Yulia Sofiatin

Intellectual and physical activities, but not social activities, are associated with better global cognition: a multi-site evaluation of the cognition and lifestyle activity study for seniors in Asia (CLASSA)

BACKGROUND population ageing will lead to a leap in the dementia population in Asia. However, information about potentials for low-cost and low-risk interventions is limited. OBJECTIVES to study the associations between lifestyle activities and global cognition from the Cognitive and Lifestyle Activity Study for Seniors in Asia (CLASSA). DESIGN a cross-sectional study. METHODOLOGY we studied the association between global cognition and lifestyle activity participation in community living older adults (60 years or over) across nine sites in East Asia. A standardised lifestyle activity questionnaire exploring activities from four categories (intellectual, physical, social and recreational) was used to measure the pattern. Global cognition was categorised by locally validated versions of Mini-mental state examination (MMSE) or Montreal Cognitive Assessment (MoCA) (good cognition, GC-scored at the top 25% among participants with no significant cognitive deficit (SCD); normal cognition, NC-middle 50% among participants with no SCD; mild cognitive deficit, MCD-lowest 25% among participants with no SCD; SCD-below local cut-offs for dementia). RESULTS two thousand four hundred and four (1,009 men; 1,395 women) participants were recruited. The mean age was 71.0 (7.2) years. A higher variety of intellectual and physical activities were associated with GC; more social activities were associated with higher risks of having impaired cognition (multinomial logistic regression). The same association was found in participants with no SCD and had regular activities for over 10 years (n = 574). CONCLUSION intellectual activity and physical exercise were associated with better cognitive states in Asian older adults. Community-based intervention may take considerations into specific types of activities to optimise cognition.

Moderate Correlation Between High Salt Taste Preference and High Sodium Intake

Background: High sodium intake daily can change human salt taste preference. High salt taste preferences will makes a person consumes excessive salt that contain sodium. Sodium will be removed from the human body through urine. Thus, the sodium intake can be calculated from urinary sodium level. The objectives of this study is to identify the correlation between salt taste threshold and urinary sodium level using predicted 24 hour urinary sodium level. Methods: The research design was analytical study and the research methods was correlation study. Samples for this study were obtained from epidemiology of hypertension and albuminuria in jatinangor community research with randomized sampling technique. Among 294 subjects, 111 were included and 183 were excluded. This study was conducted in Cipacing village, Jatinangor subdistrict during September-November 2014. Data were analyzed with Spearman Correlation statistical analysis with p value < 0,01. Result: Among 111 samples, most of them had high urinary sodium excretion. Spearman correlation test showed that correlation between salt taste threshold and predicted 24HUNa are statistically significant r = 0,597 (p < 0,01) for recognition threshold dan r = 0,407 (p < 0,01) for absolute threshold. Conclusion: There is moderate correlation of salt taste threshold and urinary sodium excretion.

31 OBSTACLES IN REDUCING SALT INTAKE ON HYPERTENSIVE PATIENTS IN JATINANGOR

Introduction: Reducing salt intake has a significant correlation to the decreased of blood pressure. Based on previous study, hypertensive patients in Jatinangor have a good knowledge about the correlation between salt intake and hypertension. However, the actual salt intake rate in Jatinangor is still high. It suggests the discrepancy between knowledge and salt intake reduction behavior in patients. Based on that phenomenon, this study was conducted to found out the obstacles that are faced by hypertensive patients in Jatinangor in practicing salt intake reduction. Method: Qualitative descriptive study with phenomenology approach through focus group discussion (FGD) method was conducted. Thirteen hypertensive patients selected by purposive sampling in accordance to research objective. The research was conducted in two villages in Jatinangor which is Cipacing and Cilayung Village during February-May 2017. Result: All the informants have tried to reduce salt intake and most of them know the correlation between salt consumption and hypertension. However, informants’ knowledge to salt intake recommendations is still low. Furthermore, informants do not really feel the direct benefit from salt intake reduction towards their body; lack of self-motivation and high salt taste threshold are hampering their intention to reduce salt intake. Informants also expressed the lack of support either from family, social environment and health care personnel. Conclusion: Hypertensive patients in Jatinangor have obstacles in reducing salt intake. These obstacles are caused by internal factors such as knowledge and self-perception of hypertension as well as salt intake reduction; and external factors such as family, social and health care personnel.

