. Prompt case management, infection prevention practices,

contact tracing, sensitization campaigns and proper cadaver disposal

were instituted.

Monthly income, daily-food-expenditure ranged 10–500 USD and

0.50–25 USD, respectively among participants (237). Logistic

regression analysis (95% confidence interval) showed age below 18

years (AOR¼7.69, CI 1.38–42.73), education below tertiary

(AOR¼2.96, CI 1.16–7.54), exclusive household toilet facility

(AOR¼0.289, CI 0.12–0.70), cold/warm food (AOR¼3.11, CI

1.34–7.23), home-food (AOR¼0.083, CI 0.39–0.18) and commun-

ity pipe-borne water (AOR¼2.15, CI 1.04–4.44) were associated.

Hand washing with soap-water, slum residence, and daily-

food-expenditure below 5.0USD and alcohol ingestion showed sig-

nificant association only with bivariate analysis.

CONCLUSIONS: Sanitary reforms and infrastructural development

is crucial to combat recurrence of cholera epidemic, however multi-

sectorial approach including oral cholera vaccine for the under-18

year olds would make significant impact.

Poster Number: M225 Abstract #: 2839How to Fairly Allocate Scarce Medical Resources:Justice Trade-Offs between an Individual and aPopulation Perspective.

T. Smieszek, PhD1,2 and P. Krutli, PhD3

1Public Health England, London, United Kingdom, 2Imperial College,

London, United Kingdom, 3ETH Zurich, Zurich, Switzerland

INTRODUCTION: The establishment of allocation schemes for

scarce medical goods and services is a serious matter as it may deter-

mine who lives and who dies. The decision concerning who is to

receive an organ transplant primarily affects the patients on the

waiting list. However, the allocation of scarce treatment and preven-

tion against infectious disease is more far reaching. Untreated indi-

viduals may infect additional people who could have been spared,

had the untreated persons been treated. An efficient allocation

scheme that might avert many cases on a population level may be


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considered unjust when focusing on the individual level, and vice

versa.

METHODS: We tested, via a hypothetical infection transmission

scenario, what kind of allocation scheme (‘lottery’, ‘youngest first’,

‘by behaviour’, etc.) is perceived to be the fairest by (A) medical lay-

people and (B) general practitioners from Switzerland. The data

were collected using an online survey tool. Participants belonging to

one of the two groups were randomly distributed to one of four con-

ditions, based on a 2x2 factorial design: Allocation purpose (a1:

treatment for infected individuals vs a2: prevention for uninfected

ones) x Information (b1: information about the population-wide

effects of each allocation scheme vs b2: no information). We also

asked participants to assess other scarcity situations.

RESULTS: We found, inter alia, that participants distinguished

between treatment of infected and prevention for uninfected individ-

uals: 34.4% of the lay-people chose the most efficient allocation

scheme, even though it meant to prefer people whose behaviour was

driving the infection spread. In the case of treating already infected

people, only 13.5% chose the efficient scheme. Here, the most popu-

lar scheme was prioritization by waiting time (35.4%).

CONCLUSIONS: There is no universally preferred allocation

scheme and fairness judgements are context-dependent. Our

research may help to define ethical policies that are widely accepted

among concerned stakeholders.

Poster Number: M27 Abstract #: 1435Acne and Prostate Cancer Risk.

A. A. Rahman, PhD1, A. Lophatananon, PhD2,3, S. S. Brown,PhD4, T. Parker, PhD5, D. Easton, PhD6, Z. Kote-Jarai, PhD7, R.A. Eeles, PhD7,8 and K. Muir, PhD3

1Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan,2Warwick University, Coventry, CV4 7AL, UK, Coventry, England,3Institute of Population Health, The University of Manchester, Oxford

Road, Manchester, M13 9PT, Manchester, England, 4Warwick University,

Coventry, CV4 7AL, Coventry, England, 5University of Nottingham,

Nottingham, England, 6Cambridge, Cambridge, England, 7The Institute of

Cancer Research, Surrey, England, 8The Royal Marsden NHS Foundation

Trust, Downs Road, Sutton, SM2 5PT, UK, London, England

INTRODUCTION: It has been hypothesized that androgens have

an important role in the aetiology of both acne and prostate dis-

eases, although the exact mechanism is yet to be established. Acne

could be a marker of excess male hormones. This study aims to

assess the association between self-reported acne and prostate can-

cer risk.

METHODS: Data of 1963 prostate cancer cases and 2078 popula-

tion-based controls from the UK Gene-Environment Interactions in

Prostate Cancer study was analysed. A Self-administered question-

naire was used to collect the exposure histories. Subjects were asked

to record a history of acne ‘when they were young’ (to try to elicit

their history of acne in their teenage years), in their 20s and 30s.

The effects of acne at these time points were investigated.

Unconditional logistic regression adjusted for age, family history of

prostate cancer and ethnicity was used to generate odds ratios and

95% CIs.

RESULTS: Subjects with no history of acne were used as the refer-

ence category. Presence of acne when they were young was associ-

ated with prostate cancer risk (OR 1.20, 95% CI 1.04–1.40, P

value<0.05). However subjects who reported having had acne dur-

ing their 20s & 30s were not at risk. No effect was observed in those

who had acne when they were young through to 20s and 30s (OR

1.07, 95% CI 0.82–1.39 and OR 1.35, 95% CI 0.94–1.93,

respectively).

CONCLUSIONS: The findings suggest modest association between

acne at young age and prostate cancer risk.

Poster Number: M14 Abstract #: 2318Socio-Economic Impact on Oral Health-RelatedQuality of Life of Parkinson’s Disease Patients:Evidence from India.

