Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 3rd World Congress on Public Health, Nutrition & Epidemiology Osaka, Japan.

Day 1 :

Keynote Forum

Hiroshi Mizushima

National Institute of Public Health, Japan

Keynote: Standardization of Patient Registry. - Importance of Patient Registry for Evidence based Public Health.

Time : 09:30-10:15

OMICS International Public Health Congress 2017 International Conference Keynote Speaker Hiroshi Mizushima photo
Biography:


Hiroshi Mizushima has his expertise in medical informatics, computer science, public health informatics, molecular biology etc. He has graduated from University of Tokyo, faculty of Pharmaceutical Science in 1983, and got PhD in 1988 at Univ. Tokyo. He established Cancer information service and Cancer Information Network at National Cancer Center. He became Professor of Medical Omics Informatics at Tokyo Medical and Dental University in 2009. He moved to National Institute of Public Health (NIPH) in 2011, and became Director of Center for Public Health Informatics at NIPH in 2017.  He is currently president of Japan  IT- healthcare Association and more.

Abstract:

A New legal structure for rare disease (nambyo) has been established in Japan in 2015, after 42 years of measures of nambyo. We have been accumulating registry for nambyo from 2003, however, as it was based on paper registration, quality was not enough. We made a prototype system for online registry used for nambyo reimbursement application. We first categorized all disease, and made standard data sets. Our new registry system will be based under ISO13606 which is a medical international standard. Authorized doctors can put in data on Line by the new system, which has data cleaning filter for accurate data entry. Patients will be supported their medical expense by authorization by this system, so the registry will be efficient.  We also made Offline registry system, in case of lacking online access due to security at hospitals.

As this system for nambyo was also used for pediatric rare disease registry, it was the good example for broad range of diseases.  We were asked to make a guideline for Patient registries as a government funded project in 2016. We compared PARENT which is a European project, and AHRQ which is an American guideline for patient registries. There are currently no international guideline or standard for patient registry, however, to perform patient research or integrate worldwide information, which is important in the field of rare disease. We are also trying to integrate patient reported outcomes data using patient portals.

It is very important to get patient database for “Evidence based public health”, and “precision public heath”. We are trying to integrate these information for this goal. 

OMICS International Public Health Congress 2017 International Conference Keynote Speaker Tomoko Tachibana photo
Biography:

Tomoko Tachibana has her expertise in research and passion in improving the health and wellbeing. Her research on regional models for progressing toward establishment of a “Disability Registry,” using the Clinical Efficacy Database creates new pathways for improving health and welfare policies for PDs. She has been building this model over years of experience in clinical medicine, research, evaluation, teaching and administration in hospitals, public health centers and an education institution. For supporting independent decision-making and activities by PDs, and putting into practice evidence-based health and welfare policies for them, she has been advancing research to promote accumulation and utilization of epidemiological evidence data which are needed for policy evaluation, cooperation between medicine and welfare, etc. The National Institute of Public Health, whose mission is to carry out human resources development and to conduct research in public health, was established in 2002, integrating The  (former) N IPH, etc.

Abstract:

The objective was to identify issues arising in information infrastructure development so that the Japanese public, regardless of the presence or absence of disability, can easily obtain and use information necessary for everyone, in a well-integrated society while mutually respecting personality and individuality, and to generate proposals that work towards improving information accessibility. Evidence-based public health policies were compared between cancer and trauma (injuries, damage, and sequelae). Public health policy for cancer follows the Cancer Control Act. Evidence such as survival rates is useful not only for health care providers and policymakers but also for cancer patients in executing the right to self-determination in promoting health. Meanwhile, evidence about long-term outcomes of trauma in Japan is overwhelmingly lacking, although the incidence of trauma is estimated to be comparable to that of neoplasms in the 2014 national patient survey. In recent years, we have assessed the promotion of the disability health and welfare policy, and engaged in research aimed at a “re-evaluation of disability health and welfare policy from the perspective of trauma prognosis.” To realize this review in the community-based integrated care system, we focus on the database of diagnoses, treatments, treatment effects, etc. of patients visiting medical institutions, and intend to develop a disability registry. Developing this registry utilizing clinical effect information is expected to enhance quality as evidence in health and welfare policies for people with disabilities (=PDs). In care-focused mature societies such as Japan, the following concept needs to be included in the definition of health: Taking into consideration the disease burden, and various other “social, physical and psychological problems,” health pertains to maintaining the patient’s quality of life, enabling his/her control over his/her own life, offering things that he/she can do him/herself, and fostering his/her self-actualization.