Detection of Urinary Epithelial Sodium Channel (ENaC) Protein

Epithelial sodium Channel (ENaC) protein is an important substance in maintaining plasma sodium level. Its DNA sequences are similar in rat model with and without salt sensitivity, but the mRNA number increase in salt sensitive rat model with high salt diet. This condition is assumed to be similar in human. ENaC protein is abundant in lung, gut and kidney, and plays a similar physiological process but different diseases. ENaC protein levels have to be measured from specific locations; kidney will be the good source for hypertension related sodium excretion. The possibility of ENaC protein as a marker to screen salt-sensitivity is needed to be explored. The aim of this research is to explore the possibility of ENaC protein detection in urine. This is an observational descriptive study. Enzyme-linked immunosorbent assay (ELISA), using Cloud-Clone reagent catalog number SED337Hu, was used to detect and measure urinary and plasma ENaC protein level. For the first step of study, ELISA was conducted toward various dilution of healthy individual spot urine; in the 2nd step, several locations of repeated centrifuged spot urine and 24 hour collected urine were explored for the presence of ENaC protein; on the next step, 3 subjects, non-hypertensive, and hypertensive with and without family history of hypertension were recruited; for the fourth step, 13 (6 male and 7 female) non-hypertensive subjects were recruited; all steps are aimed to explore the detection of urinary EnaC protein level. ENaC proteins can be detected in both supernatant and sediment of centrifuged urine. In plasma of non-hypertensive, hypertensive with, and without family history of hypertension are 1.12 ng/ml, 2.7 ng/ml and 4.0 ng/mL respectively. ENaC protein levels from centrifuged urine at lower part of supernatant are lower but consistent with serum level. Mean ENaC protein level in non-hypertensive men are lower than women. Mean ENaC protein level in those with family history of hypertension are lower both in men and women. ENaC protein is detectable in spot urine; the levels differ by hypertension status, family history of hypertension and also by gender.

75 Quality of Service for Patient with Hypertension at Jatinangor Public Health Center

Background: The quality of service at the Primary Health Care facility plays an important role in blood pressure control. The aim of this research is to assess the quality of service for patients with hypertension at Jatinangor Public Health Center. Method: This is a quantitive cross-sectionalstudy. A secondary data from the Centre of Community Health and Wellness Study group was used. The data was gained through an observation towards services process for patients with hypertension in the consultation room. The minimal sample size was 97 people. Results: The health service towards 100 patients was observed. The majority of the patients are on the age group of 46–55, and woman, 29% and 32% respectively. Themodes of service duration are generally for 3 minutes. The proper diagnostic process and education on life style modification are only given to a small portion of the patients. Education on pharmacological treatment is not given at all. Service for the first visit is not different from the next visit, and is not different whether it is provided by doctor or nurse. Conclusion: The services for hypertension patients in Jatinangor Public Health Centre do not properly follow the protocol.

15 Patientʼs Reception on Hypertension Management Education in Puskesmas Jatinangor

Background: Patient education is essential for controlling blood pressure and improving compliance. Patient has to be aware that they received the information. A priorqualitative study towards hypertensive patients at Jatinangor showed that patients do not aware of receiving a hypertension management education from their health providers. This study is conducted to explore the extent of awareness on hypertension education given to the patient at the consultation room of Public Health Center (PusatKesehatanMasyarakat, Puskesmas) in Jatinangor. Methods: This is cross-sectional descriptive study which was conducted on December 2015 – July 2016 in Puskesmas Jatinangor. A minimum sample size of 97 patients was needed. Patients were taken consecutively during their visit the clinic of Puskesmas Jatinangor and diagnosed with hypertension. Data regarding the conformity of delivery and acceptance of education about diagnosis, lifestyle modification, and pharmacology was collected through a checklist. The checklist was developed following the diagnosis and management protocol for hypertension. Result: A hundred patients were observed. In diagnosis process, 84% of patients aware of the blood pressure confirmation. More than 90% of the patients received none about lifestyle modification, if it is delivered, less than a half of patient aware of receiving it. The exception is salt intake reduction which is delivered to 44 respondents and accepted by 77% of them. Education about medication is delivered to a very small portion of the patients, but when it was delivered, it was accepted by less than half of them. Conclusion: Most of the patients are not aware of education of hypertension management delivered by health professionals, except for blood pressure confirmation and salt intake reduction.

64 Body Mass Index correlates with Lipid Profile in Jatinangor Population

Background: Obesity is an emerging epidemical issue. The percentage of individuals with high BMI consistently escalates in every year. Non-communicable disease such as hypertension, coronary heart disease (CHD) and stroke, are influenced by risk factors. One of the important risk factors is the increasing BMI and high concentration of lipid profile. The aim of this study is to discover the causal inference between BMI and concentration of lipid profile. Method: Cross-sectional design was conducted in this study. Secondary data was collected from previous study entitled “Primary and Secondary Prevention in Jatinangor society”. Sample subjects consisted of 99 individuals. Obtained data was analyzed using Spearmans Rank correlation test. Result: Characteristic of subjects from the obtained data showed that as much of 55% of the subjects were having overly high BMI (overweight and obese). Mean of BMI was 26.44 kg/m2 and lipid profile (Total cholesterol: 194.60 mg/dL; HDL-C: 42.52 mg/dL; LDL-C: 126.61 mg/dL) in female were higher compared to male (Total cholesterol: 188.6 mg/dL; HDL-C: 35.7 mg/dL; LDL-C: 123.4 mg/dL) except for male TG was higher(147 mg/dL) rather than female (132.1 mg/dL). Significant correlation was found between BMI and total cholesterol (rs = 0.244 p = 0.015), BMI and HDL-C (rs = −0.222 p = 0.027), BMI and LDL-C (rs = 0.223 p = 0.026), BMI and TG (rs = 0.242 p = 0.016). Conclusion: There was significant correlation between BMI and lipid profile.