A. Sha, MPH

Mother Hospital, Thrissur, India

INTRODUCTION: The severity of physical and mental impair-

ments and oral problems, as well as socioeconomic factors, may

have an impact on quality of life of Parkinson’s disease (PD)

patients. The aim of this research was to assess the impact of impair-

ments and oral health conditions, adjusted by socioeconomic fac-

tors, on the Oral Health-Related Quality of Life (OHRQoL) of

Parkinson’s disease (PD) patients.

METHODS: Sixty Parkinson’s disease (PD) patients, between

55–74 years of age were selected. Their caregivers answered a

OHRQoL instrument (5 domains) which combines the Parental-

Caregivers Perception Questionnaire (P-CPQ) and Family Impact

Scale (FIS). Written informed consent to participate in this study

was obtained from all the participants. The severity of dental caries,

communication ability, gross motor function, seizures and socioeco-

nomic conditions were assessed.

RESULTS: Considering the total score of the OHRQoL instrument,

only the reduction of communication ability and dental caries

severity had a negative impact on the OHRQoL (P<0.05).

Considering each domain of the instrument, the severity of the

Parkinson’s disease (PD) and its reduction of communication ability

showed a negative impact on oral symptoms and functional limita-

tions domains (P<0.05). Seizures have a negative impact on oral

symptoms domain (P = 0.006). The multivariate fitted model

showed that the severity of dental caries, communication ability and

low family income were negatively associated with the impact on

OHRQoL (P = 0.001).

CONCLUSIONS: The severity of dental caries, communication

ability, and family income are conditions strongly associated with a

negative impact on OHRQoL of Parkinson’s disease (PD) patients.

All these conditions should be assessed before medical and/or dental

treatment of the patients to prepare an appropriate treatment proto-

col and optimize oral health. Clinicians should routinely check

patients’ oral health in order to maintain high quality of life of

Parkinson’s disease patients. We suggest short and frequent dental

visits for having high range attention of the Parkinson’s disease

patients.

Poster Number: M208 Abstract #: 2714Identifying Global Patterns of Income Inequalityin Smoking & Obesity: Comparing Six EmergingEconomies with a High-Income Country.

A. Aitsi-Selmi, PhD, M. Bobak, PhD and M. G. Marmot, PhD

University College London, London, United Kingdom


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INTRODUCTION: The prevalence rates of obesity and smoking

are increasing globally and behave like epidemics. Their social distri-

bution appears to change as countries develop but it is not clear how

or why this occurs. This study examines income inequalities in these

two key non-communicable disease risk factors comparing England

with six middle-income countries to identify common and differing

patterns.

METHODS: Nationally representative data from the Health Survey

for England 2009 (n¼3740), and the World Health Organisation

Study on Global Ageing and Adult Health 2010 (SAGE) are used.

SAGE is unique in providing standardised data for six middle-

income countries (LMICs) including China (n¼14,888), Ghana

(n¼5565), India (n¼12,198), Mexico (n¼2737), Russia

(n¼4670) and South Africa (n¼4225). Relative and absolute

inequalities in total household income for smoking (current/non-

smoker) and obesity (BMI �30) are calculated, respectively, as the

age-adjusted relative index of inequality and the slope index of

inequality (RII and SII) by sex and country for adults �18 years.

RESULTS: In terms of obesity, England was the only country where

poor women were at a disadvantage with a large magnitude of rela-

tive inequality in obesity (RII¼1.90; 95% CI 1.41, 2.59; P-value

<0.001) and there was no gradient of inequality in obesity for men.

In contrast, in the lower-income countries, both poor men and

women were at lower risk of obesity reflecting a higher level of food

insecurity. In terms of smoking, poor men and women were at a dis-

advantage in all countries with England displaying the highest mag-

nitude of relative inequality (RII¼3.4; 95% CI 2.7, 4.1, P-value

<0.001).

CONCLUSIONS: The findings suggest that the smoking gradient

may reverse before the obesity gradient indicating that low income

groups may forego essential needs (food) before non-essential needs

(cigarettes). This raises questions as to the potentially harmful

nature of the global consumer environment.

Poster Number: M173 Abstract #: 2779Association between Dietary Patterns andMental Disorders in Pregnant Women inSouthern Brazil.

J. A. Ahlert, MS1, M. Drehmer, PhD1, M. T. A. Olinto, MPH2,J. A. Hoffmann, MS1, M. I. A. Schmidt, PhD3 andM. A. A. Nunes, PhD1

1Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,2University of Vale do Rio dos Sinos, Sao Leopoldo, RS, RI, Brazil,3Federal University of Rio Grande do Sul, Porto Alegre, Brazil

INTRODUCTION: Evidence shows that the diet of individuals is

related to factors potentially involved with the mental disorders.

Objective: To evaluate the association between dietary patterns and

mental disorders in a sample of pregnant women in southern Brazil.

METHODS: Cross-sectional study. A total of 712 pregnant women

were enrolled in the Food Intake and Eating Behavior in Pregnancy

Study (ECCAGe) in primary care services in Southern Brazil. The

food intake assessment was performed using the food frequency

questionnaire (FFQ). Dietary patterns were identified by cluster

analysis. PRIME-MD instrument (The primary care evaluation of

mental disorders) was used to evaluate the mental health of pregnant

women. Poisson regression models with robust variance were fitted

to estimate prevalence ratios adjusted for socioeconomic, demo-

graphic and clinical variables.

RESULTS: Pregnant women who had an insufficient intake of fruits

and a high consumption of sweets and sugars presented 42% (PR

1.42, 95% CI 1.03–1.96) and 88% (PR 1.88, 95% CI 1.16–3.06) a

higher prevalence of major depressive disorder, respectively, com-

pared to women with adequate intake or lower risk, adjusting for

age, pregestational BMI, city of residence and violence during preg-

nancy. Women with a common-Brazilian dietary pattern had a

higher prevalence of depressive disorder compared to those who pre-

sented a varied consumption pattern (PR 1.41, 95% CI 1.00–2.00),

controlled for city of residence and violence during pregnancy.

