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2017 Conference on Health Management in Post Disaster Recovery

“Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction”

nd th Banda Aceh, Indonesia, 22 – 24 May 2017

Disclaimer & Copyright

DISCLAIMER The opinions and statements of facts expressed in the Papers in these proceedings are those of the Authors and do not necessarily represent those of the 2017 Conference on Health Management in Post Disaster Recovery, the editors, the organising committee or the supporters of this conference. No responsibility can be accepted by the conference organisers for errors or omissions in the individual papers.

COPYRIGHT The material in these Papers is subject to copyright. Papers may be reproduced for publication/distribution only with the written consent of the paper author.

MESSAGE FROM THE RECTOR

I am extremely proud and happy to welcome all participants of the 2017 Conference on Health Management in Post Disaster Recovery organized by Syiah kuala University as a host. This event is conducted with fully funding supported from the the German Academic Exchange Service (DAAD). This conference is one of the most important events in Syiah Kuala University this year, since Syiah Kuala University as one of the leading university in disaster management science. We create this conference to serve the purpose in addressing the need to exchange knowledge and experience on ways of the health sector to handle a disaster, It is also our hope that this conference will act as a motivation for to publidh their idea and researches in the disaster health area.

Syiah Kuala University (Unsyiah) is the oldest public university in Aceh. Currently, Unsyiah has more than 30,000 students studying in 12 faculties and the Graduate Program. As one of the higher educational institutions, Unsyiah have a strategic functions in enhancing the quality of human resources, both for local, national and regional levels. As university of the heart of Aceh People’s which quality as priority, Unsyiah integrating universal values, national, and local levels to deliver human resources with harmony in between science, technology and character building. The balance between them is become a main component in producing quality of human resources, virtuous character, ethics, aesthetics and morality.

As the Rector of Syiah Kuala University, I would like to express my gratitude to the keynote and invited speakers, for making their time for this conference. I would also like to take this opportunity to thank the Organizing Committee for their hard work and endless support in making this event possible. Finally, to all participants, I wish you wonderful and enjoyable experience during your stay in Banda Aceh.

Thank you.

Sincerely,

Prof. Dr. Ir. Samsul Rizal, M.Eng Rector of Syiah Kuala University

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MESSAGE FROM THE CHAIRMAN

On behalf of the organizing committee, I am honored and delighted to welcome you to the 2017 Conference on Health Management in Post Disaster Recovery.

This conference is fully supported by DAAD. The committee is organized by German alumni, as well as the speakers and most of the participants. We have arranged this academic event will be participated by scholars, researchers, lecturers and stakeholders which 50 % of them are German alumni.

Our conference program is rich and varied with 3 keynote speeches and 6 invited talks and around 21 technical papers split between 11 plenary lectures and 10 poster presentations. Presenters mostly come from German/ DAAD alumni, academics, researchers, health care professionals, government official and students from at least five provinces including Aceh, Makassar, Yogyakarta, Malang and Manado.

We know that the success of the conference depends ultimately on the many people who have worked with us in planning and organizing the program. We thank everyone who has provided their wise advice and brilliant suggestion on organizing the program. We also thank to the DAAD as our main sponsor who have helped us to keep down the costs of the conference for all participants. Recognition should go to the organizing committee members who come from German Alumni Association (Perhimpunan Alumni Jerman), Tsunami & Disaster Mitigation Research Center (TDMRC), Zainal Abidin General Hospital (RSUDZA) as well as the students from Faculty of Medicine, Syiah Kuala University, who have all worked extremely hard for the details important aspects of the conference program.

Thank you.

Sincerely,

dr. Ichsan, M.Sc Chairman of the Organizing Committee

PREFACE

Over the last decade, natural disaster had become more frequent. According to EM-DAT (2015), the top 5 countries which most frequently hit by natural disasters are China, United States, Philippines, Indonesia and India. From the period 2004-2013 counts three years that have resulted in a major loss of life, including the Indian Ocean tsunami in 2004 with 226,408 with deaths, the cyclone Nargis in Myanmar in 2008 with 138,366 deaths and the earthquake in Haiti in 2010 with 225,570 deaths.

The challenges facing primary health care system after the disaster were many. The Indian Ocean tsunami struck on 26th December 2004, the primary public health concerns are clean drinking water, sanitation, shelter, food and medical care. Several hundred thousand displaced persons forced to shelter in numerous camps. And totally dependent for all basic human needs. Coastal regions and infrastructures in the affected countries were badly damaged that many of the social, economic and health gains that had been achieved in recent years were lost.

The 12th January 2010 earthquake in Haiti also affected the health system in the country. When the disaster occurred, national authorities were not equipped to manage relief or recovery priorities. Structures of the governance were destroyed. The required services, health workers, resources, surveillance, funding and (attempts at) coordination were provided almost completely by international organisations, creating its own set of complications and delaying investments into the health system.

The 11th March 2011 earthquake and tsunami in Japan had caused a massive destruction in health sector include healthcare facilities, initial shortages of food, water, aid materials and rescue teams to the affected population in a rural area. Hundred thousand of people were evacuated to shelters with no heating and suffered from freezing temperatures.

The above recent major disasters exemplify the need for health systems in strengthening their capacity to respond effectively to disaster. Each disaster and its context are different. But many of them shared similar health sector vulnerabilities. Thus, common disaster management practices and policies in the health sector can be built into the health system to create disaster resilience with all type of hazards approach.

The health sector has to perform an essential role in respond to all kinds of disasters, as the protection of human beings and their health is of primary importance in all emergencies situation. To provide reliable services in crisis situations, it is important to strengthen health systems. As the community are confronted by new challenges and threats to all type of hazards, our preparedness efforts have to be adapted accordingly. Essential health services must have better preparedness to respond and to function adequately in the time of disaster.

Lessons learnt from previous calamities clearly indicate that risk reduction efforts largely pay off in a future disaster. Preparedness programmes will be more effective if they are designed and implemented as a continuous process, based on hazards and vulnerabilities analysis. The government health institutions play a significant role in securing and coordinating public health response to a disaster. It also requires political support, including appropriate financial and human resources, to ensure that the health system is well prepared to cope with future disaster.

Disaster management is a topical issue globally. Thus, countries are being encouraged to improve their preparedness towards disaster, along with growing international commitment to strengthen health systems. Unfortunately, lessons which had been identified from disasters have not been effectively collated. Besides, the essential experience is easily forgotten. To address the need to exchange knowledge and experience on ways of the health sector to handle a disaster, it is thus essential to conduct the 2017 International Conference on Health Management in Post Disaster Recovery.

The 2017 Conference on Health Management in Post Disaster Recovery was organized in Banda Aceh from 22 to 23 May 2017. This conference is fully support by the German Academic Exchange Service (DAAD) and organized by Syiah Kuala University, German Alumni Association (Perhimpunan Alumni Jerman), ospital (RSUDZA).

The aim of this conference is to strengthen the capacity of the health sector to prepare and respond to disaster and to increase reliability and capabilities before, during and after a disaster.

The objectives of the conference were: • To better understand the current status of disaster preparedness and response of health sector. • To build consensus and to develop a framework for key areas of intervention/ strategy on disaster management in the health sector. • To provide recommendations to better improve system for assistance to the health sector during disasters. • To strengthen partnership and cooperation among government, non-government and other stakeholders. • To facilitate the dissemination of and dialogue about knowledge and practice in the field of health management in disaster recovery. • To enhance scientific and professional capacities of German alumni in the area of health management due to disaster. The conference was held with the theme “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction”.

This proceeding of 2017 Conference on Health Management in Post Disaster Recovery contain papers written by German/ DAAD alumni, academics, researchers, health care professionals, government official and students from at least five provinces including Aceh, Makassar, Yogyakarta, Malang and Manado.

Last but not least, we thank all the authors for their excellent contributions to these proceeding and all the participants for their contributions to this successful conference, either in the form of oral presentation, posters, or in the form of their attention to the presentations and contributions to the discussions.

We hope that everyone enjoys reading the proceeding and that the papers inspire you in your research or other professional activities.

Editorial Board

Rina Suryani Oktari, S.Kep., M.Si (Tsunami & Disaster Mitigation Research Center (TDMRC) and Faculty of Medicine, Syiah Kuala University)

Dr.rer.nat. dr. Muhsin (Faculty of Medicine, Syiah Kuala University)

Dr.rer.pol. Heru Fahlevi, S.E., M.Sc (Faculty of Economic and Bussiness, Syiah Kuala University)

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PROGRAM SCHEDULE

Time Description Monday – May 22, 2017 08.30-09.00 Registration 09.00-09.25 Keynote speech (MC: Amelia) Prof. dra. Fatma Lestari, M.Si, Ph.D “Health Crisis Management in Indonesia” 09.25-10.00 Opening Ceremony o Al Quran Recitation o Doa o Welcome by Chairman of 2017 Conference on Health Management in Post Disaster Recovery (dr. Ichsan, M.Sc) o Greeting by Governor of Aceh representative o Remarks by Rector of Syiah Kuala University (Prof. Dr. Ir. Samsul Rizal, M.Eng) 10.00-10.55 Keynote speeches 1. Prof. Dr. Ir. Samsul Rizal, M.Eng “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 2. Prof. Dr. med. dr. Tri Hanggono Achmad “Health System Preparedness”

10.55-11.10 Tea Break 11.10-11.30 Traditional Dance Performance 11.30-12.30 Invited Lectures I (Moderator: Dr.rer.nat. Ilham Maulana) 1. Dr. dr. Azharuddin, SpOT (K) Spine “Hospital disaster preparedness” 2. Dr. dr. Zafrullah Khany Jasa, SpAn-KNA “Coordination of humanitarian relief in Disaster” 3. Dr. Ir. M.Dirhamsyah, MT “Policy making and planning in health disaster” 12.30-13.00 Discussion 13.00-14.00 Lunch Break 14.00-15.00 Plenary lectures A (Moderator: Ns. Farah Diba, M.ScIH) 1. Dr. Aulina Adamy, M.Sc “A framework of Building Evaluation Performance for Post-Disaster Hospital Reconstruction in Aceh, Indonesia” 2. dr. Zulfa Zahra, SpKJ “The role of Psychiatrist for Victims of Disaster” 3. dr. Nurwahyuniati, M.Imun “Immune Modulation Post Natural Disaster” 15.00-15.30 Discussion 19.30-21.00 Welcome Dinner

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Tuesday – May 23, 2017 08.30-09.30 Invited Lectures II (Moderator: Muhammad Bahi, PhD) 1. Dr. Khairul Munadi, M.Eng “Health in the Context of Sendai Framework for Disaster Risk Reduction (SFDRR) 2015-2030” 2. Dr. dr. Syahrul, SpS (K) “Health response to disasters” 3. dr. Pria Agustus Yadi, Sp.B-KBD “Lesson Learn from Earthquake & Tsunami Hit Aceh in 2004” 09.30-10.00 Discussion 10.00-10.15 Tea Break 10.15-11.15 Plenary Lectures B (Moderator: Dr. Essy Harnelly) 1. Dr. dr. Dedy Syahrizal, M.Kes “Psychoneuroimmunology: The Approach for Increasing The Imunity of Disaster Victims” 2. Prof. Ediati Sasmito “Noni Fruit as Bio-immunostimulant material: Characterization of Purified Polysaccharide Fraction of Morinda citrifolia L. Fruit” 3. Dr. Trina Ekawati “Preparedness to Risks of Disaster Through Awareness On Biodiversity Conservation” 11.15-11.45 Discussion 11.45-12.25 Plenary Lectures C (Moderator: Elvira Iskandar, M.Sc 1. Dr. Meilya Silvalila, SpEM 2. Dr. Agus A Munawar “Near Infrared Technology: Fast and Simultaneous Detection of Hazardous Heavy Metal Contaminations in Disaster Affected Area” 12.25-12.45 Discussion 12.45-14.00 Lunch break 14.00-15.00 Plenary Lectures D (Moderator: Teuku Reza Auliandra) 1. Ns. Elly Wardani, MS, PhD “Dynamic Simulation modelling on health disaster policy and management in Indonesia” 2. Suazhari, M.Si “Disaster Discourse in Accounting Research: A Literature Study” 3. Mira Maisura, M.Sc “Real-time Dashboard for Disaster Management Information System in Aceh” 15.00-15.30 Discussion 15.30-16.00 Closing ceremony

TABLE OF CONTENTS

Message from the Rector ...... iii Message from the Chairman ...... iv Preface ...... v Program Schedule ...... viii

Health Crisis Management In Indonesia ...... 1 Fatma Lestari, Yuni Kusminanti, Riyadh Firdaus, Mila Tejamaya, Tri Tjahjono, Achmad Yurianto, Ina Agustina Isturini, Gde Yulian Yogadhita, Cynthia Febrina Maharani ...... 1

Psychoneuroimmunology : The Approach for Increasing the Immunity of Disaster Victims ..... 7 Dedy Syahrizal, Raisha Fathima, Imam Maulana ...... 7

The Role of Psychiatrist for the Victims of Disaster ...... 13 Zulfa Zahra ...... 13

A Framework of Building Evaluation Performance for Post-Disaster Hospital Reconstruction in Aceh, Indonesia ...... 18 Aulina Adamy, Abu Hassan Abu Bakar ...... 18

Immune Modulation Post Natural Disaster ...... 29 Nur Wahyuniati, Reza Maulana, Ichsan ...... 29

Mitigation of Disaster Through Awareness on Biodiversity Conservation ...... 39 Trina Ekawati Tallei ...... 39

Disaster Discourse in Accounting Research – A Literature Review ...... 46 Suazhari ...... 46