PS 02-51 EPITHELIAL SODIUM CHANNEL PROTEIN IN URINE IS DETECTABLE BY ELISA

Objective: Salt intake reduction is effective in lowering the blood pressure and risk of long-term cardiovascular diseases, but it is also harmful due to sympathetic stimulation and insulin resistant. Compliance toward salt intake reduction is low. It is important to screen who will get more benefit for long term salt reduction diet and educational support. Epithelial sodium Channel (ENaC) protein plays an important role in maintaining plasma sodium level. The aim of this study is exploring the possibility of ENaC as a marker to screen salt-sensitivity. Design and Method: This is an observational descriptive study. ENaC protein was detected by ELISA method using reagent from Cloud-Clone, catalog number SED337Hu. Morning urine were collected and centrifuged. For the first step of study, one male subject for each category, non-hypertensive, hypertensive with and without family history of hypertension, were recruited. For the second study 13 (6 male and 7 female) non-hypertensive subjects were recruited. Results: ENaC proteins from plasma in non-hypertensive, hypertensive with, and without family history of hypertension are 1.12 ng/mL, 2.7 ng/mL and 4.0 ng/mL respectively. ENaC protein from centrifuged urine at upper part and lower part of supernatant are 0.4 ng/mL and 0.3 ng/mL in normal male; 2.8 ng/mL and 2.7 ng/mL; and 2.7 ng/mL and 3.7 ng/mL in hypertensive male with and without family history of hypertension. Mean ENaC protein level in non-hypertensive men and women are 1.4 (0.2-2) ng/mL and 2.1 (1.5-2.7)ng/mL. Mean ENaC protein level in those without and with family history of hypertension are 1.6 ng/mL and 1.1 ng/mL in male, and 2.6 ng/mL and 1.9 ng/mL in female. Conclusions : ENaC protein is detectable in spot urine; the levels differ by hypertension status and also by gender. Further research on its use is needed.

PS 12-12 OFFICE-SETTING EDUCATION IS NOT EFFECTIVE IN MODIFYING LIFE-STYLE OF HYPERTENSIVE PATIENTS IN INDONESIA

Objective: Prevalence of controlled blood pressure is low all over the world. Patient contribution is crucial due to the importance of life-style modification and drug using. Office-setting education is part of blood pressure control and conducted by almost all physicians. This study is exploring the patients’ acceptance toward office-setting education. Design and Method: This is qualitative study. Two focus group discussions were held for patients from different village in Jatinangor, Sumedang, Indonesia. One session of FGD was held for health professional working in the same area. Results: Due to limited number of physician in Indonesia, hypertensive patients in rural area are diagnosed and treated by nurses and midwives, while those in urban area are managed by doctors, in private and public service. To add the complexity of the problem, severe hypertension is suffered more by patients in rural area. Almost all of the patients do not recall the proper education of drug using, neither the detailed life-style modification given by the health provider. Some of them do not even recall any education given. Due to the lack of details, all patients do not practice the proper diet or exercise. Patients in both areas are willing to attend the patient-support meeting to understand more about their disease, but those in urban area need higher level of educator. Health professionals ensure the delivery of office-setting education for every visit, but in public service, where a patient load is always high, they admitted that time was limited. Conclusions: Office-setting education is not effective, limited time and lack of details confounded the patients to follow the instructions. Patient-support group education is preferred.

Comparison of Mercury, Aneroid and Digital Sphygmomanometer in Community Setting

Introduction: The mercury sphygmomanometer has been the gold standard for blood pressure measurement, but it is not practical to be used in community setting. Aneroid and digital sphygmomanometers portability are higher compared to mercury device, but the reliability are still in doubt. The purpose of this study is to compare blood pressure measurment by mercury, aneroid and digital sphygmomanometer. Methods: The study was a cross sectional study conducted in April – October 2014 in Bandung. A total subject of 108 people from minimal sample size of 66 is obtained through non probability sampling technique. Blood pressure was measured on dominant arm at seated position, the measurement was conducted by using mercury, aneroid and digital sphygmomanometer, twice for each device. Blood pressure measurement was conducted by following protocol from ‘European Society of Hypertension International Protocol revision 2010 for the validation of blood pressure measuring devices in adults’. The data was analyzed by Paired Sample T-Test for comparing blood pressure measured by mercury, aneroid and digital sphygmomanometer with significance p value < 0.05. Results: Among 108 pairs of data, average systolic measurement using digital (124.57 mmHg) and aneroid (124.31) is similar to mercury (125.01), there was no significant difference of average blood pressure measurement between digital and mercury sphygmomanometer (p = 0.71), between digital and aneroid sphygmomanometer (p = 0.46) and between aneroid and mercury sphygmomanometer (p = 0.71) Conclusion: Digital and aneroid sphygmomanometer can be use to replace mercury sphygmomanometer in a community setting.