Finally, women with an insufficient intake of legumes showed a sig-

nificant association with generalized anxiety (PR 1.39, 95% CI

1.01–1.90), adjusting for age and violence during pregnancy.

CONCLUSIONS: Adequate consumption of fruits, vegetables and

legumes during pregnancy was associated with lower prevalence of

mental disorders compared with inadequate intakes. The results

reinforce the importance of an adequate dietary intake to ensure bet-

ter mental health in pregnancy.

Poster Number: M34 Abstract #: 2278Association Between Maternal Factors andSurvival Patterns of Children in Rural KwaZulu-Natal,South Africa.

A. N. Makumi, MS

University of Witwatersrand, Johannesburg, South Africa

INTRODUCTION: Globally, child mortality is a great concern,

especially in resource-limited settings. The Millennium

Development Goal (MDG) four was set with an aim to reduce

under-5 child mortality by two-thirds between 1990 and 2015. This

study examines mortality trends in infants, 1–4 and above 5-year-

old children in rural KwaZulu-Natal, South Africa, the causes of

death as well as the association of maternal HIV status and ART

usage to child mortality.

METHODS: We use a longitudinal birth cohort study design of chil-

dren born between 1 January 2004 and 31 December 2010, in the

Africa Centre DSA in rural KwaZulu-Natal, South Africa. Children

had to have been resident in the DSA at the time of birth.

RESULTS: A total of 12,413 children born in the study period were

eligible for this study. The main outcome measure was mortality

either in infancy, at 1–4 years or at five and above years of age,

while assessing its association with maternal HIV and ART status

on a time-varying basis. A total of 619 children died during the

study period and mortality was observed to be highest in the infant

group with 67% of the children dying in infancy. Fifteen percent of

mothers were HIV positive at the time of birth of the child, about

59% were HIV negative while the HIV status of the rest was

unknown. There was a three-fold increase in mortality observed for

both infants and 1–4 year olds, who had mothers who were HIV

infected compared to children whose mothers were HIV negative

(P<0.05). Children whose mothers were on ART however had a

reduced mortality compared to those whose mothers were not on

treatment. Infants and 1-4year olds whose mothers HIV status was

not reported had a two-fold increase in mortality. Low maternal

education, single motherhood, multiple births and parity of four or

more children were also associated with increased child mortality.

CONCLUSIONS: We concluded that although mortality varied by

the age of the child, children born to mothers who were HIV positive

had higher mortality rates than children born to HIV negative


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mothers but being on ART treatment reduced children mortality.

Interventions targeting HIV positive pregnant women and mothers

should be carried out in the study area, with specific emphasis on

reducing child mortality associated with maternal HIV status.

Poster Number: M227 Abstract #: 2674Socioeconomic Health Disparities within andbetween Age Groups in the NorthernNetherlands.

S. K. van Zon, MS1, U. Bultmann, PhD1, C. F. Mendes de Leon,PhD2 and S. A. Reijneveld, PhD1

1University Medical Center Groningen, Groningen, Netherlands,2University of Michigan School of Public Health, Ann Arbor, MI

INTRODUCTION: Socioeconomic gradients are frequently deter-

mined for combined measures of socioeconomic status (SES) indica-

tors and wide age-ranges. We assessed whether this obscures

variations in the magnitude of socioeconomic gradients for self-

rated health (SRH) across measures of SES, i.e. education and

income, and across age-categories.

METHODS: Baseline measurements from individuals aged 25–93

years (n¼89964) from LifeLines, an observational follow-up study

in the Netherlands, were used. Education (8 categories) ranged from

no education to academic higher education. Household income (6

categories), standardized for the number of people living in the

household, ranged from <€1000 to �€2000. Both socioeconomic

indicators were also categorized into three categories: low; medium;

and high. The highest level of education/income served as reference

group. SRH was categorized into poor and good. Age was catego-

rized into six groups. Age-stratified logistic regression models

adjusted for age and gender were used to examine the association

between education/income and SRH using both categorizations.

RESULTS: Using three categories, Odds ratios (ORs) for poor SRH

were 2.44 ((95% CI) 2.29;2.60) and 2.05 (1.93;2.18) for low educa-

tion and low income in the overall population. Using eight and six

categories, ORs were 4.97 (4.18;5.91) and 2.98 (2.73;3.25) for pri-

mary education and an income <€1000. In age-group specific analy-

ses using eight and six categories, ORs were 10.91 (7.07;16.84) and

4.38 (3.52;5.45) for primary education and an income <€1000 in

�25–�34 year olds. While ORs for educational level decreased with

age to 3.30 (1.39;7.87) in �65–�74 year olds, the ORs for income

fluctuated between age groups and was 1.72 (1.22;2.44) in

�65–�74 year olds.

CONCLUSIONS: Combining the SES measures education and

income obscures variation in the magnitude of socioeconomic gra-

dients in SRH. The magnitude of the socioeconomic gradient in

SRH declines with age for educational level and fluctuates for

income. A similar obscuring effect holds for combining age-

categories.

Poster Number: M39 Abstract #: 2757Impact of Parental Multiple Sclerosis and theAssociated Mental Comorbidity on EarlyChildhood Development in Manitoba, Canada.

N. Razaz, MPH

University of British Columbia, Vancouver, BC, Canada

INTRODUCTION: Exposure to early-life stressors, are believed to

tax children’s bodies and mind in ways that has the potential for

altering gene expression leading to harmful changes in their social,

emotional or behavioural functioning. We aimed to examine the

impact of parental multiple sclerosis (MS) and the associated mental

comorbidity on child developmental outcomes.