Near Infrared Technology: Fast and Simultaneous Detection of Hazardous Heavy Metal Contaminations in Disaster Affected Area ...... 51 Agus Arip Munawar, Maulana Yusuf, Mulkan Azhari, Ichsan, Shahril Anuar Bahari ...... 51

Preliminary Study on Faloak Bark Potency for Prevention of Microbial Infection ...... 59 Triana Hertiani, Prisci Permanasari, Herlyanti Mashar, Siswadi ...... 59

Physical Properties of Polypropylene Itaconate-Silicates Coating Material ...... 67 Atmanto Heru Wibowo, Listyaningrum, Maulidan Firdaus ...... 67

Morinda Citrifolia L (Noni) Fruit as a Source of Immunostimulant : The Influence of Altitude Cultivation Area to Bioactive Substance (Polysaccharide) Content ...... 76 Ediati Sasmito, Rumiyati, Endang Lukitaningsih ...... 76

Relationship Between Gender With Sputum AFB Conversion in Pulmonary Tuberculosis Patients in Primary Healthcare Banda Aceh ...... 83 Novita Andayani ...... 83

Anti-Aging Compound of Morinda Citrifolia Based on In Silico Reverse Docking ...... 89 Mohamad Amin, Reni Istiningrum, Endang Suarsini, Betty Lukiati, Ahya Zhilalikbar Amin And Umie Lestari ...... 89

Lesson Learn from Earthquake & Tsunami Hit Aceh in 2004 ...... 98 Pria Agustus Yadi ...... 98

Coordination of Humanitarian Relief in Disaster ...... 99 Zafrullah Khany Jasa ...... 99

Medical for Pidie Jaya Earthquake ...... 101 7 December 2016 In Banda Aceh, Indonesia ...... 101 Safrizal Rahman , Andria Saputra , Panji Anugerah ...... 101

Dynamic Simulation Modeling on Health Disaster Policy and Management in Indonesia ..... 102 Elly Wardani ...... 102

Epidemiology and Laboratory Data of Dengue Cases in 2016 in Semarang City Indonesia .... 104 Anto Budiharjo, Dea Hapsari, Retno Murwani, Nur Endah Wahyuningsih ...... 104

The Role of Hospital During Pidie Jaya Earthquake: A Lesson Learnt ...... 109 Azharuddin, Diaz Novera ...... 109

HEALTH CRISIS MANAGEMENT IN INDONESIA

FATMA LESTARI1*, YUNI KUSMINANTI1, RIYADH FIRDAUS1, MILA TEJAMAYA1, TRI TJAHJONO1, ACHMAD YURIANTO2, INA AGUSTINA ISTURINI2, GDE YULIAN YOGADHITA3, CYNTHIA FEBRINA MAHARANI1

1Disaster Research and Response Center (DRRC) UI * [email protected] Gedung ILRC Lantai 2, Kampus UI Depok 2Pusat Krisis Kesehatan, Kementerian Kesehatan Republik Indonesia 3World Health Organization

Abstract. This paper aims to give further explanation about health crisis management in Indonesia and to provide some case studies based on study about evaluation on mass-exodus management during Idul Fitri Holiday that already conducted by the writer. This study was designed as a pilot study in Java and Sumatra Island to evaluate the implementation of health crisis management system in Indonesia. The subvariables studied in this research were the implementation of health crisis management during the pre-disaster stage, emergency response stage and post-disaster stage. This study was conducted using a survey approach to the check point or the target set locations. In each set location, the survey was conducted in both “Pos Kesehatan” and “Dinas Kesehatan” to provide a broad perspective of the implementation of health crisis management system during “mudik” period. Based on the study that has been conducted, the implementation of health crisis management are different in each area. Some areas already implement health crisis management system very well and the others need to do some improvements. The evaluation of the implementation of health crisis management system was conducted at Dinas Kesehatan and Pos Kesehatan along the “mudik” route. Pos Kesehatan and Dinas Kesehatan that need to do the improvements in the implementation of health crisis management system were in area K, area S, and area B. In summary, this study found that the health crsisi management system has inadequately implemented during Eid-fitr in some areas or cities in Indonesia. Based on the findings, it is clearly seen that some improvements need to be undertaken. The suggested recommendations are the socialization plan for all the personnel involved and the community, additional amenities health services which include the availability of medicines for basic emergency situation, increase the availability of Public Safety Center in each city in Indonesia.

Keywords : health, crisis, management, disaster

BACKGROUND

Based on disaster management data from United Nations or UNISDR (The United Nations Office for Disaster Risk Reduction), there are around 70% of fatalities globally that caused by the natural disasters that occur in Asia. Indonesia is on the eleventh position among the other Asian countries as the country with the most natural disaster occurences in 2015 (The United Nations Office for Disaster Risk Reduction, 2015). On the other hand, according to the data that provided by BNPB (Badan Nasional Penanggulangan Bencana), the highest number of natural

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia disaster events occur in the following areas: East Java (315 events); Central Java (392 events); West Java (221 events); West Sumatra (96 events); Aceh (90 events) (BNPB, 2015). In January 2016, there are 174 natural disasters events that occur in Indonesia and the most frequent disasters were flood, tornado, and landslide. One of the biggest factor that affect the number of natural disasters in Indonesia is the geographical location and confition of the country. In Indonesia, there are many active mountains that potentially erupting (Center for Excellence in Disaster Management and Humanitarian Assistance, 2015). Besides, Indonesia is in meeting area of three tectonic plates, include Indo-Australia plate, Eurasia plate and Pacific plate. This condition affect the high number of earthquake that happen in many parts of the country (BNPB, 2015). Geographically, Indonesia is also adjacent to the Indian Ocean and Pacific Ocean which increase the risk of tsunami disasters. The other factors that influence the high number of natural disasters in Indonesia are greenhouse gases effects and forest fires (BNPB, 2015). On the other hand, some industrial areas that operate in Indonesia also have a great potential to cause fire, spill, and leakage that affect the environmental damage and result in fatalities. (BNPB, 2015). Generally, the disaster impacts can be divided into four categories, namely the material impact, health impact, psychological impact, and reputation impact (mainly for the industrial disaster cases) (BNPB, 2015). Generally, the biggest impact that should be considered in disaster events is health crisis issues, include fatalities, injuries, nutrition issue, refugees, hygiene and sanitation, the availability of fresh water, health services, infectious diseases, mental health and reproduction health services issues (Kemenkes RI, 2011). The health related problems that should be resolved as part of health crisis management during disaster events are the information system, coordination among the stakeholders to cover some health issues, mobilization of asistance to the disaster sites, unsupported financial system, early warning system, limited resources to be sent to disaster areas, and the management of local and international aid that poorly supervised (Kemenkes RI, 2011). Based on this reason, the integrated health crisis management is needed to solve some health related issues during the disaster events in Indonesia.

Health Crisis Management

Based on the Ministry of Health Regulation No 77, 2014 about The Information System in Health Crisis Management, in order to manage the health crisis during the disaster events, there are some elements as stated below that should be considered: 1. Pre-disaster stage a. The local government should identify the greatest potential disasters in their areas and also the most vulnerable groups b. Prepare the ability of health personel to solve health related issues during the disaster events c. Build network with some health service providers d. Prepare supply system and logistic dsitribution system 2. Emergency Response Stage a. Arrange emergency response priority to prevent death and injuries among the casualties b. Give health service immediately to emergency victims

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia c. Arrange health services that might be needed by the vulnerable groups, such as children, pregnant women, elderly, people with disabilities, and patients with chronic disease. d. Ensure reproductive health services can be provided during disaster events e. Monitor of victim’s nutritional needs f. Control the infectious disease and the quality and availability of fresh water g. Monitor the mental health of victims or volunteers h. Arrange the funeral of the victims who died i. Prepare the integrated health service system between BNPB and BPBD (Badan Penanggulangan Bencana Daerah) 3. Recovery Stage a. Measure the number of health facilities damaged that caused by the disaster b. Arrange rehabilitation and reconstruction plan by considering the structural mitigation

The Integrated Emergency Response System

According to Ministry of Health Regulation No 19 that established in 2016, The Integrated Emergency Response System consist of communication system in emergency response, emergency casualties or patients handling system, and integrated emergency transportation system. The Integrated Emergency Response System was arranged to enhance the accesibility and quality of emergency response services and improve the response time to reduce the number of death or injuries. The Intgerated Emergency Response System in Indonesia involved National Command Center (NCC) with the access code 119 that can be used all over the country and Public Safety Center (PSC) as the emergency response service providers that located in some cities. NCC has responsibility to give the information and guidance for every emergency call, forward those emergency calls to PSC, monitor and evaluate the system, and also make the reports (Kemenkes RI et al., 2016). On the other hand, PSC has responsibility to give immediate health service to victims, give guidance for triage process to the caller, first aid instructor, evacute the victims, and build the coordination with health service providers. The health personels that involved in PSC team are medical personels, nurses, and midwives. All the health personels involved in PSC should have been trained about emegency response system and actions. Nowadays, there are 66 PSC in Indonesia and 27 PSC are aready integrated with NCC (Kemenkes RI et al., 2016). The figure below presents how the emergency call 119 works in Indonesia. The yelow boxes and the green arrows show the recommendations suggested by the writers.

EMERGENCY CALL 119

Operational Time : 24 Hours Response Halo Kemkes Time (500567)

PSC Services : q Give guidance based on emergency response algorhitm q Sent health personel and ambulance q Sent victims to hospital Caller Health Facilities

Increase the number of Socialization PSC Plan

NCC and PSC Health Services: External Unit Additional recommendation 1. Call Tracker 2. Emergency Response Algorhitm 3. Health service providers information 4. TT Information 1. Training 5. Halo Kemkes 2. Simulation 6. Ambulance services 7. Reporting application and dashboard monitoring

FIGURE 1. Emergency Call 119 (Source: Ministry of Health Regulation No. 19, 2016)

PURPOSE

This paper aims to give further explanation about health crisis management in Indonesia and to provide some case studies based on study about evaluation on mass-exodus management during Idul Fitri Holiday that already conducted by the writers.

METHODS

This study was designed as a pilot study in Java and Sumatra Island to evaluate the implementation of health crisis management system in Indonesia. The subvariables studied in this research were the implementation of health crisis management during the pre-disaster stage, emergency response stage and post-disaster stage. This study was conducted using a survey approach to the check point or the target set locations. The data was collected over

“mudik” or mass-exodus period from 7th to 14th of July 2016. The target set locations including Lampung, Karawang, Subang, Garut, Banjar, Tasikmalaya, Ciamis, Indramayu, Cirebon, Banyumas, Ngawi, Sragen, Solo, Boyolali, Salatiga, Banyuwangi and Situbondo. In each set location, the survey was conducted in both “PosKesehatan” and “DinasKesehatan” to provide a broad perspective of the implementation of health crisis management system during “mudik” period. This study was performed in three steps: desktop study that covered the evaluation of guidelines and other existing documentation as secondary data; observation and survey in the set locations and data analysis. The observation and survey were conducted to gain primary data consists of information and data achieved from the interview with standby officers in “Pos Kesehatan” and “DinasKesehatan” in the set locations.

RESULTS

Based on the study that has been conducted, the implementation of health crisis management are different in each area. Some areas already implement health crisis management system very well and the others need to do some improvements. The areas or the cities that need to do the improvement in the implementation of health crisis management, include:

K Area Based on survey and interview data, this area already provided ambulance and health personel during the mass-exodus period on Idul Fitri holiday. But, there was no any health personels who were prepared to handle health crisis during that mass-exodus period. In this area, the number of road accidents during the mass-exodus period was also high. There were some traffic lights that could not be seeen very clearly by the drivers. On pre-disaster stage, the health personels in this area never did any socialization to the drivers about driving safely. Besides, the health personels themselves never did any training to evacuate the victims if the accidents occur. Either ‘Pos Kesehatan’ or ‘Dinas Kesehatan’ in this area had not arrrange any health crisis management system. They also did not know about the emergency call 119. On emergency response stage, this area had not prepared neither mitigation team nor standard operating procedure to manage health crisis. Although the health facilities and health service providers were already provided, this area had not arranged and ensured the minimum response time to give treatment to emergency victims or patients. Rehabilitation plan, damage measurement report, and evaluation as a part of post-disaster stage on health crisis management had not been prepared yet.

S Area The most frequent disaster that occur in this area was road accidents. Based on the survey data, the health facilities already provided during the mass-exodus period by each ‘Pos Kesehatan’. But, the amount of those health facilities, such as medicines and ambulances were not enough because the number of accidents happened were quite high. Socialization of safety driving, evacuation training, health monitoring, and health crisis managemnet procedure had not been arranged yet on pre-disaster stage.

In addition, on emergency-response stage, the mitigation team and standard operating procedure to manage health crisis had not prepared yet. But, the health personels already informed about health service providers that will be available if the health crsisis occur. On the other hand, the response time of emergency response unit had not been set yet. Lastly, on post-disaster stage, the rehabilitation plan, damage measurement report, and evaluation and monitoring report related to health crisis management were not available.

B Area In this area, the health facilities such as medicines, emergency aid kit, ambulances were already available on pre-disaster stage. But, the evacuation training, health checking, socialization plan related to safety driving and health crisis management were not available. This area also never implement or run any health crisis management system. The health personels never been infomed about the presence of emergency call 119.

As part of emergency response stage, this area already arrange standard operating procedure to manage health crsisis but the mitigation team was unavailable. However, the health service providers already provided as well as the communication system to manage the health crisis events. But, the minimum response time of emergency response team had not been measured yet. On post-disaster stage, the rehabilitation plan, damage measurement report, and evaluation and monitoring report related to health crisis management were unavailable.