  • Epidemiology and Public Health | Modern Public Health Practice | Diet and Nutrition |Globalization and Health | Nutritional Epidemiology | Occupational Safety and Health | Others

Session Introduction

Jerome R D McIntosh

Dr Jerome R D McIntosh, Tameside & Glossop NHS Foundation Trust, United Kingdom.

Title: Do E-Health interventions improve physical activity in young people: A systematic review

Time : 11:20-11:50

Speaker
Biography:

Dr Jerome McIntosh is a newly qualified doctor with a passion for innovation and enterprise in healthcare. His continual conquest for healthcare improvement has driven him to complete a BSc alongside his medical degree in Innovation and Enterprise in Clinical Medicine. He has used his time here to be involved in various healthcare improvement and evaluation projects, with a special interest in sport and its application in healthcare improvement. His commitment has been rewarded early in his professional journey having been awarded Early Career Innovator Prize at the International Festival of Public Health 2016.  Alongside his academic proficiencies he is a national level athlete competing in the 100m and 200m disciplines and has won various honors, the most notable; a Bronze medal at the British Universities and College Sports National Championships and the Gold medal at the North of England Senior Indoor Championships 2016. 

Abstract:

Objectives: This study aims to review current literature to assess the effectiveness of E-Health interventions in increasing physical activity in young people.

Study Design: This study is a systematic review of the literature.

Methods: A search of the literature databases Embase, Medline and the Cochrane Library, using key words ‘Adolescents’; ‘Young people’; ‘Students’; ‘Young Adults’; ‘Teenagers’; ‘E-health’; ‘Internet-based’; ‘Web-based’; ‘Exercise’; ‘Activity’; ‘Sport’; and ‘Intervention’ yielded 10 articles which fit the criteria for inclusion. PRISMA protocol was used and papers were excluded if they were disease focused, not specific to young people (those attending school, college or university), or did not measure physical activity as an outcome.

Results: Eight of the 10 studies had significant increases in physical activity as a result of an E-health intervention. Studies that did not use a theoretical principle to underpin their intervention did not achieve successful results. Interventions based on social cognitive theory were very successful in achieving an increase in physical activity. The theory of planned behaviour had mixed results, with studies having contrasting results. SMART goal principle was not effective in increasing physical activity, but had positive findings in supplementary outcomes such as goal setting.

Conclusions: E-health interventions are a very successful way to increase physical activity. More research is required to look at what theoretical principles are best to underpin interventions, and also to assess the length of intervention required for optimal results post intervention. Ideas surrounding implementation and the mediums used requires more study to evidence base these interventions for schools, colleges and university via intra or extra curriculum. 

Jean-Claude Javet

University Psychiatric Services, Switzerland

Title: Mental health and religious extremism - International Health System perspectives

Time : 11:50-12:20

Speaker
Biography:

Jean-Claude Javet holds a doctorate in Neurology from Zurich University and a M.Sc. in health system management from Montreal University. Dr. Javet was stationed in Kenya and Afghanistan prior to joining the United Nations Population Fund (UNFPA) where he served in different management positions. Dr. Javet has shown an increasing interest in private-public partnerships and served as Executive Director of the International Association of Infant Food Manufacturers (IFM) in relations with the World Health Organization, UN agencies and NGO’s. Mr. Javet is Managing Partner at Swiss Health Invest (SHI), an International Health consulting firm offering a platform for strategic partnerships in global health.  On the clinical side Dr. Javet is serving at the department of forensic psychiatry of Berne University Clinic where he focuses on the mental health challenges in the penitentiary context both of regular and migrant inmates. 