METHODS: Retrospective matched cohort study in Manitoba,

Canada, using linked population-based administrative databases. Of

49,328 children who were part of the Early Development

Instrument data (EDI) collection, and born between 1999 and 2006,

those with an MS parent were compared to children matched from

the general population. MS and mental comorbidity were identified

through validated algorithms using health administrative data.

Developmental outcomes included the five EDI domains: physical

health, social competence, emotional maturity, language and cogni-

tive, and communication skills. Findings are expressed as adjusted

odds ratios (aOR) from multivariable conditional logistic regression

models adjusting for confounders.

RESULTS: Overall, 153 children had an MS parent and 888 formed

the matched cohort. Children with an MS parent were similar to the

matched population on all EDI domains, except vulnerability in

social competence (aOR 0.50;95% CI 0.25–0.97). However, mental

comorbidity affected more MS parents compared to the general pop-

ulation (77/153 [50.3%] vs 313/888 [35.3%], P<0.001).

Compared to unaffected MS parents, those with mental comorbidity

were more likely to have a child who was vulnerable on the social

competence (aOR 5.33; 95% CI 1.12–25.44) or emotional maturity

(aOR 3.11;95% CI 1.10–8.77) domains.

CONCLUSIONS: The presence of parental MS was not independ-

ently associated with adverse developmental outcomes in children.

However, mental comorbidity was more common in MS parents

and had a detrimental impact on development. Health professionals

need to be aware of the impact of mental health in MS on childhood

development and help to improve outcomes for this potentially ‘at

risk’ children.

Poster Number: M73 Abstract #: 2504Impact of the 2011 Great East Japan Earthquakeand Tsunami on Functional Disability amongOlder People: A Longitudinal Comparison ofDisability Prevalence among JapaneseMunicipalities.

Y. Tomata, PhD1, Y. Suzuki, PhD2, M. Kakizaki, PhD1, M.

Kawado, PhD3, S. Hashimoto, PhD3 and I. Tsuji, PhD1

1Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan,2Sendai Shirayuri Women’s College, Sendai, Miyagi, Japan, 3Fujita health

University School of Medicine, Toyoake, Aichi, Japan

INTRODUCTION: Natural disasters are known to have a chronic

effect on the functioning of older persons. However, no study has

yet clarified the impact that natural disaster had on a long-term

increase of the disabled elderly. The aim of the present study was to

examine the hypothesis that the disability prevalence would have

increased in the areas severely affected by the Great East Japan

Earthquake and tsunami on 11 March 2011, relative to other areas

of Japan.

METHODS: Longitudinal analysis using public statistics data from

the Ministry of Health, Labour and Welfare in Japan. The analysis


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included 1,549 municipalities covered by the Long-term Care

Insurance (LTCI) system. ‘Disaster areas’ were defined as three pre-

fectures (Iwate, Miyagi, Fukushima). The outcome measure was the

number of aged people (�65 years) with LTCI disability certifica-

tion. Rates of change in disability prevalence from February 2011 to

February 2012 were used as the primary outcome variable, and

were compared by analysis of covariance between ‘Coastal disaster

areas’, ‘Inland disaster areas’ and ‘Non-disaster areas’.

RESULTS: Regarding disability prevalence at all levels, the mean

value of the increase rate in Coastal disaster areas (7.1%) was higher

than in Inland disaster areas (3.7%) and Non-disaster areas (2.8%)

(P<0.001). When stratified by the increase in the level of disability,

the increase in mild disability in Coastal disaster areas (12.6%) was

higher than in Inland disaster areas (4.8%) and Non-disaster areas

(3.3%) (P<0.001). For the increase in moderate to severe disability,

although that in Coastal disaster areas was higher than Non-disaster

areas and the Inland disaster areas, the difference was not significant

(P¼0.190).

CONCLUSIONS: The areas that were severely affected by the

earthquake and tsunami had a significantly higher increase in dis-

ability prevalence during the one year after the earthquake disaster

than other areas.

Poster Number: M75 Abstract #: 2545Sources for Obtaining Drugs for Treating HighBlood Pressure and Diabetes in Brazil.

K. S. Costa, PhD1,2, P. Francisco, PhD1, D. C. Malta, PhD2,3 andM. Barros, PhD1

1State University of Campinas—UNICAMP, Campinas, Brazil, 2Ministry of

Health, Brasılia, Brazil, 3Federal University of Minas Gerais, Belo

Horizonte, Brazil

INTRODUCTION: Guaranteed access to drugs represents one of

the State’s main responsibilities and is increasingly incorporated into

public health policies throughout various countries and interna-

tional organizations.

METHODS: Socio-demographic and regional differences were ana-

lyzed regarding the use of high blood pressure and diabetic drugs,

according to drug obtainment sources: Health Units in the public

health system (HU), drug stores and/or pharmacies (D&P) accred-

ited by the Brazilian Popular Pharmacy Program (BPPP) and D&P

not accredited by the BPPP, through a population-based cross sec-

tional study in individuals in Brazilian capitals, 20 years of age or

older and interviewed through a VIGITEL telephone survey in 2011.

RESULTS: 71.8% of the 15,027 hypertensive patients and 78.2% of

the 4,083 diabetics were undergoing treatment with drugs; 45.8% of

hypertensive individuals obtained the drug at HU; 15.9% through the

BPPP and 38.3% at D&P. Among diabetics, these percentages were

54.4%; 16.2% and 29.4%, respectively. The percentages for obtain-

ing drugs from HU were higher for individuals who had a lower level

of education, who reported their skin color as black or mulatto, and

who had no private health insurance. On the other hand, the residents

of less economically developed regions of the country had to assume

the costs of drugs much more than those residents in more developed

regions of the country. An inverse profile was observed in patients

who acquired drugs at D&P and at BPPP.