CONCLUSION

In summary, this study found that the health crsisi management system has inadequately implemented during Eid-fitr in some areas or cities in Indonesia. Based on the findings, it is clearly seen that some improvements need to be undertaken. The suggested recommendations are the socialization plan for all the personnels involved and the community, additional amenities health services which include the availability of medicines for basic emergency situation, increase the availability of Public Safety Center in each city in Indonesia, provide the calculation of response time in each city or region to give some predictions how long that the emergency process could be done, provide training for all the health workers mainly the operators who give the emergency instruction to the callers, and some annual simulations to ensure that the system run properly.

REFERENCES

1. Evaluation on Mass Exodus Management during Idul Fitri Holiday. Ministry of Health Republic Indonesia and WHO. University of Indonesia: Disaster Research and Response Center 2. Technical Guidance on Health Crisis Management Ssyetm. 2011. Ministry of Health Republic Indonesia and WHO. 3. Peraturan Menteri Kesehatan Republik Indonesia Nomor 19 Tahun 2016 tentang Sistem Penanggulangan Gawat Darurat Terpadu 4. Peraturan Menteri Kesehatan Republik Indonesia Nomor 77 tahun 2014 tentang Sistem Informasi Penanggulangan Krisis Kesehatan

PSYCHONEUROIMMUNOLOGY : THE APPROACH FOR INCREASING THE IMMUNITY OF DISASTER VICTIMS

DEDY SYAHRIZAL 1*, RAISHA FATHIMA 2, IMAM MAULANA2

1Biochemistry Department, Medical Faculty of Syiah Kuala University, Banda Aceh, 23111, Indonesia *[email protected] 2Medical Biochemistry Study Group, Medical Faculty of Syiah Kuala University, Banda Aceh, 23111, Indonesia

Abstract. Disaster victims tend to have a reduction of immunity. This problem may cause the disaster victims to be susceptible for suffering from several diseases. The decreasing nutrition and exacerbated sanitation because of the current disaster are presumed to be the factors that cause the reduction of immunity on the disaster victims. But, the progress of paradigm regarding to psychoneuroimmunology conveyed that the disruption on the process of body immunity is not only determined from the external factors, but much more caused by the incapability from the victims for adapting with the encountered stressor. The failure of the adaptation will cause the distress condition. This condition causes the molecular and cellular changes in brain which are mediated by the activation of hypothalamus- hypophysis-adrenal axis (HPA axis) that causes the increment of cortisol hormone in blood in order to suppress the immune system. The suppressed immune system is not only ensued on the victims’ increment of vulnerability toward the diseases but also causes the healing process inhibition. The psychoneuroimmunology approach for the disaster victims is aimed in order to give the victims a right perception towards the received stressor so it will affect the stress response, reflected by the changes of immune system which determine the individual’s immunity quality. This happens to become a very strategic step for being done in the disaster prone areas so the society may have the optimal immune system in facing the disaster stressors.

Keyword: psychoneuroimmunology, disaster victims, stress, immunity, cortisol

INTRODUCTION

A disaster is a condition which is not expected by anyone. This condition will cause the life inconvenience and affliction for the victims. The affliction is portrayed as a condition of loss that affects the physical, emotional, and spiritual welfare. The disaster victims will have several stages of emotional reaction, such as anxiety, depression, even anhedonia, all of which will meet at a point of distress condition. The distress on disaster victims happens due to the emergence of sense of loss, separation, economic difficulty, working incapability and incapability in doing interesting activities (Nihayati, 2015). The existence of distress condition will cause an under pressure condition on the immune system which cause the bigger risk of being attacked by diseases for the disaster victims. Such

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia condition is caused by the increment of hormonal secretion, especially glucocorticoid hormone that suppresses the immune system activity. As it is known before, leucocyte cell has a receptor for glucocorticoid, whereas immune system suppression is predicted to happen because of these receptors are controlled by brain (Notosoedirdjo, 2011). That This is proven by a research that said if someone feels unhappy or depression, so there will be the suppression of Immunoglobulin A (Ig A) that causes that person can be easily attacked by infection (Lorenz & Anders, 2014). Another research shows for people that feel distress will feel lymphocyte reduction4 and the humoral or even cellular immunoglobulin reduction (Nakata, et.al., 2011). Someone becomes more susceptible to illness not only because of the stressors they are experiencing, but rather because of the way people manage and deal with stressors (coping mechanism). A person's ability to have good coping mechanisms is not self-evident, but rather a structured learning process that combines scientific, social and spiritual values. This process requires thinking from across disciplines. Departing from that, then developed a paradigm called Psychoneuroimmunology. Psychoneuroimmunology paradigm is a fundamental view of the subject matter that is based on understanding the stress cell, whether alarm, resistance (eustress), or exhausted (distress). This suggests that the essence of psychoneuroimmunology approach is an immunological approach that takes into account the influence of learning processes in the brain that produce cognition. This situation determines the suitability of individual responses to stimuli that can modulate immunity. Such a paradigm is intended to get a new axis that explains the linkage of the brain and the immune system through stress-cell communication in the brain and immune system. It is an attempt to explain the non- autonomous immunoregulation paradigm in more detail (Putra, 2011, Furtado & Katzman, 2015). The handling of disaster victims with psychoneuroimmunology approach focuses on the perception of stress and stress response. It is expected to create a good coping mechanism for disaster victims so that there will be no long-term hyperactivity condition of the HPA axis. This condition causes cortisol levels in the blood to be controlled which has implications for increasing the viability of the immune system in disaster victims.

STRESS IN PSYCHONEUROIMMUNOLOGY

Stress is a term that develops as the psychological development does. Eric Lindermann- Gerald Caplan gives a limitation that is, stress is a psychological condition that involves a cognition and emotion. The proposed limitation is having the sense of psychology. This is different with the concept of stress according to Hans Selye that defines stress as nonspecific response of the body to ay demand. The stress concept from Selye has the sense of biology. Therefore,, the concept of stress emerges from Dhabhar-McEwen that said, stressor (source of stress) will be responded by brain (stress perception) which will be responded by other systems (stress responses). Stress has several stages , all of which are activation , resistance, and exhaustion. Those stages are formulated by Hans Selye to become a term, known as general adaptation syndrome (GAS). The concept of stress from Selye is a stress concept from a psychologist which is so focus on biological function in adapting to the living environment. This concept need an understanding, regarding to stress is not only an exhaustion stage or just disadvantageous,

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia but also not supposed to be meant as always becoming disadvantageous (distress), but also can be advantageous (eustress) (Putra, 2011). The factors that may cause stress is named as stressor which can be differed to be 3 classifications, which are: 1. Physio-biological stressor, like a disease which is hard to be cured, physical defect or less functioning on one of body parts. 2. Psychological stressor, like accusation, frustration due to the failure of getting the 3. Social stressor , like the disharmony ,relation among the family members diforce, jobless, death, and job discontinuance (Putra, 2011). Disaster victims feel those three stressors. This strengthens the meaning of disaster which is, disaster is the group of stressors that if they are not treated well, it will cause the disaster victims will fall into the stage of exhaustion (distress). The disaster victims’ treatment through the psychoneuroimmunology approach is expected to make the disaster victims to have the mindset of all received stressors which will be well accepted, may result a eustress condition that will be useful for the body protection.

PSYCHONEUROIMMUNOLOGY AND IMMUNITY SYSTEM

Biomolecular changes are different between the acute and chronic stressor. On the acute stressor (duration in minutes-hours), the sympathetic system especially noradrenergic will have its activation. That kind of conditionwill happen for the light psychological stressor or along with the certain physical exercise. Otherwise on the chronic stress (duration in days-months), is a hard psychological stress and get exposed by a hard psychological stress so it will activate the HPA axis and therefore it will disturb the immunology system and the plasticity process (Putra, 2011; Dhabbar & McEwen, 1997). A stimulation or stressor may activate the HPA axis which is reflected by hormones release , which are the corticotropin realizing hormone (CRH) and vasopressin (AVP), produced by paraventricular nucleus of hypothalamus, then they will stimulate the production of adrenocoticotropic hormone (ACTH) of anterior hypophysis. ACTH will stimulate the synthesis of glucocorticoid in adrenal cortex gland. The balanced regulation of HPA axis is necessary for the cell survival. This is done through the feedback mechanism of glucocorticoid, whether in the hypophysis gland or even several components of brain, including hippocampus (Yudiarto, 2011). The existence of interaction between brain and immune system through the hypothalamus- hypophysis-adrenal axis (HPA axis) pathway. Hypothalamus and adrenal gland are able to produce neurotransmitter, neuropeptide, neurohormone, or protein mediator which may become characterized as immunosuppressive. Corticotropin realizing factor (CRF) is a coordinator of stress response. A stressed condition or thoughts may reach hypothalamus through axon, therefore will be responded by neuron in limbic system or anterior side of brain9. Norepinephrine (NE), serotonin (Ser), and Acethil colin (Ach) are the typical of important neurotransmitter, which necessarily regulate CRF release due to the existence of neurogenic stimulation. The increment of CRF secretion, followed by the increment of ACTH and cortisol content may cause the increment of IL-1,6, also TNFα, IFNα, IFN γ , all of which are proinflammative. The whole proinflammatory cytokines will be distributed in body and cause an inflammation which is basically beneficial to conduct the body immunity. But if the stressed

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia condition happens for a long periode of time, so it will cause the exhausted condition, which is a reduction of lymphocytes activity and immunoglobulin that will cause one’s immunity drop. That kind of person will be more susceptible of sickness (Yudiarto, 2011; Nasronudin, 2011). The existence of cytokines, which are proinflammative inside of tissues, will affect the paraventricular nucleus of hypothalamus for the CRF production10. This wil figure the distributed cytokines inside the tissues also give the positive feedback towards the CRF secretion so the process of stressed cells is not only caused by the external stressor but also the cross talk process from one chemical mediator to other mediators which are secreted due to the process of stress itself.

PSYCHONEUROIMMUNOLOGY TREATMENT FOR DISASTER VICTIMS

Psychoneuroimmunology approach towards disaster victims’ treatment is needed in order to improve the victims’ capability to manage the stress condition from the disaster to be a eustress condition. Eustress condition can be achieved by the victims if they look the stressor as a disturbance to be coped instead avoiding it. This condition creates a coping mechanism which stimulates the immune system to protect the victims from pathogen. Eustress condition can be acquired by forming an adaptation ability in the victims. This ability can be a psychological adaptation, a social adaptation, and a spiritual adaptation which will create a good physical adaptation towards stressors, especially to immunity system. The treatment can be applied to a victim without physical injury in other words a healthy disaster victim. But, for victims with physical injuries the compliance for physical treatment should become a priority in order to save lives. The disaster victims’ adaptation process are: a. Psychological Adaptation Psychological adaptation is addressed to support the optimal physical health condition by decreasing the victims’ anxiousness and stress. Anxiousness and stress condition happen because victims tend to feel threatened, losing control, isolated, and afraid of the death11. Psychological approaching that can be done to disaster victims including: 1. Giving them an opportunity to control themselves and choose their own activity. This will give the victims autonomy to control themselves. 2. Observing their culture and habits. This intervention will help the victims to improve their self-actualization and confidence base on ethics and social values. 3. Having internal and external dialogs. This action is beneficial to help the victims improving their confidence, self-control, problem solving, and optimism (Nursalam, 2011). b. Social Adaptation Disaster usually causes an isolated condition to the victims. This condition will increase the victims’ burden, tension, and stress. Research showed that isolated social condition is increasing physical distress which in the end will lower the immunity (Cruces, et.al., 2014). A capability to overcome this harmful condition is easier to achieve if the society not only capable to empower themselves but to one another. A support from society outside the disaster zone will greatly improve victims’ capability to cope with their condition. Social adaptation will grow if the victims realize that the disaster is there to be coped, not to be ignored or refused. Besides, they must realize that they are not the only side who has to suffer from the disaster.

By this approach, it is expected for the victims will be free from the isolation and be able to socially adaptive. c. Spiritual Adaptation The spiritual needs are the most essential and important needs for treating the disaster victims. The spiritual approach towards the disaster victims are aimed for their sincerity in facing the calamity and may take the wisdom from the befallen disaster. Spiritual adaptation on the disaster victims is reflected through their capability in controlling their emotion, courageous in facing the tragedies, having realistic hopes for their future and capable to take the wisdom (Nursalam, 2011). d. Physical Adaptation Physical adaptation is an aim from the psychoneuroimmunology approach on the disaster victims. If the victims are able to have the psychological, social, and spiritual adaptation towards the befallen disaster, it means that the victims have had the coping mechanism, so it will work on their immune system. The explanation above shows that the psychoneuroimmunology approach is a holistic approach that has body-mind and soul relation. The phenomenon is very often proven, especially in the cellular research, so then it’s proper to be developed further as a model for the social approach on community of disaster victims.

CONCLUSION

The treatment of disaster victims by the psychoneuroimmunology approach is emphasizing the stress perception and response. Those kind of perception and response are hoped may create a good coping mechanism for the disaster victims so there will not be any prolonged hyperactivity condition on HPA axis. This condition may cause the cortisol content in blood will may be controlled which implicates toward the disaster victims’ increasement of immune system viability.