Abstract:

What can mental health as an integral part of the international health system contribute to prevent terrorist attacks that are motivated by violent religious extremism? Mechanisms of the international health system provide various political tools to address cross-border and domestic public health challenges. But are the mechanisms in place powerful enough to address the current threat of fundamentalist terrorism? The mental health dimension of violent religious extremism is not yet represented sufficiently on the global health agenda while the burden of mental health related problems is gaining more and more attention, political weight and funding. Traditional if not strict secularism in policy making by the World Health Organization (WHO) and many of its member states does not help efforts to increase collaboration and to promote stronger leadership among the most powerful religious groups in addressing mental health as an important component of counterterrorism.  The willingness of WHO, other UN agencies and member states to include participation of religious groups in public mental health based counterterrorism efforts is key. At the same time, mental health should be more prominent among the proposed strategies of the UN Counterterrorism Committee (UNCTC). This would pave the way for mental health approaches to become more influential in informing ongoing initiatives of the UNCTC, including public-private partnerships with social media- and internet companies.  

Kunda Mendhekar

Health Service Group, Tata Power Delhi Distribution Limited, India

Title: Screening for non-communicable disease risk factors at a workplace in corporate organization, Delhi. India

Time : 12:20-12:50

Speaker
Biography:

Abstract:

Noncommunicable diseases (NCDs) account for two-thirds of all deaths globally. Health Check up camp and Health Tips  have the requisite expertise to initiate and lead NCD risk factor screening and prevention programmes. The workplace can provide an ideal setting for Health check up camps  to screen for risk factors and implement prevention programmes.

Objective

This study was designed to identify the common modifiable risk factors for NCD among employees of a corporate institution.

Methods

A cross-sectional study of NCD risk factors was conducted in  corporate institution , Delhi, India. Employees were evaluated using the World Health Organisation STEPS Instrument (Steps I and II). The prevalence of risk factors were expressed as frequencies and percentages.

Results

A total of  1086 employees (response rate 36.2%) participated in the study. Poor dietary habits, suboptimal blood pressure, Random Blood sugar level and physical inactivity were identified as the most common modifiable NCD risk factors in this population.

Conclusion

Knowledge of NCD risk factors can be used by Health care workeres  to implement health promotion programmes in the workplace as a means of reducing NCD-related economic and social burdens in  organization.

 

Betty PC Khong

Tan Tock Seng Hospital Pvt Ltd, Singapore

Title: The innovative journey of a Wound Management System for sustainability

Time : 13:40-14:10

Speaker
Biography:

Dr Betty is a Senior Nurse Manager with more than 13 years of nursing experiences specifically working in the outpatient settings and 12 years as an administrator. As a nurse, Dr Betty has been actively involved in quality improvement (both clinical and operations) projects as well as  innovative projects such as development and implementation of a Wound Management System and development and prototyping of a novel wound applications to digitalize measurement of wound dimension. She also focuses on researching topics related to pressure ulcer (knowledge of nurses, interface pressures between prophylaxis dressings and object surfaces; and prevalence study), nurses’ mental model and their decisions in adopting the Clinical Decision Support System (CDSS); and the phenomena of second victims. Dr Betty serves on the committee to the Singapore Nursing Association (Nursing Informatics) and the Board of Directors for Upsilon Eta Chapter, a subsidiary   of Sigma Theta Tau International Honor Society of Nursing, Singapore.

Abstract:

Background:

Information technology systems have been capitalized in healthcare to support evidence-based practices. An innovative Wound Management System (WMS) was developed with a clinical decision support system (CDSS) embedded with decision-tree algorithms.

Methods:

A mixed method with pre- and post-evaluation designs was utilized. Usability testing and formative evaluations were conducted on the WMS and its treatment modalities. The initial modular,  ontological framework faced difficulties in its adoption by nurses. Thereafter, an exploratory descriptive study was conducted to understand the nurses’ decision in adopting the CDSS after initiation. Subsequent enhancement cycles focused on improving the architecture of  the WMS  to fulfill quality and operational  requirements.

Findings:

The WMS ontology consisted of (1) the information-processing unit with an input for data capture and image uploading, an output that recommends patient-specific treatment(s) prioritized according to efficacy, cost and product availability, as well as automatic billing of wound treatment; (2) the knowledge base that maintains codified treatment logics and the reasoning engine that  integrates  the data input with treatment knowledge; and (3) the simple data analytic element that mines progression of wound healing, tracks dressings for change, studies treatment compliance,  summarizes patients’ wound outlooks and reports billing reconciliation. The usability testing has ensured deployments of the successful system and enhancements in approximately 90% of the inpatient nursing units. The formative evaluations concluded with an overall agreement exceeding 90% between the subject matter experts and the CDSS. The qualitative study informed enhancements to meet nurses’ decision-making patterns that influence their adoption.