CONCLUSIONS: Having access to different sources of diabetic and

high blood pressure drugs was not homogenous among all Brazilian

regions and capitals or among the population’s social segments.

Monitoring of tendencies may favor a redirection of this public pol-

icy, with the goal of promoting more equitable actions throughout

the county.

Poster Number: M140 Abstract #: 2800Association between Maternal Obesity andNeonatal Mortality: A Brazilian PopulationBased Study.

M. S. Felisbino-Mendes, PhD, A. D. Moreira, MS and G.Velasquez-Melendez, PhD

Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte,MG, Brazil

INTRODUCTION: Obesity is a condition related to the occurrence

of reproductive outcomes, including mortality. We aimed to esti-

mate the association between maternal obesity and neonatal mortal-

ity in the Brazilian population using secondary data from the last

Demographic Health Survey (DHS), conducted in 2006.

METHODS: This is a cross-sectional study using secondary data of

a representative sample of the Brazilian women of reproductive age

(15–45 years old) from the National Demographic and Health

Survey in 2006. Maternal anthropometric indexes used were mater-

nal body mass index (BMI) and waist circumference (WC). Logistic

regression modeling of the survey data was used to evaluate the rela-

tionship between obesity and the offspring neonatal mortality. Data

analysis considered the complex sample design: strata, cluster and

weights in order to produce population estimates.

RESULTS: Neonatal mortality was more frequent among women

with obesity. Children whose mothers were abdominally obese had

higher chance of death in the neonatal period (OR¼3.19; 95% CI

1.25–8.12). Mothers with overweight and obesity (BMI �25 kg/m2)

also presented higher chance of neonatal death (OR¼2.45; 95% CI

1.16–5.18). These associations remained statistically significant

after adjusting for sociodemographic characteristics and smoking

status.

CONCLUSIONS: These findings suggest that obesity is a potential

determinant of neonatal death and women would benefit from

weight control counseling prior to pregnancy.

Poster Number: M125 Abstract #: 2684Improving Vaccine Safety Monitoring Systemsusing Mobile Health Solutions.

A. Leeb, MD1, A. K. Regan, MPH2, I. Peters3, L. Tracey, MPH4

and P. V. Effler, MD4

1Illawarra Medical Centre, Ballajura, Australia, 2University of WesternAustralia, Perth, Australia, 3Datavation, Perth, Australia, 4WesternAustralia Department of Health, Perth, Australia

INTRODUCTION: Recent advances in mobile technology and the

growing coverage of mobile phones across the globe present new

opportunities for public health surveillance. One such example is

the integration of mobile phone use into post-vaccination safety

monitoring programs. In 2011, an Australian general practice

piloted an active adverse event following immunisation (AEFI) mon-

itoring system which used short message service (SMS) texts to fol-

low-up patients who received a vaccination at that practice.

METHODS: Between November 2011 and March 2013, all paedi-

atric and adult patients who had received a vaccination at the


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practice (n¼3,291) and provided a mobile phone number

(n¼3,226; 98.0%) were sent a SMS which asked whether or not

they had experienced an AEFI. Patients who replied ‘yes’ as well as

those who did not reply to SMS were interviewed by telephone by

practice staff.

RESULTS: Over the two year study period, 72.6% (95% CI

70.0–75.1%) of vaccinated patients responded by SMS, of which

264 (11.3% [95% CI 9.9–12.7%]) reported a possible AEFI. The

proportion of patients reporting an AEFI by SMS (11.3% [95% CI

9.9–12.7%]) was statistically similar to the proportion reporting by

telephone (11.8% [95% CI 9.2–14.4%]; P=.99). The rate of AEFI

reported decreased as time between vaccination and follow-up

increased, although the response rate did not (P=.10). The majority

(80.0%) of SMS replies were received within two hours of transmis-

sion of the query SMS. SMS response rates were high for both paedi-

atric and adult patients (86.3% and 80.7%, respectively). Response

rate remained>70% regardless of the time of day the query SMS

was sent.

CONCLUSIONS: Results from this pilot system indicate SMS is a

useful method of data capture for monitoring AEFI and could

improve existing AEFI surveillance. Active AEFI surveillance using

SMS can be used to complement existing passive reporting systems,

enabling more rapid identification of emerging safety signals.

Poster Number: M65 Abstract #: 2597Association between Self-Esteem, Anxiety andRural Attempted Suicide in Shandong, China.

C. Jia, PhD1, M. Han, MS2 and X. Wang, PhD1

1Shandong University School of Public Health, Jinan, China, 2Qingdao

Municipal Children’s Hospital, Qingdao, China

INTRODUCTION: Suicide is one of important public health prob-

lems in the world. Attempted suicide is important predictor of sui-

cide. Attempted suicide is involved social-demographic, biological,

psychological and mental factors. In China, it’s unclear that whether

there is association relationship between self-esteem, anxiety and

attempted suicide.

METHODS: Paired case-control study method was used. Six coun-

ties, in disease surveillance points of Shandong Province, were

selected, and rural residents aged 15–70 years old who commit

attempted suicide and received treatment in the emergency rooms of

the comprehensive hospitals during the period from 1 October 2009

to 31 March 2011, were consecutively sampled. Meanwhile, the

controls with same gender, age (no more than three years), and

without suicide history, were random sampled in the neighbor vil-

lage of the attempted suicides. The instruments include Suicide

Intent Scale (SIS), Self-Esteem Scale (SES), Trait Anxiety Inventory

(TAI), Interview for Recent Life Events (IRLE), Center for

Epidemiologic Studies Depression Scale (CES-D) and Structured

Clinical Interview for DSM-IV Axis I Disorders (2001, Research

Version). Conditional logistic regression model was used.