REFERENCES

1 Nihayati HE. 2015. Perubahan persepsi positif dan penurunan kadar kortisol pada penderita kanker payudara yang diberi asuhan psikospiritual SEHAT (Syukur Selalu Hati dan Tubuh). Disertasi. Program Studi Ilmu Kedokteran Jenjang Doktor Fakultas Kedokteran Universitas Airlangga Surabaya: 2 Notosoedirdjo M. 2011. Psikobiologi sebagai dasar psikoneuroimunologi in Psikoneuroimunologi Kedokteran. Airlangga University Press. Surabaya: 27-32 3 Lorenz T, van Anders S. 2014. Interactions of sexual activity, gender, and depression with immunity. J Sex Med.11(4):966-79. 4 Nakata A, Irie M, Takahashi M. 2011. Psychological distress, depressive symptoms, and cellular immunity among healthy individuals: a 1-year prospective study. Int J Psychophysiol. 81(3):191-7 5 Engeland CG, Hugo FN, Hilgert JB, Nascimento GG, Junges R, Lim HJ, Marucha PT, Bosch JA. 2016. Psychological distress and salivary secretory immunity. Brain Behav Immun. 52:11-7.

6 Putra ST. 2011, Paradigma Psikoneuroimunologi menuju ke discipline hybrid in Psikoneuroimunologi Kedokteran. Airlangga University Press. Surabaya: 1-18 7 Furtado M, Katzman MA. 2015. Neuroinflammatory pathways in anxiety, posttraumatic stress, and obsessive compulsive disorders. Psychiatry Res. 229(1-2):37-48 8 Dhabhar FS, McEwen BS. 1997. Acute stress enhances while chronic stress suppresses cell- mediated immunity in vivo: a potential role for leukocyte trafficking. Brain Behav Immun. 11(4):286-306 9 Yudiarto L, Putra ST, Kasan U. 2011 Memori ditinjau dari neuroanatomi dan biomolekuler in Psikoneuroimunologi Kedokteran. Airlangga University Press. Surabaya: 205-218 10 Nasronudin. 2011. Pengaruh psikososial terhadap perkembangan infeksi HIV menjadi AIDS in Psikoneuroimunologi Kedokteran. Airlangga University Press. Surabaya: 157-172 11 Nursalam. 2011. Model asuhan keperawatan pasien di rumah sakit Terhadap Modulasi respon imun in Psikoneuroimunologi Kedokteran. Airlangga University Press. Surabaya: 173-190 12 Cruces J, Venero C, Pereda-Pérez I, De la Fuente M. 2014. A higher anxiety state in old rats after social isolation is associated to an impairment of the immune response. J Neuroimmunol. 277(1-2):18-25

THE ROLE OF PSYCHIATRIST FOR THE VICTIMS OF DISASTER

ZULFA ZAHRA

Staff, Department of Psychiatry Faculty of Medicine – Syiah Kuala University [email protected]

Abstract. Disaster is a condition that happens suddenly that can cause a very sudden change both physically and psychologically. Many disaster victims lost property, shelter, and even relatives. It is certainly not easy to accept all the losses that exist due to disastrous event and feel acceptance. The heavy burdens that disaster victims have to bear may have a negative impact on mental health, especially for people with poor stress management skills. Emotional responses that appear in each individual are different, one of which depends on the response phase of the disaster. The role of a psychiatrist is deemed necessary because it can help assess the patient's acceptance of the stressors one’s facing.

Keywords: disaster victim, psychiatrist, disaster management

INTRODUCTION

In recent times, impact of crisis is multiplied, both of natural crises such as disasters and human-made non-natural disaster. The crisis itself is defined as a state of sudden psychological disturbance caused by a great deal of pressure beyond one's ability to overcome which eventually cause a malfunction. The conditions are psychological in nature and may take different forms between individuals (Maramis, 2005; Wiguna, et.al., 2015). Some of the events that can cause a crisis include: 1. Disaster 2. Health problems and disease 3. Economic downturn 4. Accident 5. Legal problem 6. Material Lost (Maramis, 2005).

Definition

Based on Law No.4 of 2007, disaster is defined as an event or series of events that threaten and disrupt the lives and livelihoods of the community, caused by both natural and/or non- natural factors as well as human factors resulting in human casualties, environmental damage, material lost, and psychological effects (Maramis, 2005; Hidayat, 2011).

Natural disasters can include earthquakes, fires, tsunamis and floods. While non-natural disasters are disasters that can be caused by human activity itself, it may be a conflict due to human activities or human-made disaster such as the Lapindo mud eruption (Hidayat, 2011).

Phases of Disaster

Disaster consists of 3 phases, namely the pre-impact, impact and post-impact phases. 1. Pre-impact phase. Pre-impact phase or also called warning phase. In this phase there has not been any impact from a disaster, it could be because the disaster is small in size or because there has not been a disaster, such as the increase in the earth temperature and the movement of livestock from a place as one of the signs of the eruption of the mountain. 2. Phase impact. In this phase there has been a disaster in the form of a condition that exceeds the ability of a society and cause disruption in a community normal function, where the disturbance is immense that its function cannot be restored without the help and support from outsiders. In this phase each individual or group are busy looking for help. 3. Post impact phase In this post-impact phase changes in psychological condition begin to take place. According to Elisabeth Kuble Ross there are stages of psychological conditions that occur in this phase, namely: • Denial (refusal) • Anger (revolted, angry) • Bargaining (bargain,bid) • Depression • Acceptance (reception) This psychological condition can be different in each individual, according to magnitude of the disaster, support of family, number of losses that occur, and from the aspect as a victim or not. People with poor stress management skills can develop mental disorders, while good stress management skills and social support from closest people can make a person gain the ability to get through a great post-disaster situation smoothly (Maramis, 2005; Hidayat, 2011).

POST-DISASTER EMOTIONAL REACTIONS

Disasters that occur always cause changes in psychological conditions, especially if the disaster is large in scale such as tsunami or earthquake. Just like what has happened so far in Aceh. Disaster becomes a frightening, life-threatening, separated family from a loved one, loss part of the body, and cause destruction of the environmental system especially of houses, schools and places of worship. This condition causes the emergence of various kinds of emotions such as fear, sadness, guilt, anxiety, sadness and even jealousy to the survivors. Emotion is an atmosphere of feelings can be either positive or negative emotions. Every emotion that appears in both negative and positive forms is reasonable. For example, a person who loses one of his family members feels profound sadness, this emotion only becomes pathological when remains for a long period of time, affecting everyday life due to adjustment.

Emotions that arise can be sadness, anger, fear, anxiety, embarrassment or guilt. Sense of pain is a form of feeling that arises based on the disappointment, loss or failure. Sadness is very easily seen in the form of behavior, affects and cognitive aspects.Sadness causes depression, withdrawal, and difficulty in concentrating. The flood of feelings toward failure can also be in the form of anger. Anger arises when a person does not succeed in reaching his will or when forced to accept the conditions he does not want. Feelings of shame can arise when there is a failure, rejection, behavior or feelings of humiliation, and guilt. On the other hand guilt can arise from failure. In a state of disaster, guilt can arise because of failure to save the people around. Fear is an uncomfortable feeling and is a powerful emotion caused by anticipation of a disaster. Anxiety is different from fear. Anxiety is a feeling of anticipation of something that is not real or even not sure will happen.

PSYCHOSOCIAL INTERVENTIONS

Psychosocial interventions given to disaster victims are not always the same, but adjusted by the time period of the disaster and also based on the conditions of acceptance.

FIGURE 1. Community response to disaster

Based on Figure 1. There are several phases of response to the disaster, namely: 1. Predisaster In this phase has not been a disaster, such as in normal conditions or the beginning of warning as a alarm of erupting volcanoes. In this condition one can be in a prepared condition or not. 2. Impact In this phase of disaster, individuals are initially in a state of distress, fear, helplessness and confusion but usually last only a few moments, hours or days. In this condition individuals can quickly refocus to save themself and their closest

people. In this condition emotion began to emerge in the form of a sense of responsibility. 3. Heroic This phase follows the previous phase, where in this phase the individual feels compelled to help each other, emerging altruism and easily willing to help others to survive and recover without seeing their own condition. 4. Honeymoon This phase appears usually last 1 week - 6 months after the disaster. Direct victims usually develop strong sense of other danger particularly on catastrophic situation. Help, attention and hope continue to emerge in this phase. Visible emotions are usually in the form of gratitude and hope. 5. Disillusionment Usually appear within a period of 2 months - 2 years. This phase will witnessed the reality of recovery, the individual will bring up the emotions of disappointment, anger, frustration, and annoyance when faced with diminished help and attention or even when assistance come too late. Individuals who become direct victims of disasters are beginning to realize that there are many things to do on their own and that their part of life that has changed. 6. Reconstruction It usually lasts for years. Individuals and the environment have begun to rebuild their lives, many new things are starting to happen both the home environment, school and even the presence of new family members. All these changes are also accompanied by new plans (Hidayat, 2011; Ibrahim, 2003; Freightner, 1990).

THE ROLE OF A PSYCHIATRIST

Disasters always cause many problems, both in terms of material, physical and mental health disorders. Unlike the two previous ones, mental disorders are conditions that are not visible directly and immediate. Mental disorders or psychiatric problems usually do not occur immediately after disaster took place, but start to occur gradually, slowly and steadily increasing in accordance with time. As has been discussed earlier that sadness, anger and regret are normal reactions that emerged after a disaster event took place. Mental disorders occur when these emotional states continue beyond the normal time span, which is over 3 months with a persistent emotional state. In the early phase of the disaster, psychiatrists play a role as a companion. Usually the victims in this phase only need to be heard, cared for and given empathy. This mentoring role needs to be built as early as possible to prevent more severe emotional disturbance in the next phase. It is hoped that in the next phase the disaster victims will be more emotionally controlled. Emotional disturbances will be more apparent in the disillusionment phase. Relief agencies and volunteers began to disappear, local communities began to weaken. Feelings of togetherness will begin to disappear as they begin to focus on rebuilding their own lives and overcoming individual problems. Emotions of doubt, loss, sadness and isolation are very evident

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia in this phase. The role of a psychiatrist is needed to re-establish a stable emotional state. The deep disappointment and sadness and the anger appear very prominent in some individual victims of the disaster. In certain conditions even needed psycho-pharmaceutical assistance, such as antidepressants, anti-insomnia or antianxiety. In the reconstruction phase, individuals and groups of disaster victims are seem to be psychologically acceptableto the condition, but not infrequently in this phase there will be ups and downs. This condition is usually triggered by other events that trigger certain emotional reactions. Emotional responses vary between individuals in reacting to a disaster condition. This condition is partly due to personality type, family support, direct or indirect victim, and kinship with victims, education level and also economy. Individual approach is indispensable in the early stages. Group therapy also plays an important role, with the presence of togetherness to make the victims can be mutually reinforce one another (Wiguna, 2015; Linley, 2004; Lazarus, 2009).

REFERENCES

1. Maramis, W.,F., Catatan Ilmu Kedokteran Jiwa. Surabaya, Airlangga University Press (2005). 2. Wiguna, T., Citraningtyas, T., Hadisukanto, G., Understanding the mental health of children and adolescents in disaster areas. Disasters and Mental Health of Children and Adolescents. Media Aesculapius. Central Jakarta (2015). 3. Hidayat, R.,. Disaster Impact on Mental Health Aspects. Jakarta (2011) 4. Ibrahim, A., S.,. Stress and psychosomatic. Pt. Dian Ariesta. Jakarta (2003) 5. Feightner, JW., Early detection of depression by primary care physicians. Can Med Assoc J 142. (11), 1215-25 (1990) 6. Jenifer TL, Christopher, LL and Rex. Primary care of treatment of post traumatic stress disorders, American family Physician (2000). 7. Wiguna, T.,. Understanding the emotional reactions of children after the disaster. Jakarta. Division of Child and Adolescent Psychiatry. Department of Psychiatry FK UI / RSCM (2015) 8. Linley, PA,. Positife change following trauma and adversity: a review. Journal of Traumatic Stress 17 (1), 11-21 (2004) 9. Lazarus, S., Z et.al.,. Stress and emotion: A new synthesis. New York, Springer Publicashing Company (2009).

A FRAMEWORK OF BUILDING EVALUATION PERFORMANCE FOR POST-DISASTER HOSPITAL RECONSTRUCTION IN ACEH, INDONESIA

AULINA ADAMY1*, ABU HASSAN ABU BAKAR2

1Master of Public Health, University of Muhammadiyah Aceh Banda Aceh, Aceh 23245, Indonesia *[email protected] 2University of Science Malaysia, Penang, 11800, Malaysia

Abstract. Previous studies show that low quality of construction in reconstruction process is still found in humanitarian projects. There is no specific tool to evaluate post-disaster building performance in every stage of building life cycle. building performance evaluation (BPE) has been well developed and is proven to exist as a scientific contribution in construction industry specifically in developed countries. This study proposed BPE as a built-in assessment tool for reconstruction building by adding disaster risk management (DRM) variable into the framework. The objective of this study is to measure the validity and reliability of the proposed framework. Based on the literature review, the framework consists of four variables, 16 criteria and 72 items. The framework is categorized as hierarchical construct model (HCM) with reflective-reflective relationship and third order. To gauge the validity and reliability of the HCM this study used structural equation modelling based on partial least squares (PLS) analysis. Methodologically, it confirms that PLS path modelling can be used to estimate the parameters of a higher order construct. A survey was conducted by delivered questionnaires individually. As a case sample, this study focuses in public hospital which is considered as one of the most important buildings during emergency and should be priorities aftermath. The sampling method used probability sampling in four public rebuilt hospitals (type C) from post-tsunami reconstruction in Aceh, Indonesia. This study managed to collect a total of 405 respondents as building user. Result from partial least squares (PLS) analysis shows the reflective- reflective relationship with third order model is valid and reliable and all path coefficients are considered to be highly significance. The degree of explained variance of third-order post-disaster building performance construct is reflected in its second-order components, that is, built environment and building user (89%), building system (93%), and DRM (85%). This framework can be used to evaluate post-disaster hospital building performance in the future.