Conclusion:

The WMS, thought to be the first of its kind in Asia, has seamlessly integrates with Singapore’s cluster- wide electronic medical record system. This disruptive innovation underwent multiple iterative enhancements to ensure its accessibility and adoption as it serves as a real-time, evidence-based solution and  point-of-reference  for wound management.

Tomoko Miyake

Osaka University Graduate School of Medicine, Japan

Title: The association between taste perception and zinc deficiency in young Japanese women

Time : 14:10-14:40

Speaker
Biography:

Ms. Tomoko Miyake is a Ph.D. student in health sciences, Osaka University Graduate School of Medicine, Japan. She has experience of working as a midwife for 5 years at general hospital in Kobe, Japan. She got her master’s degree in health sciences from Osaka University Graduate School of Medicine, in 2016. Her master’s thesis entitled “Taste perception in Japanese reproductive aged women and relationship to nutritional status and body composition”. Her current research interests are to educate eating a balanced diet for Japanese reproductive-aged women, and to promote their nutritional status and dietary behavior.

Abstract:

Statement of the Problem: There has been increased concern regarding taste disorder in young Japanese women. The most commonly reason for this increase was relevant to their dietary habits. The purpose of this study was to examine the association between taste perception, and nutritional intake in young Japanese women.

Methodology & Theoretical Orientation: Participants (n=74) were young women in their late teens and twenties. Taste perception was measured by electrogustometry and the filter-paper disc method (FPD method) over areas of the chorda tympani nerve and glossopharyngeal nerve. Nutritional status was evaluated by brief, self-administered diet history questionnaires. The index of nutritional status was based on 2015 dietary reference intakes for Japan. This study was approved by the ethical committee at Osaka University.

Findings: There were no abnormalities in relation to taste perception in electrogustometry. However, 33 (44.6%) were abnormalities in the FPD method. There were no significant differences in the nutritional intake between normal taste perception group and abnormal taste perception group. The subjects who took from 5mg to 7mg zinc per day were significantly at decreased risk of abnormal taste perception compared with subjects who took below 5mg zinc per day [odds ratio 0.094, 95% confidence interval 0.010-0.873]. In this study, about 50% of all participants had problems with taste perception. The present result suggested abnormality in taste perception was associated with zinc deficiency in young women in their late teen and twenties. Further studies are needed in order to eat well-balanced diet in order to effectively take zinc for young Japanese women.  

Blessing J. Akombi

Western Sydney University, Australia

Title: Socioeconomic inequalities in childhood undernutrition in Nigeria

Time : 14:40-15:10

Speaker
Biography:

Blessing Akombi has a background in public health with a passion for improving maternal and child health through evidence-based research. Her current research interest lies with epidemiology, child nutrition, international health, systematic reviews and meta-analyses. Blessing is curious about knowledge and new information. She has excellent communication and administrative skills with a drive for achievement and excellence.

Blessing Akombi has an MPH from the University of Newcastle, Australia. She recently concluded a self-sponsored PhD within 2 years with a track record of 5 peer-reviewed journal articles. Her PhD research focused on child undernutrition in sub-Saharan Africa and provided policy insights to improving child nutrition in sub-Saharan Africa, with a particular focus on Nigeria.

Blessing has conducted several systematic reviews and is currently involved in data collection and evaluation of the FRESH Health promotion aspects; a project funded by Western Sydney University partnership grant.

Abstract:

Background: Undernutrition is the underlying cause of child morbidity and mortality in Nigeria, accounting for more than 50 per cent of deaths among under-five year old children. This study examined socioeconomic-related inequalities in child undernutrition in Nigeria using the decomposition approach.

Methods: The study analysed data from the Nigeria Demographic and Health Survey (NDHS) 2003 to 2013. Trends in child undernutrition were examined against socioeconomic factors. The outcome variables were stunting (HAZ<-2SD), wasting (WHZ<–2 SD) and underweight (WAZ<–2 SD) among children 0-59 months. The magnitude of child undernutrition was estimated via a concentration index, and the inequality was decomposed to ascertain the contribution of socioeconomic factors to child undernutrition over time.