RESULTS: Data of 409 paired attempted suicides and controls were

obtained. Multivariate analyses showed that higher self-esteem score

was negatively associated while higher anxiety score was positively

associated with attempted suicide, with their Odds Ratio (OR) and

95% confidence interval (CI) being 0.697 (95% CI 0.418–0.970),

2.454 (95% CI 1.527–3.944).

CONCLUSIONS: Our study supports that self-esteem and anxiety

are independent factors for attempted suicide. Suicide prevention

practice should be paid attention to population with low self-esteem

and higher anxiety scores.

Poster Number: M197 Abstract #: 2807Indigenous One Health in the Arctic, aSystematic Literature Review of CircumpolarZoonoses.

C. M. Nelson, BS1, S. J. Romain, BS2,3 and M. F. Davis, PhD4

1University of Alaska Anchorage, Odense, Denmark, 2University of

Toronto, Toronto, ON, Canada, 3University of Toronto Scarborough,

Toronto, ON, Canada, 4Johns Hopkins University, Baltimore, MD

INTRODUCTION: The PUBMED, EBSCO, and Web of Science

databases were utilized to perform a systematic review of research

on zoonotic exposure of indigenous populations in the Arctic region,

with no publication date limitation.

METHODS: Study selection: We included original research studies

that evaluated either or both exposures and disease outcomes related

to zoonotic pathogens in indigenous communities, focusing in par-

ticular on circumpolar communities. Search: We performed litera-

ture searches in PUBMED using the following search strategy and

MeSH keywords: ‘zoonoses’ and ‘indigenous population’ or ‘arctic.’

We searched PUBMED, EBSCO, and Web of Science using the fol-

lowing search strategy: (‘indigenous’ or <other indigenous commun-

ity keywords>) and (‘one health’ or ‘zoono*’) with or without

(<circumpolar key words>). All searches were conducted without

date restriction. We considered articles in English or Spanish or

French.

RESULTS: The initial searches resulted in 755 articles. Exclusions

were used: research articles only, geographic region only, indigenous

only. The resulting 44 articles were identified and reviewed for rele-

vance. After sorting the articles and removing those that were out of

the defined circumpolar geographic area, reviews, and/or were inac-

cessible, the remaining 33 articles that were pertinent to indigenous

One Health in the Circumpolar region were reviewed. A critical

examination of the aggregated research presented three article

themes: specific animal exposure studies, new zoonotic risks due to

global climate change, and epidemiological disease tracking.

CONCLUSIONS: The close proximity of indigenous residents of

the Arctic to animals both as companions and as food stocks has

brought about higher incidence of zoonotic pathogen exposure. As

global warming changes the climate, new species of animals and

new infectious agents are both moving into closer proximity to the

residents. Subsistence hunting, fishing, and herding, especially with

canine assistance, are a source of much of the infections. New stud-

ies tracking exposures and infections are clearly indicated.

Poster Number: M161 Abstract #: 2185Interaction between Interleukin1-b GenePolymorphism and Cigarette Smoking on HbA1cin a Japanese General Population.

Y. Nishida, PhD1, M. Hara, PhD1, H. Nanri, PhD2, K. Nakamura,PhD3, T. Imaizumi, PhD1, T. Sakamoto, PhD4, Y. Higaki, PhD5,N. Taguchi, PhD1, M. Horita, BS1, K. Shinchi, PhD1 and K.Tanaka, PhD1

1Saga University, Saga, Japan, 2Showa University, Tokyo, Japan,3St. Mary’s College, Fukuoka, Japan, 4Fukuoka Institute of Health and


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Environmental Sciences, Fukuoka, Japan, 5Fukuoka University, Fukuoka,Japan

INTRODUCTION: Both inflammation and cigarette smoking are

known as major risk factors for type 2 diabetes. We, therefore,

investigated possible gene-environmental interactions between sev-

eral inflammation-related gene polymorphisms and cigarette smok-

ing on the level of HbA1c in a Japanese general population.

METHODS: We performed cross-sectional analysis using data col-

lected from 2638 individuals (1281 men and 1357 women) aged

35–69 years who participated in the baseline survey of the Japan

Multi-Institutional Collaborative Cohort Study (J-MICC study).

Nine polymorphisms in eight inflammatory genes (IL-1b, IL-2, IL-4,

IL-6, IL-8, IL-10, IL-13, and TNF-a) were examined. Associations

between the inflammatory polymorphisms, smoking, and HbA1c

were assessed by multiple regression analysis and analysis of cova-

riance, with adjustment for potential confounders.

RESULTS: A significant interaction was detected between IL-1bgene polymorphism and smoking status (P¼0.0005), with greater

multiple regression coefficient in TT, compared to the CC and TC.

In individuals with TT, the level of HbA1c was significantly higher

in smokers than that in non-smokers (P¼0.0125), while HbA1c lev-

els were similar in the subjects who have C allele.

CONCLUSIONS: The current results suggest that individuals with

TT genotype of IL-1b gene polymorphism may have greater deleteri-

ous influence of cigarette smoking on HbA1c in middle-aged

Japanese people.

This study was conducted for The J-MICC Study Group.

Poster Number: M139 Abstract #: 2380Association of Maternal Working Status withEarly Childhood Overweight in Brazil.

M. S. Felisbino-Mendes, PhD, T. Gea-Horta, MS, F. P.Matozinhos, MS and G. Velasquez-Melendez, PhD

Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte,MG, Brazil

INTRODUCTION: The number of working mothers is increasing

and recent research has shown an association between maternal

work and children’s body mass index (BMI) in high income nations.

We examined the relationship between maternal working status and

child overweight in an emerging economy nation using a representa-

tive sample of the Brazilian population.