Keywords: evaluation performance, hospital, reconstruction, post disaster

INTRODUCTION

There are many cases where building users are not able to maintain and operate the new rebuilt buildings as the product of aid reconstruction projects (Adamy, 2009; BKRA, 2009; Government of Aceh, 2011; Jha et.al., 2010; Kirkpatrick, 1991; the Aceh Institute, 2010). One example is the case from post-tsunami reconstruction in Aceh province in Indonesia. Based on

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia the Aceh government’s asset inventory report in 2009 (Assitance Team for Aceh Governor, 2009) there are some issues related with the reconstruction buildings: administration problem faced by the local government because all the reconstruction assets not fully handover, lack of budget for operation and maintenance, some assets were not functionalized and there was a lack of human capacity to maintain and operate the assets. A synthesis report published in 2006 by Tsunami Evaluation Coalition (TEC) – a multi-agency learning and accountability initiative in the humanitarian sector established in February 2005 explained why quality continues to be such an issue in humanitarian projects is because the model quality control in normal business is driven by its costumers however, does not operate in the aid sector (Telford et.al., 2006). Meanwhile building performance evaluation (BPE) as one of the quality control tools has been proven and used for many years in many countries for commercial-business oriented projects (Leaman et.al., 2010; Shauna et.al., 2012). As stated by Bordass et al. (2001) the main drivers in building performance in use in the building industry are commercial competitiveness in seeking to reduce costs in use and add value through increased productivity. Business and humanitarian are two different sectors. Humanitarian project as not-for-profit oriented with an aim to produce a unique product for certain duration and to elevate the living condition of people (Moe & Pathranarakul, 2006). This study aims to fill the gap of BPE as business driven tools to be applicable in humanitarian sector by proposed BPE framework for post-disaster reconstruction context and validate the framework with partial least squares (PLS) path modeling estimation. According to Hair et al., reliability and validity assessment play a vital role in outer model assessment (Hair et.al., 2012).

POST-TSUNAMI RECONSTRUCTION IN ACEH, INDONESIA

Because of the unprecedented scale of the disaster and humanitarian response from around the world, the Indian Ocean tsunami of 2004 provided a turning point in the history of post- disaster reconstruction (Lyons & Boano, 2010). With projects and programs worth $7.7 billion U.S. allocated by almost 500 organizations making it the largest reconstruction project in the developing world (Takahashi, et al., 2007), Aceh’s post reconstruction experience may provide useful lessons (Masyrafah & McKeon, 2008). In responding to the Indian Ocean Tsunami disaster, the central government formed a Reconstruction and Rehabilitation Bureau for Nanggroe Aceh Darussalam and Nias Island (BRR NAD-Nias) on April 14th 2005 to lead and coordinate the post-disaster rehabilitation and reconstruction processes within four years of operational period (BRR, 2009). It is based in Banda Aceh, with a branch office in Nias and a representative office in Jakarta (capital city of Indonesia). About US$2.6 billion funds was given to the government as well as the grants from international donations and categorized as APBN (state expenditure income budget) (BRR, 2008). The entire on-budget funds were implemented directly by BRR and the projects were supposed to be completed before April 2009. After more than four years of reconstruction period, the government and aid agencies were able to repair and build 276 local assisting health clinics, 211 local health clinics, 395 village polyclinics and revitalized 28 hospitals all over Aceh (BRR, 2009). This far exceeds the number of hospitals and health services damaged by the earthquakes and tsunami (Dinkes Aceh, 2006;

Wibisana & Bitai, 2009). It should be said that health facilities before the disasters were in a state of neglect and the need for health facilities has substantially increased in the aftermath. This study focuses on hospitals that were completely rebuilt, not rehabilitation or renovation only. In the case of post-tsunami reconstruction in Aceh, only four hospitals with the same grade C falls into this category which are included in this study: Meuraxa Hospital in Banda Aceh city, Aceh Jaya Hospital in Aceh Jaya district, Nagan Raya Hospital in Nagan Raya district, and Teuku Peukan Hospital in Aceh Barat Daya district.

THEORETICAL FRAMEWORK FOR POST-DISASTER RECONSTRUCTION BUILDINGS PERFORMANCE EVALUATION

Building performance evaluation definition is the process of systematically comparing the actual performance of buildings, places and systems to explicitly documented criteria for their expected performance (Preiser & Vischer, 2005; Shauna et al., 2012). Preiser and Vischer (2005) stated that BPE, proven as a universal evaluation concept and tool, offers a broad and adaptable framework for professionals affiliated with the building industry at all levels to find ways of implementing a user-oriented, cost-effective and high quality approach to produce all types of buildings. BPE has gained credibility through a considerable amount of research and projects in the public and private sector. However, BPE is still rarely practice in developing countries (Adewunmi et.al., 2011) while they are the one whose suffer more when disasters strike (Ofori, 2001). While Thampi (2005) recommended Citizen Report Cards (CRCs) to evaluate public services, this study recommended BPE to evaluate reconstruction projects. It is highly desirable for the built environment discipline to be able to contribute to increased resilience through a strategy that is inter-disciplinary (Haigh & Amaratunga, 2010). In humanitarian sector, the usual preferred approach in trying to evaluate the effectiveness of aid is to, first – define objective, then establish measurable performance indicators, and finally evaluate aid affective against the agreed indicators (Jayasuriya & McCawley, 2010). This is similar to the BPE concept (Preiser & Vischer, 2005) therefore, indicates that BPE can be applied in aid sectors as well. Haigh and Amaratunga (Haigh & Amaratunga, 2010) reminded to consider the nature and extent of the built environment “discipline’s” potential contribution to the development of society’s resilience to disaster. Disaster management can be defined as the range of activities designed to maintain control over disaster and emergency situations and to provide a framework for helping those who are at risk to avoid or recover from the impact of the disaster (Kelly, 1996). Specifically, Disaster risk management (DRM) is a series of actions (programmes, projects and/or measures) and instruments expressly aimed at reducing disaster risk in endangered regions, and mitigating the extent of disasters (GTZ, 2002). The term DRM is used when referring to legal, institutional and policy frameworks and administrative mechanisms and procedures related to the management of both risk (ex-ante) and disasters (ex-post) (UNCHS, 2001). Assessing post-disaster reconstruction building towards disaster risk is part of disaster management by conducting DRM activities. Therefore, DRM is arguable to be included in BPE since it can be applied in every stage of building cycle that also reflects disaster timeline. Every reconstruction is unique therefore the nature and magnitude of the disaster, the country and institutional context, the level of urbanization, and the culture’s value all influence

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia decisions in managing reconstruction (Jha, 2010). In this study, the BPE for post-disaster projects is broken down following the nature of the scope of study as shown in Figure 1.

FIGURE 1. Interpretation of the post-disaster BPE framework with the scope of this study

METHODOLOGY

This study is categorized as deductive approach which emphasis on the deduction of ideas or facts from the new theory in the hope that it provides a better or more coherent framework than the theories that preceded it (Pathirage et al., 2008). The quantitative approach is based on survey method with individually delivered questionnaires distribution. The sample units are individual people from building users. Both groups of population, hospitals’ staffs and hospitals’ visitors use probability sampling since the list of population is available. A five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) was adopted to capture the performance of hospital buildings in Aceh. Totally 670 questionnaires were sent out to the four hospitals. 107 respondents or 48.6% replied to the survey in Meuraxa Hospital. 90 respondents or 75% replied in Aceh Jaya Hospital. 100 respondents or 67% replied in Nagan Raya Hospital survey and 108 respondents or 60% replied in Teuku Peukan Hospital. Overall, the response rate is 60% or 405 respondents.

DATA ANALYSIS

Hierarchical constructs or multidimensional constructs can be defined as constructs involving more than one dimension. The framework for BPE for post-disaster reconstruction hospital

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia building is categorized into hierarchical construct model with three orders level shows in Figure 2. The first-order has 16 criteria (A until P) that are distributed under second-order where there are four main variables: built environment and building user, building system, and DRM. Those main variables are under “post-disaster building performance” variable which is categorized as third-order. With four variables, 16 criteria and 72 items, the nature of this study required many factors to be evaluated to gain a holistic perspective of building performance. Douglas (1996) states that to assess how well a building is behaving overall and in the long term, a more holistic approach is needed. Therefore, developing performance metrics is an important step in the process of performance evaluation as it includes relevant indicators that express the performance of the facility in a holistic manner (Lavy et al., 2010). The use of a higher-order construct allows researchers to achieve far more theoretical parsimony and reduce complexity (Edward, 2001; MacKenzie et al., 2005).

FIGURE 2. Post-disaster BPE framework for hospital building in Aceh

The measurement approach in this study uses reflective measurement since this study explores indicators from each construct and has no prediction relationship. The 16 criteria role is to measure four variables or to measure post-disaster reconstruction building performance and not as a prediction (causes). Reflective indicators can be viewed as a representative sample of all the possible items available within the conceptual domain of the construct (Hair, 2013). All indicators in this model share a common theme and dropping and indicators should not alter conceptual domain of the construct. Any single item can generally be left out without changing the meaning of the construct, as long as the construct has sufficient reliability (Martinez & Aluja, 2009).

The conceptual grounds in HCM are complemented by two empirical points: reliability and validity of measures of the multidimensional constructs (Edwards, 2001). According to Wetzels et al. (Wetzels, 2009), as the heterogeneity of the dimensions of the multidimensional construct increases, the internal consistency of the summed dimension scores will eventually be reduced. Furthermore, Law et al. (Law et al., 1998) emphasized that the construct validity of the dimension measures has been questioned, as it contains large amounts of specific and group variance

PARTIAL LEAST SQUARES (PLS) PATH MODELING ANALYSIS

Generally, HCM using latent variables can be estimated using structural equation modeling (SEM). Both covariance-based SEM and component-based SEM can be employed to estimate the parameters in a hierarchical model (Wetzels et al., 2009). However, with covariance-based SEM involves various constraints regarding the distributional properties (multivariate normality), measurement level, sample size, model complexity, identification, and factor indeterminacy (Chin, 1998; Fornell & Bookstein, 1982). These limitations might be avoided entirely with the use of component-based SEM or PLS path modelling (Chin, 1998). Chin and Newsted (1999) observed that PLS path modeling is generally more suitable for studies in which the objective is prediction, the phenomenon under study is new or changing (i.e. theoretical framework is not yet fully crystallized) (Hair & Sarstedt, 2011; Ruiz & Aluja, 2009), and the model is relatively complex (i.e. large number of the manifest and latent variables). As this study objective is to develop BPE theory into disaster management context therefore, the HCM in this study is applicable to be assess by PLS path modeling. PLS path modeling allows for the conceptualization of a hierarchical model through the repeated use of manifest variables (Guinot et al, 2001; Lohmoller, 1989; Noonan & Wold, 1993; Tenenhauset al., 2005). Consequently, the manifest variables are used in each level of order: for the first-order latent variable (“primary” loadings) and for the second-order latent variable (“secondary” loadings) (Wetzels et al., 2009) and so on. This study used PLS path modelling version 2.0 to construct the reflective HCM using the three key steps. Finally, the hierarchical model can be estimated by using PLS modelling. It obtains estimates for first-order loadings, second-order loadings, and third-order loadings. To assess the psychometric properties of the measures, this study specified a null model for the first-order latent variables, in which included no structural relationships.

TABLE 1. Reliability of Higher Order Construct

Construct Loading AVE CR Building Form Material 0.908

Building Quality 0.873

Built Environment& Engineering 0.877 0.550 0.962 Building User Access 0.509 Staff & Patient 0.953 Environment Safety 0.913 Health 0.876 Order - Comfort 0.852

Building System Easiness 0.818 0.525 0.960

Second Control Environment 0.852 Impact Architecture 0.822 Sustainability 0.911

Disaster Resilience 0.878

DRM 0.627 0.962 Functionality 0.893 Local Capacity 0.898

- Built Environment 0.942

Building System 0.965 BPE 0.501 0.983 Order Third DRM 0.924

To assess the reliability of the measures, the PLS calculated the composite scale reliability or CR (should be >0.7) and average variance extracted or AVE (should be >0.5) (Fornell & Bookstein, 1982). All items had the CR exceed .80, and the AVE of all measures compellingly exceed .50, the lowest AVE is 0.638 in the null model. All items also have a loading number higher than .70. A rule of thumb generally accepted is 0.7 or more (Ruiz & Aluja, 2009). In Table 1 shows that the loadings of the first-order latent variables on the second-order factors exceed 0.8 which are similar with the loadings of the second-order latent variables on the third- order factors are exceed 0.8. However, the AVE values for BPE variable in the third-order are less than cut-point of .5 (AVE=.4470). Therefore, this study checked again all items with very small loading number in the second and third orders and deleted those items. After 14 items were deleted, the AVE values for BPE exceeded .5 (AVE=.5010). The elimination of items whose factorial loading below 0.5, improves the AVE of the second and third orders constructs. In reflective relationship construct, all indicators in the model share a common theme and dropping and indicators should not alter conceptual domain of the construct (Chin & Newsted, 1999). The items that were deleted are D3, D4, D5, D6, D7 (under Access), A5 (under Building Form and Material), B4 (under Building Quality), MI, M2, M3 (under Operational and Maintenance Guidelines), C5 (under Engineering), H4 (under Comfort), O6 (under

Functionality), and L5 (under Sustainability). This impacted the rest of the results. The items displayed are only the items that were not deleted. Reflective measures are expected to be unidimensional, and if so, individual measures can be removed to improve construct validity without affecting content validity (Akter et al., 2010). A nonparametric bootstrapping procedure used with 200 replications and construct level changes pre-processing to obtain the standard error and calculate t-statistic for inferential purposes (Wetzels, 2009). To assess the significance loadings, weights and path coefficients, standard error and t-values may be computed by bootstrapping (200 samples; t-values >1.65 significant at the .05 level; t-value >2 significant at the .01 level) (Ruiz & Aluja, 2009). The result from bootstrapping where all the path coefficients in the model are considered high significant (p<0.001). The measurement model was considered satisfactory with the evidence of adequate reliability, convergent validity and discriminant validity.