Results: Socioeconomic inequality in child undernutrition increased between 2003 and 2013. The decomposition of the concentration index showed that the consistent contributing factors to the increase in socio-economic inequalities in child undernutrition were: child’s age (0 – 23 months), maternal education (no education), household wealth index (poorest household), type of residence (rural) and geopolitical zone (North East, North West).

Conclusions: This result suggests the need for a multifaceted nutrition intervention that involves improving maternal education and the adoption of social protection policies, to reduce inequalities in child undernutrition especially among socioeconomically disadvantaged groups in Nigeria. This would set the country on its path to achieving the post-2015 sustainable development goals of improving children’s health.

Speaker
Biography:

Ariani Khairunnisa Nasution is a Hospital Manager in An-Nisa Hospital, Tangerang, Indonesia. Presently, she is pursuing Magister Hospital Administration Program, Faculty of Public Health, University of Indonesia. She also has an experience in hospital and healthcare management field for 4 years, where she has focused in business development in healthcare to support better quality and improvement in health care service.

Abstract:

Long waiting time for patient in out-patient department of healthcare becomes important in healthcare process of service nowadays because of highly demand for improvement of quality and safety in healthcare. Many studies had been done to analyze the most effective method to reduce patient waiting time in outpatient department; some of them used Six Sigma, Lean and combination of both methods. This review aims to compare the results of business process reengineering through Six Sigma method, Lean method and combination of both, in reducing outpatient’s waiting time. Systematic Review is performed to compare studies about waiting time in outpatient department (OPD) using Six Sigma method, Lean method and combination of both in health care systems. The search of journals used ProQuest, Springer and Emerald database with only journals from 2013 to 2016 that being included for this review. From 6 selected studies, there are 2 studies using Six Sigma method, 3 studies using lean tools and 1 study using lean six-sigma. In six-sigma method, patients average waiting time in Columbia and Taiwan were reduced about 40.7% and 56%. While in Lean method in Tanzania, India and South Africa the patients average waiting time were reduced about 40.7%-56%. In Lean Six Sigma method in India, the project has shown a 94% reduction in patients’ average waiting time. The findings of this study show the methods that used give significant effect in reducing waiting time, the combination of Six Sigma and Lean have a greater impact in reducing patients’ average waiting time based on the studies. The Lean Six Sigma method has more dramatic reductions in patients waiting time in outpatient department process based on the review. But the other methods still have significant value too in reducing patients waiting time.

Speaker
Biography:

Hui LU, female, MB, MSc, PhD in Social Medicine and Health Management, associate professor and head of Dept. of Social Medicine & Health Education, School of Public Health, Nanjing Medical University. She has been to Dept. of Public Health Sciences, Karolinska Institutet, Sweden for 3 months, and has worked in foreign loan office, Ministry of health, China for half year. In 2011, she got CMB Young Faculty Seed Grant in Health Policy and Systems Project “The impact of free distributing antipsychotics to the poor schizophrenics”. She has her research expertise in health system strengthening and policy development on disease control, health care services research for vulnerable populations, and health education and health promotion. She has done the path breaking studies on developing a “medical-nursing combined” health care model for the elderly with chronic diseases and “task shifting” in mental health services in China supported by national and provincial projects

Abstract:

Statement of the Problem: Hypertension is a leading cause of cardiovascular morbidity and mortality. As China's population ages, burden of hypertension has concentrated in elderly women groups. The empirical analyses has identified making health-related behavior changes is to be effective in controlling hypertension. The study was to discover the main behavioral risk factors influencing blood pressure control of elderly women with hypertension in Jiangsu Province, China. Methodology & Theoretical Orientation: 5,234 cases of women aged 60 and above in Jiangsu Province was recruited by multi-stage stratified cluster and random sampling method in 2013, and investigated by the household health survey. The data of self-reported level of blood pressure control among diagnosed hypertension cases, and their demographic factors and behavior factors of tobacco use, alcohol use, physical activities and therapeutic actions were analyzed by chi-square test and Logistic regression modeling. Findings: (1) Hypertension were observed 2,227 out of 5,234 respondents (42.5%), of whom 1721 reported keeping blood pressure normal (77.3%). (2) According to univariate analyses, exercise frequency per week, annual physical examine, blood pressure monitoring, medicine-taking behavior, education level, geography of the place, and per capita annual incomes of households were statistically greater in the normal blood pressure group than in the abnormal blood pressure or be not aware of their blood pressure group (p < 0.05). (3) Multivariate logistic regression analysis revealed that exercise frequency per week, blood pressure monitoring and medicine-taking behavior were independent behavior influencing factors for blood pressure control (p < 0.05). It could be concluded regular physical activity, periodical monitoring blood pressure and taking medicine as directed have significant effect on blood pressure control. According to elderly female's features, to set up community behavior intervention model and strengthen disease management on hypertension, can help to improve the prevention and control of cardiovascular disease for elderly women.