METHODS: 4.148 mothers and their singleton children under 5,

from the last Brazilian DHS from 2006. Maternal work was defined

when the woman declared to work apart from the domestic chores.

Overweight (including obesity) was defined by the International

Obesity Task Force cut-offs using body mass index-for age (BAZ) z-

scores. We estimated OR and 95% CI using logistic regression

models.

RESULTS: Maternal and children’s mean age was 27 and two years,

respectively. Children’s mean BAZ was 0.50. Prevalence of working

mothers was 40.6% and children’s overweight/obesity 7.3%.

Women working apart from domestic chores were associated with

children’s increased BAZ (>þ2SD). Thus, the offspring from work-

ing mothers had 64% more chance of being overweight/obese when

compared to non-working mothers (OR¼1.64; 95% CI

1.12–2.40). This result remained significant after adjusting for

household income, maternal BMI, maternal education, maternal

age, and children’s age (OR¼1.58; 95% CI 1.04–2.49).

CONCLUSIONS: Like in the high income nations, the working sta-

tus of Brazilian women also showed an important impact on child-

ren’s nutrition health, contributing somehow with childhood

obesity.

Poster Number: M231 Abstract #: 2817Streptococcus Agalactiae Colonization inPregnant Women Living in the Brazilian FederalDistrict Area.

F. Siqueira, MS, D. M. Magalhaes, MS, I. M. Calderon, PhD andA. Dias, DrPH

Botucatu Medical School, Botucatu, Brazil

INTRODUCTION: Streptococcus agalactiae (GBS) can cause

severe pneumonia, sepsis and meningitis in neonates up to one week

of age. Neonatal GBS colonization incidence is related to maternal

GBS colonization prevalence and prophylaxis. However, GBS colo-

nization screening is not currently practiced in the public healthcare

services of the Brazilian Federal District.

OBJECTIVE: To estimate the occurrence of GBS colonization dur-

ing pregnancy in a healthcare district located in the Brazilian

Federal District.

METHOD: This cross-sectional study included women at 32–37

weeks of pregnancy, who attended the Regional Hospital of

Tabatinga and its affiliated basic healthcare units. Vaginal and rectal

swabs were collected and processed for the identification of micro-

organisms and antimicrobial susceptibility testing (AST), according

to the recommendations of CDC (2010).

RESULTS: Samples from 263 women were investigated. Mean ges-

tational age at the time of collection was 35 weeks, while mean

patient age was 28.7 years and BMI was 30.5kg/m2. During preg-

nancy, 35.7% of the subjects showed some kind of infection, with

infection of the urinary tract accounting for 80% of the cases. The

prevalence of GBS colonization was 13.8%. AST revealed clindamy-

cin-resistance and erythromycin-resistance in 6.1% and 30.3% of

the cases, respectively. No beta lactam- or vancomycin-resistant

GBS was found.

CONCLUSION: GBS prevalence in the study area is similar to that

found in other regions previously investigated. This finding under-

scores the need for screening all pregnant women in order to prevent

neonatal infection.

Poster Number: M84 Abstract #: 2462Structure Profile of Telemedicine in CommunitiesIsolated by Exclusion in Health in Rural area,Paraguay. A Case Study.

M. B. Cabral1, V. Cane1, X. Basogain2, A. Cabello, MD3, R.Galeano3, M. Paez, MD3, M. Samudio, PhD1, M. Ascurra1, P.Galvan1 and Y. Pereira3

1Instituto de Investigaciones en Ciencias de la Salud IICS/UNA,Asuncion, Paraguay, 2Universidad del Pais Vasco UPV-EHU, Bilbao,Spain, 3Direccion General de Vigilancia de la Salud DGVS/MSPBS,Asuncion, Paraguay

INTRODUCTION: Paraguay addresses the epidemiological surveil-

lance with information and communication technologies (ICT).

Information support is useful for improving health outcomes related

to the disease. The ICT can help in providing such assistance and


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support. The objectives were to develop a system of community and

ICT-based surveillance in rural isolated populations with access

problems.

METHODS: Location: Tte. Irala F. in the Paraguayan Chaco (400

km from the capital city). Baseline surveys on analysis of health sta-

tus and use of ICTs, where villagers voluntarily participated, were

performed. The BONIS telemedicine system with cell phone calls

according to syndrome was used. The system can record, classify

and prioritize automatically through an IVR (Interactive Voice

Response) febrile cases to provide community notification. A public

access portal (web.www.vigisalud.gov.py) with general information

was incorporated as well as a notification service that identified the

areas of diarrheal, acute and chronic respiratory, acute febrile and

eruptive syndromes.

RESULTS: 400 surveys identified health problems such as tubercu-

losis, malnutrition, gastrointestinal diseases, hypertension, inad-

equate medical care, teenage pregnancy and alcoholism. The use of

ICT in the community: 40.2% have access to electricity, 88.6%

have a radio, 73.2% have a cell phone, availability of TV only 23%,

2% own a computer, 0.9% internet service at home and 3% at

work. Weekly calls to the Bonis system were made by community

workers in a pilot study where according to epidemiological week

these cases were reported: diarrhea (174), influenza (713) and respi-

ratory symptoms (266). On warning, the notified numbers were:

diarrhea (100), influenza (48), acute febrile (41) and exanthematic

febrile (45).

CONCLUSIONS: The operation of the BONIS system has been

adapted to promoters and community workers who are the com-

munity leaders. The collected information shows the coexistence of

transmissible and non-transmissible diseases and the functionality of

the Bonis system and cell phone calls, the compliance of days and

the syndromes identification is highlighted. The notification system

is intended for local doctors, the Direction of Surveillance of the

Ministry (MSPBS in Spanish) and the referral hospitals. To support

surveillance, the use of ICT of the inhabitants has been investigated

in a rural village in the Paraguayan Chaco, where there is high exclu-

sion in health and a vulnerable population with a high proportion of

aboriginal people with low education levels and high poverty.