RESULTS AND DISCUSSION

In order to analyze the HCM holistically, this study used the approach of repeated indicators (Wetzels et al., 2009) in estimating the higher-order latent variables and confirmed adequate measurement and structural properties for the proposed model by using PLS-SEM estimation. In general, PLS-SEM studies should provide information on the population and sample structure; the distribution of the data; the conceptual model; and the statistical results to corroborate the subsequent interpretation and conclusion which all has discussed in the previous section. According to Akter et al. (Akter et al., 2010) that variance of second order constructs is reflected in its corresponding first order construct. The degree of explained variance of third- order post-disaster building performance construct is reflected in its second-order components, that is, built environment and building user (89%), building system (93%), and DRM (85%). The result from bootstrapping shows that all the path coefficients in the model are considered highly significant (p<0.001). The framework offers an estimation of building performance in the context of post-disaster reconstruction holistically. If researchers and practitioners are able to contribute to an inter-disciplinary strategy for disaster risk reduction through buildings, spaces and places, it is important that a suitable conceptual framework is developed that explores the interaction between the built environment, its disciplines, and the disaster management process (UNCHS, 2001).

CONCLUSION

This study proposed disaster risk management (DRM) to denote disaster management paradigms in BPE theoretical framework. Overall, the new adaptation framework is categorized as HCM with reflective relationship and third-order construct. Most constructs in management research are multidimensional. The main objective of this study is to validate the multidimensional construct model with PLS path modeling analysis. The results provide empirical support for the second- and third-order latent variables which the entire path coefficients are valid and reliable. The new adapted model “post-disaster reconstruction building performance evaluation” is part of inter-disciplinary strategy between built environment knowledge to contribute to disaster risk management practice.

The reconstruction process should be considered as a development opportunity and should open the door to different types of innovative solutions. Proposing BPE as an evaluation system in post-disaster reconstruction hospital buildings not only leads to vulnerability reduction but also enhances human security in long term. Many leading healthcare experts firmly believe that the arts and environment have an important part to play in improving the health and wellbeing of people in many ways.

ACKNOWLEDGMENT

The authors thank the Universiti Sains Malaysia (USM) Fellowship for three years of financial support for this study.

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IMMUNE MODULATION POST NATURAL DISASTER

NUR WAHYUNIATI1*, REZA MAULANA2, ICHSAN3

1Department of Parasitology, Faculty of Medicine, Syiah Kuala University, Darussalam, Banda Aceh, Indonesia *[email protected] 2Department of Anatomy and Histology, Faculty of Medicine, Syiah Kuala University, Darussalam, Banda Aceh, Indonesia 3Department of Microbiology, Faculty of Medicine, Syiah Kuala University, Darussalam, Banda Aceh, Indonesia

Abstract. Disaster experiences have been associated with higher prevalence rates of (mental) health problems. Severe psychological and/or physical stress from disaster experiences can result in homeostatic imbalances and abnormal immune responses. Internal or external stress induces cytokine imbalances that play important roles in the expression and continuity of depressive symptoms in vulnerable individuals. Stress simultaneously activates the hypothalamicpituitary- adrenal (HPA) axis and the sympathoadrenal system (sympathetic nervous system and adrenal medulla). Stress can upregulate components of the immune system involved in inflammation. Heightened neuroinflammatory responses to social stress may increase a person’s risk for a number of diseases that involve inflammation. Psychoneuroimmunology (PNI) as an interdisciplinary field that examines the relationships between psychological factors (behavioral) and changes in neural, endocrine and immune processes/ function, with possible consequences for health status able to answer the concepts of immune modulation due to stress occurs after natural disaster.

Keywords: disaster, immune modulation, psychoneuroimmunology

INTRODUCTION

Disasters cause a wide range of health impacts. Although there remains a need to understand and improve acute disaster management, a stronger understanding of how health is affected in the medium and longer term is also required to inform the design and delivery of measures to manage post-disaster health risks, and to guide actions taken before and during events which will also lead to reduction in health impact (Nomura et al, 2016). Early intervention is needed following disasters, especially when the disaster is associated with extreme and widespread damage to property, ongoing financial problems for the stricken community, violence that resulted from human intent, and a high prevalence of trauma in the form of injuries, threat to life, and loss of life (Norris et al., 2002). The notion that psychological stress can affect mental and physical health is extremely popular nowadays. Negative emotions can intensify a variety of health threats. Production of proinflammatory cytokines that influence these and other conditions can be directly stimulated by negative emotions and stressful experiences, such as natural disaster. Additionally, negative emotions

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia also contribute to prolonged infection and delayed wound healing, processes that fuel sustained proinflammatory cytokine production. Stress exposure increases risk for poor clinical outcomes across a variety of major health conditions, including rheumatoid arthritis (Cutolo & Straub, 2006), depression (Kendler et al., 1999; Monroe et al., 2007), cardiovascular disease (Kivimaki et al., 2006), chronic pain (Loeser & Melzack, 1999), human immunodeficiency virus/AIDS (Leserman, 2008), ovarian cancer (Lutgendorf et al., 2013) and breast cancer (Bower et al., 2014). Stress has also been implicated in accelerated biological aging and premature mortality (Kiecolt et al., 2002; Epel et al., 2004).

NATURAL DISASTER AND HEALTH IMPACTS

Disasters are events that challenge the individual's ability to adapt, which carries the risk of adverse mental health outcomes including serious posttraumatic psychopathologies. While risk is related to degree of exposure to psychological toxins, the unique vulnerabilities of special populations within the affected community as well as secondary stressors play an important role in determining the nature and amount of morbidity. Disasters in developing countries and those associated with substantial community destruction are associated with worse outcome (Davidson & McFarlane, 2006). Communicable diseases were found to be the predominant syndrome group in all three natural disaster types (flood, earthquake, typhoon) in the Philippines in 2013. The top six syndromes found were: acute respiratory infections, open wounds, bruises and burns, high blood pressure, skin disease, fever, and acute watery diarrhea. The most common syndromes can be addressed by measures such as providing for shelter, water, sanitation, hygiene, nutrition, and common health services. Most post-disaster syndromes may be addressed by prevention, early diagnosis, and early treatment (Salazar et al., 2016). Although acute responses are ubiquitous, few disasters lead to posttraumatic psychopathology in the majority of people exposed. Disaster experiences have been associated with higher prevalence rates of (mental) health problems. Social determinants exert a powerful influence on different elements of risk, principally vulnerability, exposure and capacity, and thus, on people's health. Regardless of health outcomes and event types, the influence of disasters on chronic heath persists beyond the initial disaster period, affecting people's health for months to years (Nomura et al., 2016; Van den Berg et al., 2012). Social organizational stressors are well-known predictors of mental health disturbances (MHD). Disaster exposure independently predicted symptoms of PTSD symptoms. A social network analysis (SNA) used as a methodology to investigate community resilience after the December 2004 tsunami and the March 2005 earthquake which struck both Nias and Aceh, Indonesia. Through the analysis focuses on the urban and rural gradients shows how victims' personal characteristic such as religion, ethnicity and gender create different community's circles of social support (Guarnacci, 2016). Exposure to the earthquake was associated with multidimensional impairment in Quality of Life (QOL), including physical, psychological and environmental domains at 3 months, and psychological and environmental domains at 9 months. The victims also suffered significantly more psychological distress in terms of depression, somatization and anxiety. Post-disaster variables could be as important to post-disaster psychosocial outcomes as variables of pre- disaster vulnerability and disaster per se (Wang et al., 2000).

Hurricane Katrina had significant negative impacts on the mental and physical health of Vietnamese New Orleanians. A study investigated pre- to post-disaster changes in happiness of 491 women affected by Hurricane Katrina. A predictive of lower happiness 1 year post-disaster is associated with hurricane stressors and losing a loved one to the hurricane. Four years after the hurricane only exposure to hurricane stressors was predictive of lower levels of happiness. In contrast, pre-disaster happiness and post-disaster social support were protective against the negative effect of the hurricane on survivors' happiness (Calvo et al., 2014; Vu & Van Landingham, 2012). Trauma exposure and pre-disaster vulnerability factors is a predictors of chronic psychopathology. increased risk of psychopathology can persists 27 years after disaster. Both disaster exposure and vulnerable personality are important predictors of chronic psychopathology. Depression and anxiety disorders were common among disaster victims 2.5 years after the 2004 tsunami in Khao Lak, Thailand. Psychiatric disorders other than PTSD, especially depressive disorders, are of clinical importance when considering long-term mental health effect of disasters. Pre-disaster psychological problems and inevitable relocation were predictors of more post-disaster psychological problems. Survivors of disaster with pre-disaster psychological problems are believed to be at risk for presenting post-disaster psychological and physical morbidity. Post-disaster psychological problems were more influenced by the disaster, while post-disaster physical symptoms were more influenced by pre-disaster psychological problems (Boe et al., 2011; Hussain et al., 2011; Soeteman et al., 2006; Yzermans et al., 2005).

IMMUNE MODULATION THROUGH PSYCHONEUROIMMUNOLOGY

Psychoneuroimmunology (PNI) is an interdisciplinary field that examines the relationships between psychological factors (behavioral) and changes in neural, endocrine and immune processes/ function, with possible consequences for health status. Bidirectional pathways/ interactions connect the brain and the immune system and provide the foundation for neural, endocrine, and behavioral effects on immunity. Neuroendocrine influences modulate immune function, and there is feedback from the immune system to the brain. CNS-immune interaction appears to play a role in psychosocial influences on immunologically resisted and mediated diseases. There is a growing literature suggesting that psychosocial stressors can impact negatively on health through deleterious changes in immune function, but finding clinically relevant measures of immune function is still an important challenge in psychoneuroimmunological research (Kennedy, 2016; Tausk et al., 2008; Solomon, 1987; Burns, 2012). Historically, clinicians have suspected that both major and minor stressful events can have health implications. Observations and case reports link severely stressful life events with a sudden onset or worsening of a variety of illnesses. The immune system was quickly implicated as a means to help explain how stressful life events could produce this relationship. The mammalian response to stress involves the release of soluble products from the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. Cells of the immune system respond to many of the hormones, neurotransmitters, and neuropeptides through specific receptors. The function of the immune system is critical in the mammalian response to infectious disease. A growing body of evidence identifies stress as a cofactor in infectious

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia disease susceptibility and outcomes. It has been suggested that effects of stress on the immune system may mediate the relationship between stress and infectious disease (Sheridan et al., 1994; Ader et al., 1995). Severe psychological and/or physical stress can result in homeostatic imbalances and abnormal immune responses. Several hypotheses have proposed that immunologic imbalances affect the central nervous system (CNS) and result in psychopathology. Depression is a disease that is associated with changes in the CNS that might be caused by immunological abnormalities. Recent clinical and experimental studies have confimed that internal and external stress significantly affects the expression of depressive symptoms and their persistence in vulnerable individuals with immunological abnormalities. Moreover, cytokines affect the activity of the two biological systems that are most associated with the pathophysiology of depression: The hypothalamicpituitary-adrenal (HPA) axis and the catecholamine/ sympathetic nervous system. The CNS affects the immune system through the autonomic nervous system and the neuroendocrine system. Reciprocally, the immune system affects the CNS through cytokines secreted by immune cells that regulate brain activities and emotions. Thus, the immune system can be regarded as a sensory organ that recognizes internal or external stress. Stress can trigger overall changes in the immune system, neurotransmitters, neuroendocrine system, and CNS, and their interactions contribute to the expression, continuation, and termination of depressive symptoms. This psychoneuroimmunologic perspective suggests that depression is mediated by inflmmatory responses and cytokines, and that the disease results from a failure to adapt to stress. This view might compensate for some of the limitations of the monoamine theory, which is an important psychopathologic model of depression (Jeon & Kin, 2016). Cortisol secreted from the adrenal cortex as a result of HPA-axis activation is most important in peripheral cytokine production. When cortisol levels are low, the production of proinflmmatory cytokines increases, while their production is inhibited when cortisol levels are high. Neurotransmitters regulate peripheral cytokines through cortisol levels (Jeon & Kin, 2016).

FIGURE 1. The role of cytokine network in depression in connection with immune system, hypothalamicpituitary-adrenal axis, neurotransmitter, and autonomic nerve system (Jeon & Kin, 2016).

STRESS-CYTOKINE-INFLAMMATION-DEPRESSION

According to the cytokine hypothesis (Figure 2), internal or external stress induces cytokine imbalances that play important roles in the expression and continuity of depressive symptoms in vulnerable individuals. Neuroinflammation and cytokines, which affect patterns of brain signal transmission, are important in the psychopathology of depression and mechanism of antidepressants. Furthermore, they are associated with neurogenesis and neural plasticity in the brain. Thus, neuroinflammation and cytokines appear to cause or continue depression and might be useful for determining the diagnosis and prognosis of depression. Epidemiological studies support the view that increased levels of IL-6, IL-1ra, and C-reactive protein (CRP) can

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia be harnessed to predict the occurrence of depression. A recent meta-analysis demonstrated that the markers of inflammation with relatively consistent increases in patients with depression are IL-6, TNF-α, TNF-β1, IFN, and CRP (Jeon & Kin, 2016).