Mohsen Shams

Yasuj University of Medical Sciences, Iran

Title: Using Social Marketing to Promote Normal Vaginal Delivery in Primigravida Women in Iran

Time : 16:30-17:00

Speaker
Biography:

Mohsen Shams, MD, PhD in health education and associate professor of Yasuj University of Medical Sciences- IRAN, has his expertise in designing, implementing and evaluating the health education, health promotion, and health communication. His work is an intervention based on social marketing model to promote normal vaginal delivery and reduce the Cesarean section in primigravida pregnant women in Yasuj, Iran. 

Abstract:

Designing and implementing the effective interventions to promote normal vaginal delivery is a main health priority in Iran. This study is aimed at reducing selection of Cesarean section by primigravida through an intervention based on social marketing in Iran. In this field trial, a mixed method was done to analyze audience, market, and channel. Pregnant women who intended to do Cesarean section were selected as the specific target segment. Tailored intervention was developed based on the findings of this formative research and marketing mix or 4P (Product, Price, Place, Promotion) was developed. The product was an educational course, and messages for brief intervention in health facilities, and phone consultations by a trained midwife. Their intention to do Cesarean section was studied and compared with baseline measure. Before the intervention, 25.2 percent of the women intended to do Cesarean section (44.5% in urban and 10% in rural regions). After the intervention, we found that the intention of 78.9% of the pregnant women who had cesarean intention was changed (76.7% in urban and 87.5% in rural regions) (P< 0.001). The study showed the effectiveness of an intervention based on consumer-oriented social marketing theory and could be used to reduce Cesarean intention.

Speaker
Biography:

Hui Wang has her expertise in nutritional epidemiology and molecular epidemiology. Her passion was dedicated on the mechanism of environmental and genetic impact on the diseases pathogenesis .Previously, she focused on the genetic deficiency of innate immunity would trigger the process of cancer, research has published on Hepatology.  Recently, the dietary pattern of China is undergoing the transition period; meanwhile, the overweight situation gets more and more serious. Thus, she moved her research on the nutritional epidemiology. Papers have published in European Journal of Clinical Nutrition and Nutrition research.  

Abstract:

Purpose: To investigate the gender difference of getting metabolic syndrome (MetS) and its various associations with dietary diversity at different ages. Methods: Data of adults(n=4308) aged 18+ y with three consecutive 24-h recalls and complete co-variates information were extracted from Chinese Nutrition and Health Survey in 2009. Modified Dietary Diversity Score (DDS) was adopted to capture the diversity of diet. MetS was defined by the harmonized criteria. Multivariable adjusted logistic regression was carried out to detect the association between DDS and MetS and its components for young, middle aged and elderly adults by a cross-sectional study. Results: Female were more likely to get MetS than male counterparts, especially after 50 years old, and the risk follows an inverse-U shape for both genders. Moveover, DDS played a significant protective role in MetS for young female (<45), similar trends were detected in serum TGs, abdominal adiposity, blood pressure, and fasting blood glucose (all P trends < 0.05). However, this association reversed in old female (>60) [OR (95%CI): 1.69(1.05, 2.72)] and male adults [OR (95%CI): 1.59(1.04, 2.44); 2.18(1.30, 3.65)]. Greater DDS was associated with higher serum TGs, and lower HDL-C level for male adults (45≤ & <60) [OR (95%CI): 1.56(1.17,2.08); 2.00(1.24,3.24)], higher blood pressure for old men (>60) [OR (95%CI): 2.49(1.76,3.53); 1.54(1.00,2.35)], but lower blood pressure and fasting blood glucose in young man(<45) (all P <0.05). Conclusion: The association between DDS and MetS varies at different ages and differs for male and female. Targeted strategy of health education in balanced diet should be designed for different population, especially, the old women and middle aged men to reduce the burden of chronic diseases.