Furthermore, it is important to present the lessons learned from the

evaluation of a complete telehealth project about the success factors

and evaluation methodology for this type of projects

Poster Number: M29 Abstract #: 2632Invasive Disease Caused by HaemophilusInfluenzae Serotype a, an Emerging Pathogenin Alaska.

M. G. Bruce, MD1, T. Zulz, MPH2, C. Debyle, BS2, R. Singleton,MD3, D. Hurlburt, BS1, D. Bruden, MS1, K. Rudolph, PhD2, T.Hennessy, MD1, J. Klejka, MD4 and J. Wenger, MD5

1CDC Arctic Investigations Program, Anchorage, AK, 2CDC, Anchorage,AK, 3Alaska Native Medical Center, Anchorage, AK, 4YKHC Hospital,Bethel, AK, 5Bill and Melinda Gates Foundation, Seattle, WA

INTRODUCTION: Prior to introduction of the Haemophilus influ-

enzae type b (Hib) conjugate vaccines, rates of Hib disease among

indigenous people living in Alaska (AK), especially western AK, were

among the highest in the world. Routine Hib vaccination reduced

these rates dramatically; however, invasive Haemophilus influenza

type a (Hia) disease is increasingly being recognized in Alaska.

METHODS: We identified all cases of invasive Haemophilus influ-

enza disease in AK from 1983 to 2012 through Alaska state-wide

laboratory-based surveillance. Serotyping was performed by slide

agglutination and polymerase chain reaction. Multi-locus sequence

typing was performed. Medical charts were reviewed using standar-

dized forms to characterize clinical presentation.

RESULTS: During the study period, isolates from 912 cases of inva-

sive Hi disease were serotyped, 35 (3.8%) of these were Hia. The

first identified Hia case occurred in 2002. From 1983 to 2001, none

of the 30 encapsulated non-type b Hi strains were Hia, compared to

35 of 73 (48%) isolated from 2002 to 2012 (P<0.001). Median age

of Hia cases was 0.7 year (range 0.3–48 years); 91% of cases

occurred in children <5 years; 3 Hia cases, all among infants, were

fatal. The most common clinical presentations included: meningitis

(40%), pneumonia with bacteremia (26%), and septic arthritis

(17%). Overall annual incidence of Hia disease (2002–12) among

children <5 years of age was 5.4 per 100,000; 30 cases occurred in

Alaska Native (AN) children (18 per 100,000) vs two cases in non-

AN children (0.5 per 100,000) (Risk Ratio¼36, P<0.001).

Eighteen cases occurred in southwestern Alaska from December

2009 through December 2012 (in children <5 years of age, a rate of

141 cases per 100,000 population).

CONCLUSIONS: More than 10 years after introduction of Hib

conjugate vaccine, Hia has emerged as a significant invasive bacte-

rial disease in Alaska, with the highest rates among AN children.

Further research is needed to investigate severity of illness and long

term sequelae, risk factors, and regional differences in rates to

inform development of prevention strategies. An evaluation of oro-

pharyngeal carriage, transmission patterns and the potential role for

chemoprophylaxis is underway.

Poster Number: M167 Abstract #: 2821Association of Serum Level of microRNAs(miR-27a, miR-122, and miR-320) with ObesityIndex among Japanese Subjects.

H. Yamada, PhD1, K. Suzuki, PhD2, N. Ichino, PhD3, K. Ohashi,PhD4, K. Osakabe, PhD3, K. Sugimoto, PhD3, Y. Ando, PhD4, H.Ishikawa, PhD4, R. Teradaira, PhD4, T. Inoue, PhD3, N.Hamajima, PhD5 and S. Hashimoto, PhD6

1Fujita health University School of Medicine, Toyoake, Japan, 2Fujitahealth University School of health sciences, Toyoke, Japan, 3Fujita health

University School of health sciences, Toyoake, Japan, 4Fujita healthUniversity School of health sciences, Toyoake, Japan, 5Nagoya

University Graduate School of Medicine, Nagoya, Japan, 6Fujita healthUniversity School of Medicine, Toyoake, Aichi, Japan

INTRODUCTION: Recent studies have demonstrated that

miRNAs are stably detectable in serum and can serve as diagnostic

and prognostic biomarkers for various diseases. It has been reported

that some miRNAs, such as miR-27a, miR-122, and miR-320, can

help regulation of cholesterol and fatty acid homeostasis. In this

study, we investigated the association of these serum miRNAs with

obesity index, such as BMI, visceral and subcutaneous fat.

METHODS: This cross-sectional study was conducted among 527

Japanese (219 men and 308 women) who attended a health exami-

nation in 2012. Visceral and subcutaneous fat were measured by

ultrasound scan, and serum miRNAs (miR-27a, miR-122, and miR-

320) were quantitatively analyzed by real time PCR. Relationships

between serum microRNA and obesity index are given by Pearson’s

correlation coefficient and multiple linear regression analysis


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adjusted for sex, age, smoking habit, serum total cholesterol, serum

triglyceride, HbA1c, and systolic blood pressure.

RESULTS: Multiple regression analysis adjusted for possible con-

founders revealed serum miR-27a was correlated with BMI (stand-

ardized b coefficient¼�0.12, P¼0.004) and subcutaneous fat

(standardized b coefficient¼�0.13, P¼0.004). Serum miR-122

was independently correlated with visceral fat (standardized bcoefficient¼0.09, P¼0.02), but not with BMI and subcutaneous

fat. On the other hand, there are not significant associations

between serum miR-320 and obesity index.

CONCLUSIONS: Serum miR-27a and miR-122 levels are associ-

ated with obesity index.


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