FIGURE 2. Schematic representation of neuroinflmmatory pathways in the pathogenesis of depression (Jeon & Kin, 2016).

CYTOKINES AND CENTRAL NEUROTRANSMISSION

Stress simultaneously activates the HPA axis and the sympathoadrenal system (sympathetic nervous system and adrenal medulla). The most important stress response is activation of the noradrenergic (NA) neurons, which show stress responses through pathways from the locus coeruleus to the cortex, hippocampus, and cerebellum, and from the nucleus tractus solitarius to the hypothalamus. According to this hypothesis, acute psychological stress triggers tryptophan defects and mood swings. To correct the 5-HT imbalance, 5-HT synthesis and receptor expression are modified. This is the first stage of coping with psychological stress. If the psychological stress is chronic, the levels of proinflmmatory cytokines increase. The levels of proinflammatory cytokines also increase in cases of physical stress or chronic diseases. These increases in proinflammatory cytokines trigger an increase in the levels of anti-inflammatory cytokines as a compensatory mechanism in order to maintain balance. This is the second stage. If the balance is not maintained and the levels of proinflammatory cytokines increase

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia excessively, animals show sickness behaviors, while humans show depressive symptoms. The increased levels of proinflammatory cytokines activate the IDO enzyme and accelerate the metabolism of tryptophan to kynurenine. The level of 5-HT in the brain decreases, which further aggravates the symptoms of depression in individuals vulnerable to depression. Through the complicated tryptophan metabolism process, the neurodegenerative quinolinate and the neuroprotective kynurenate are formed in the brain. This is the third stage, which is important for maintaining balance between neurodegeneration and neuroprotection (Figure 2) (Jeon & Kin, 2016). Stress induces inflammatory responses through cytokine secretion. Cytokines are secreted from peripheral immune cells and central immune cells. Chronic stress activates brain microglia, which secrete cytokines and in turn affect neurogenesis. Neurogenesis is either inhibited or stimulated according to the level of microglia activation (Jeon & Kin, 2016). From a psychoneuroimmunological point of view, the immune, endocrine, and neurotransmission systems closely interact with each other, and inflammation acts as an allostatic load to disconnect them. Depression can be caused by these functional impairments. The sickness behaviors that are observed under inflammatory conditions are similar to depressive symptoms, and some cytokine treatments lead to depression. These results confirm the association between inflammation and depression. Cytokines including IL-1, IL-2, IL-6, IFN- γ, and TNF-α, and hormones like CRF and glucocorticoid have been suggested as inflammation markers. Inflammatory responses that are thought to affect the synthesis and transmission of neurotransmitters, glucocorticoid resistance, and neurodegeneration/neurogenesis contribute to the onset of depression and inhibit recovery (Jeon & Kin, 2016). Stress can upregulate components of the immune system involved in inflammation (Segerstrom & Miller, 2004; Slavich & Irwin, 2014). Moreover, consistent with the stress–health links described above, there is emerging evidence showing that stressors involving interpersonal loss and social rejection are among the strongest psychosocial activators of molecular processes that underlie inflammation (Murphy et al., 2015; Murphy et al., 2013; Slavich et al., 2010). Although inflammation is typically thought of as the body’s primary response to physical injury and infection, researchers have recently identified that inflammation plays a role in several of the most burdensome and deadly diseases (Couzin, 2010; Slavich, 2015), thereby making inflammation a potential common pathway linking stress with several disease states. Although life stress is a strong risk factor for disease, not everyone who experiences stress gets sick. As a result, some researchers have turned to the brain to understand individual differences in how people experience stress, as well as how the brain initiates downstream biological processes that promote disease (Slavich, 2016). If repeatedly engaged, however, heightened neuroinflammatory responses to social stress may increase a person’s risk for a number of diseases that involve inflammation (Slavich & Irwin, 2014; Nusslock & Miller, 2016). Recent research has also begun to examine how social stressors affect the activity of the human genome (Slavich & Cole, 2013). Because people cannot detect changes in their own genomic activity, they generally experience their bodies as being biologically stable over time and across the different social and environmental circumstances they experience in daily life. In reality, though, the human genome is continually shifting its activity to coordinate biological processes that are needed to sustain life and to calibrate the body to deal with the surrounding social, physical, and microbial environment. Some of the earliest work on this topic found that living in a rural versus urban environment has a substantial effect on individuals’ genomic

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia profile (Idaghdour et al., 2008). More than 200 genes were differentially expressed in lonely versus non-lonely individuals. Because many of those differentially expressed genes are involved in immune system activity, including inflammatory responding and the antiviral response, these data provided some of the first indications that experiences of social stress and adversity may affect disease risk and mortality in part by influencing some of our most basic biological processes—namely, the expression of our genes. The notion that stress can exert biological “wear and tear” on the body that develops over time is not new. Indeed, several theorists have proposed different models for how acute life events and chronic difficulties may accumulate and disrupt biological systems that lead to altered neural and immune system function, oxidative stress, accelerated biological aging, and ultimately different disease states and premature mortality (Graham et al., 2006; Lupien et al., 2009; McEwen, 1998).

REFERENCES

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MITIGATION OF DISASTER THROUGH AWARENESS ON BIODIVERSITY CONSERVATION

TRINA EKAWATI TALLEI

Department of Biology, Faculty of Mathematics and Natural Science, University of Sam Ratulangi Kampus UNSRAT Manado, 95115, Indonesia [email protected]

Abstract. Biodiversity encompasses managed and unmanaged ecosystems. It forms the foundation of ecosystem service that contribute to well-being of human. In addition, biodiversity is also a source of food and medicine, so the loss of biodiversity can threaten the welfare of mankind. However, the vast growing of human population demands improvement of human livelihoods and at the same time biodiversity faces major threats. Biodiversity is currently also facing major lost due to climate and human- driven environmental change. This phenomenon can cause disaster, such as droughts, floods, landslides, and others. Policies on biodiversity conservation have been outlined in various development planning. But in practice, various government policies put economic growth above all else. It is time for biodiversity conservation to be integrated into the disaster management cycle in mitigation phase. Things that pose a threat to biodiversity includes habitat destruction, over-exploitation, forest conversion, competition by exotic species, and invasion of alien species. Public awareness to conserve biodiversity needs to be increased. Efforts to increase community awareness of biodiversity conservation are through education and training, by infusing biodiversity conservation within the school curriculum. Communities, especially school children, can be trained to be agents of change to convey the message of biodiversity conservation in the effort to mitigate disasters.

Keywords: biodiversity, conservation, disaster, education, mitigation

INTRODUCTION

Natural disasters are natural events that can harm people or have the potential to cause harm. Although natural disasters are difficult to prevent, efforts to reduce the risk of natural and man-made disasters can be done. Some examples of natural disasters are drought, forest fire, tornadoe, typhoon, earthquake and tsunami. Examples of mand-made disasters are chemical spill, groundwater contamination, bioweapon, nuclear power blast, and cyber terorism. Law no. 24 of 2007 defines disaster as an event or series of events that threaten and disrupt people's lives and livelihoods, Which is caused by both natural and / or non-natural factors as well as human factors resulting in the occurrence of human casualties, environmental damage, loss of property, and psychological impact. There are three basic aspects of disaster: (1) Occurrence of threatening or destructive events; (2) Such events or disturbances threaten the lives, livelihoods, and functions of society; and (3) Such threats result in casualties and beyond the ability of communities to cope with their resources.

Increasing public awareness on natural disaster can be achieved among others through education (Muttarak & Pothisiri, 2013) and mass media (Charkhsaz et al., 2016). They must be made aware of the consequences from natural hazards they may face which can be life threatening and motivated to initiate preparedness actions Sattler et al., 2000). Article 1, paragraph 6 of Government Regulation No. 21 of 2008 on Disaster Management Implementation states that mitigation is a series of efforts to reduce disaster risks, both through physical development and awareness and capacity building for disaster threats. Education on disasters can be done by describing the stages in disaster management, which include pre- disaster, emergency response, and post-disaste (Khan et al., 2008). Pre-disaster management is a mitigation activity undertaken in order to prevent the occurrence of natural disasters so that later can reduce the losses caused by natural disasters itself. There are four important things in disaster mitigation: (1) The availability of information and map of disaster prone areas for each type of disaster; (2) Socialization to increase public awareness and awareness when faced by disaster due to live in disaster prone areas; (3) Knowing what needs to be done and avoided, and knowing how to save oneself when a disaster occurs, and (4) Setting up and structuring of disaster prone areas to reduce disaster threats. The growing number of human population provides a high burden for the environment. Increasing human population means the need for food and shelter is also increasing. These needs can not be separated from the exploitation of environmental resources and the expansion of residential areas. If not managed sustainably then the existing resources become disrupted. Currently the rate of environmental damage and natural resources is at an alarming point. Environmental damage is caused by excessive exploitation of natural resources by the formal sector as well as public pressure in utilizing natural resources. Therefore, biodiversity management needs to be balanced, ecologically, economically, and socially (Laurila et al., 2015). Conservation efforts are among the alternative to overcome this problem in order to make sustainable use of natural resources while ecosystems and biodiversity are always protected (Xu et al., 2017). Conservation activities should be sustainable, equitable and beneficial to communities in the vicinity of conservation areas. This paper aims to promote and disseminate the importance of biodiversity conservation in mitigating natural disasters, especially in vulnerable areas.

BIODIVERSITY CONSERVATION

Biodiversity refers to the variety of the whole species present on earth. According to the United Nations Environment Programme (UNEP), biodiversity encompasses variation at the genetic, the species, and the ecosystem level. Biodiversity maintains ecosystem balance and contributes to human well-being (Ingram et al., 2012; Bélair et al., 2010). In the aim of protecting species, their habitats, and ecosystem from being lost, biodiversity needs to be conserved. Biodiversity conservation may help reduce the impacts of natural disasters (Briceńo, 2004), because biodiversity lost can destroy the ability of the nature to bounce back from disaster (MacDougall, 2013). The richer the biodiversity the quicker the earth can recover from disasters. The large-scale disasters cannot be entirely avoided, however, through better ecosystem management, its impact can be mitigated. Biodiversity is the foundation of human health and it has been highlighted as an important issue for the post-2015 development agenda. The consequences of continuing loss of biodiversity include species extinction,

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia imbalance ecosystem, and decrease in ecosystem function (Naeem, 2009); all of them will lead to the disaster and may increase the risk of infectious disease transmission. Ecosystem stability often depends on species and its composition. Biodiversity and human health are interlinked in various ways, extensive and complex. Sustainable use of biodiversity has positive impacts on human health. Biodiversity loss leads to reduce in food and medicinal sources (Pranab, 2016), with its consequence to reducing human health and fitness. Environmental and natural resource management policies have been integrated into applicable laws and regulations, and outlined in various development planning policies. Each of these legislation has a special section that talks about the environment, including the policy on conservation.

DISASTER RISK REDUCTION

Every year, millions of people are impacted by man-made and natural disasters. The vulnerability of a region to disasters depends on many factors including exposure, susceptibility, coping capacities, and adaptive capacities. Exposure refers to the elements at risk from a natural or man-made hazard event in exposed area. Susceptibility includes many factors such as economic, sosial, cultural, political, institutional, and psychological factors that shape peopole’s lives and their surrounding environment (Twigg, 2004). Coping capacity refers to the ability of people or system to use available skills and resources to manage adverse conditions, risk or disasters. Adaptive capacity is the capacity of a system to adapt to a changing environment. World Health Organization defines disaster as a sudden ecological phenomenon of sufficient magnitude to require external assistance. Disasters often follow natural hazards, and the severity depends on its impact on environment and society. There is risk to disaster, which is the combination of the severity and frequency of a hazard, the numbers of people and assets exposed to the hazard, and their vulnerability to damage (UNISDR, 2015). Reduction of disaster risk involves planning through comprehensive systemic analysis to reduce the disasters causal factors. A disaster can have consequences on health and can occur without warning. Mitigation to disaster risks requires careful planning, among other is through biodiversity conservation (Doswald & Osti, 2011).

STRENGTHENING THE LINKS BETWEEN DISASTER RISK MANAGEMENT AND BIODIVERSITY COSERVATION STRATEGIES

In order to be able to reduce the impact of disaster, mitigation needs to be assessed and implemented carefully through good management practice (Usman et al., 2013). Hazard cannot be completely prevented but its vulnerability can be reduced by increasing the capacity of the community to take action before, during, and after disaster (Sena, 2006). In mitigation phase, the awareness of community is increased to prevent the damage caused by disaster from reoccurrin (Lindell, 2013). An important step in mitigation phase in a successful disaster management is the awareness on biodiversity conservation. Convention on Biological Diversity recognizes that biodiversity is more than living things and their interaction with their ecosystems. It is about food security (Sunderland, 2011), medicines (Bernstein, 2008), and healthy environment (Sandifer et al., 2013).

The main threats to biodiversity include habitat degradagation, fragmentation, and losss, the spread of invasive species, climate change, and unsustabile use of natural resources. International policies have supported the ecosystem-based approaches to disaster risk reduction because it contributes to the achievement of the Strategic Plan for Biodiversity 2011-2020 (Lo, 2016). Biodiversity conservation to halt biodiversity loss is a part of sustainable development goals and it may help reduce the impacts of natural disasters. However, sustainable development goals is a dynamic concept which needs to involve public awareness through education and training to create or enhance an understanding of the linkages among the issues of sustainable development and to develop the knowledge, skills, perspectives and values (Tallei, 2009). The cycle of disaster management (Schwab et al., 2007; Coppola, 2007) which integrates biodiversity conservation in mitigation phase as shown in Figure 1 illustrates the continuous process which need to be taken, not only by government but society as well. This effort will empower people of all ages to assume responsibility to prepare disaster through biodiversity conservation for a sustainable future. There are wideworld examples on infusing biodiversity conservation in school curriculum. Tallei and Saroyo (2009) performed the workshop on biodiversity conservation for high school teachers and realized that there was an improvement in teachers’ understanding about concept of conservation after following the workshop. Ramadoss and Poyyamoli (2010) promoted students’ commitment to protect local biodiversity. They found that the education program increased students’ knowledge, interest, and skills to protect and conserved local natural resources and biodiversity. Shemdoe (2015) suggested that the entry point to sustainable biodiversity conservation was to integrate participatory approach based-sustainable management on the extracurricular activities of students in secondary schools.

EVEN

Preparedness Response

Migaon Recovery

Figure 1. Integration of biodiversity conservation in disaster management cycle

McKeown (2002) also suggested the importance of teachers in enhancing awareness about the sustainability of biodiversity. This can be achieved by having the teachers trained in enhancing their skill and knowledge as well as developing curriculum about the risk reduction

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia preparedness. Afterall, education still amongst one of the means in spreading knowledge about sustainable development in various aspects. The biodiversity conservation curriculum maybe designed for students and community to gain knowledge on the coservation methods, to carry out simple biodiversity assessment, and to design a monitoring program.

CONCLUSION

Disaster mitigation can be achieved among others by infusing biodiversity conservation in local curriculum of high School students. First step is to train teachers about preparedness to disaster risk through biodiversity conservation and the second is to design its curriculum accordingly. School children can be trained to be agents of change to address the message of biodiversity conservation to mitigate disasters.

ACKNOWLEDGMENTS

This work was supported by The Support to The Development of Higher Education Project, Islamic Development Bank 7in1, Sam Ratulangi University, through Penelitian Unggulan Perguruan Tinggi (University Competitive Resesarch Grant) Fiscal Year 2017.

REFERENCES

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for the benefit of biodiversity and human well-being.’ (2010). Secretariat of the Convention on Biological Diversity, Montreal. Technical Series no. 52, 184 pages. 9. S. Briceńo, Natural disaster and global vulnerability. In The humanitarian decade : challenges for humanitarian assistance in the last decade and into the future. (2004) United Nation, New York : p.58 10. A.A. MacDougall, K.S. McCann, G. Gellner, R. Turkington, R, Diversity loss with persistent human disturbance increases vulnerability to ecosystem collapse. Nature 494 (2013) 86– 89. DOI:10.1038/nature11869 11. S. Naeem, D.E. Bunker, A. Hector , M. Loreau , C. Perrings, Biodiversity, ecosystem functioning and human wellbeing: an ecological and economic perspective. (2009) Oxford University Press. 12. D. Pranab Pal, Managing Biodiversity with Emphasis on Sustainable Development. J Ecosys Ecograph S5 (2016) 008. DOI:10.4172/2157-7625.S5-008 13. J. Twigg, Good Practice Review, Disaster Risk Reduction, Mitigation and preparedness in development and emergency programming (2004) Humanitarian Practice Network at Overseas Development Institute, London. 14. UNISDR (United Nations International Strategy for Disaster Reduction), Hyogo framework for action 2005–2015: Building the resilience of nations and communities to disasters (2005) http://www.unisdr.org/files/1037_hyogoframeworkforactionenglish.pdf. Accessed Apr 2015. 15. N. Doswald, M. Osti, Ecosystem-based approaches to adaptation and mitigation - good practice examples and lessons learned in Europe (2011) Federal Agency for Nature Conservation, Bonn. 16. R.A. Usman, F.B. Olorunfemi, G.P. Awotayo, A.M. Tunde, B.A. Usman, B.A, Disaster Risk Management and Social Impact Assessment: Understanding Preparedness, Response and Recovery in Community Projects, Environmental Change and Sustainability (2013) Dr. Steven Silvern (Ed.), InTech, DOI: 10.5772/55736. Available from: https://www.intechopen.com/books/environmental-change-and-sustainability/disaster- risk-management-and-social-impact-assessment-understanding-preparedness-response- and-recove 17. L. Sena, Disaster Prevention and Preparedness. (2006) Jimma University, Ethiopia. 18. M.K. Lindell, Recovery and Reconstruction After Disaster, in Encyclopedia of Natural Hazards (2013) pp.812-824 Peter T. Bobrowsky, ed. Springer, Netherlands. DOI:10.1007/978-1-4020-4399-4_285. 19. T.C.H. Sunderland, Food security: why is biodiversity important? International Forestry Review 13(3) (2011) 265-274. Doi:10.1505/146554811798293908 20. A.S. Bernstein, D.S.Ludwig, The Importance of Biodiversity to Medicine. JAMA 300(19) (2008) 2297-2299. DOI:10.1001/jama.2008.655 21. P.A. Sandifer, A.E. Sutton-Grier, B.P. Ward, B.P, Exploring connections among nature, biodiversity, ecosystem services, and human health and well-being: opportunities to enhance health and biodiversity conservation. Ecosystem Services 12 (2013) 1-15. DOI:10.1016/j.ecoser.2014.12.007. 22. V. Lo, Synthesis report on experiences with ecosystem-based approaches to climate change adaptation and disaster risk reduction. Technical Series 85 (2016). Secretariat of the Convention on Biological Diversity, Montreal, 106 pages.

23. T.E. Tallei, Saroyo, Workshop and Field Training on Sulawesi Biodiversity and Conservation for High School Biology Teachers of North Sulawesi: A Practical Role of Sam Ratulangi University for a Sustainable Future. The 3rd International Conference Higher Education for Sustainable Development (2009). DOI: 10.13140/2.1.4344.0327 · 24. A.K. Schwab, K. Eschenbach, D.J. Brower, Hazard Mitigation and Preparedness. (2007) Wiley, Danvers. 25. D.P. Coppola, Introduction to International Disaster Management. (2007) Oxford: Butterworth-Heinemann. 26. A. Ramadoss, G. Poyyamoli, Biodiversity Conservation through Environmental Education for Sustainable Development - A Case Study from Puducherry, India. Int. El. J. Ev. Edu. 1(2) (2010) 97-111. 27. R. Shemdoe, Towards integration of sustainable environmental and biodiversity conservation in secondary schools students extra-curricular in Tanzania: Where do we start? Int. J. Afr. As. Stu.16 (2015) 35-42 28. R. McKeown, The ESD Toolkit 2.0, Web-published document. (2002). www.esdtoolkit.org

DISASTER DISCOURSE IN ACCOUNTING RESEARCH – A LITERATURE REVIEW

SUAZHARI

Accounting Department, Faculty of Economics and Business, Syiah Kuala University – Banda Aceh, Indonesia [email protected]

Abstract. This study reviews the existing literature on disaster discourse in accounting literature to highlight and discuss the development of the literature and further research agenda. Disaster topic in accounting is a relatively new research agenda. Therefore, the search of articles was not selective. The articles were achieved by using three stages and approaches. Firstly, we search on the words ‘accounting’ and ‘disaster’ (for mainstream accounting journals only) within abstracts, topic descriptors and/or keywords. This was done in Scopus searching engine and Google. Secondly, we traced the same or relevant papers in the references of papers founded in the first steps and then collected them. Thirdly, we search the citation of the selected papers in Google to find relevant articles which cited them and to count the number of citations. Based on this three stages research, we identify 16 articles, and excluded 3 articles due to irrelevant research purpose. Consequently, 13 articles formed the basis for review. The review method is descriptive with the aims are to highlight the number and impact of the articles related to disaster in accounting literature. This study found that disaster discourse has entered accounting literature since the end of 2000s. The type of disasters under study are also divergent i.e. earthquake, drought, flood, gas disaster and famine. Interestingly, the disaster discourse has been introduced in accounting literature by top rank accounting journals (Q1 journals) which are trendsetters in accounting research. The journals are Critical Perspective on Accounting (4 articles), Accounting, Organizations and Society (2 articles), and Accounting, Auditing & Accountability Journal (1 article). However, this study found that the development of such study is slow. The articles have been cited not more than 12 times in average and more importantly, the citing articles are not focus substantially on disaster discourse. This study found that disaster discourse in accounting research is in its early stage. This is can be associated with the type of works which are mostly qualitative, critical and in-depth analysis which is relatively new for accounting researchers. Further research agenda could be cross country practices of disaster budgeting practice and the elaboration of accounting and reporting practices in emergency situation.

Keywords: disaster; accounting; accountability; impact; reporting

INTRODUCTION

Accounting as a dynamic science has grown so rapidly along with the use of methods, social research approaches and social theory. The use of such an approach is imperative and cannot be avoided in an effort to understand the paradoxes and accounting practices with existing theories. In addition, accountants are also required to understand the social reality in which they work. Accounting has also been understood is no longer limited to numbers, but rather a reflection of an entity's structure and ideology where the practice of accounting is encountered.

The behavioral accounting research can be said as the initial basis of the use of social theory and approach in accounting. The use of psychological research theories and approaches has also long been used by behavioral accounting researchers. Furthermore, the use of organizational theory such as institutional theory began to emerge and became a new phenomenon in accounting studies (e.g. Fahlevi, 2017). This update is usually introduced by reputable accounting research journals that later became a trendsetter in subsequent research. The issue that is developing today is research involving disaster discourse. Several studies related to disaster accountability have introduced new perspectives in viewing practices and the role of accountability in the post-disaster period (recovery process). The purpose of this study is to review the structured disaster discourse that has been entered into accounting research since several decades ago. This review literature study is expected to provide disaster-related assessment maps in the context of accounting research and propose future research agenda and assist subsequent researchers in determining what kind of research should be done (Van Wee and Banister, 2016).

RESEARCH METHOD

This research is a literature review based research. Literature review papers (LRPs) are very useful for researchers in getting an updated and well-structured picture of the special literature (Van Wee and Banister, 2016). Disaster-related topics are a new issue in accounting studies. Therefore, this study uses three relevant stages of article collection. First, we use Scopus website search engine by using 'accounting' and 'disaster' filters for period of time between 2000 and 2017. Based on this method, we obtained 14 articles. The second step is to use the forward snowballing technique that is a technique of finding relevant articles by tracing the citing articles (Jalali & Wohlin, 2012). The search for citation is using the Google website. Lastly, the backward snowballing technique i.e. a searching technique dealing with the reference of the articles (Jalali & Wohlin, 2012). The total number of articles obtained was 17 articles. However, 3 articles are issued because they do not fit the criteria of accounting articles. Based on the 14 articles, the research fund analysis was conducted using descriptive and critical methods to map the issues and research methods that have been done before.

RESULTS AND DISCUSSION

This study found some important results. Firstly, accounting studies related to disaster issues are still relatively limited. An initial research on the topic was conducted by Labadie (2008) which focuses on auditing in times of disaster and recovery process. In 2014 there are 3 publications on the topic in one of the best journals. Since 2008, almost every year there are articles published on accounting and disaster topics although the numbers are very limited. Secondly, this study found that the top journals of accounting journals that are commonly becoming trendsetters for accounting researchers are actively engaged and can be regarded as the main actor who brings disaster issues to accounting research. The Critical Perspectives on Accounting Journal publishes 4 articles on disaster themes followed by Accounting, Organizations and Society journals and Accounting, Auditing & Accountability Journal. The three journals are included in the Q1 group released by Scimago in 2015.

Tabel 1. List of collected articles (between 2000 and 2017)

No Authors Year Title Published in 1 Matilal and Höpfl 2009 Accounting for the Bhopal disaster: Accounting, Auditing footnotes and photographs & Accountability Journal 2 Philip O’Regan 2010 ‘A dense mass of petty Accounting, accountability’: Accounting in the Organizations and service of cultural imperialism Society during the Irish Famine, 1846– 1847 3 Shimizu and 2010 Accounting in disaster and Accounting, Fujimura accounting Business & Financial for disaster: the crisis of the Great History Kanto Earthquake, Japan, 1923 4 Sargiacomo, Lanni 2010 Accounting for suffering: Critical Perspectives and Everett Calculative practices in the field of on Accounting disaster relief 5 Lai, Leoni, and 2014 The socializing effects of Critical Perspectives Stacchezzini accounting in flood recovery on Accounting 6 Sargiacomo 2015 Earthquakes, exceptional Accounting, government and extraordinary Organizations and accounting Society 7 Vosslamber 2015 After the earth moved: Accounting Accounting History and accountability for earthquake relief and recovery in early twentieth-century New Zealand 8 Labadie 2008 Auditing of postdisaster recovery Disaster Prevention and reconstruction activities and Management: An International Journal 9 Baker 2014 Break downs of accountability in Critical Perspectives the face of natural disasters: The on Accounting case of Hurricane Katrina 10 Bisman 2012 Budgeting for famine in Tudor Accounting History England, 1527–1528: social and Review policy perspectives 11 Taylor, Tharapos, 2011 Downward accountability for AFAANZ Conference, Khan and Sidaway Victoria’s ‘Black Saturday’ bushfire Carlton, Australia, 3-5 recovery: evidence from reports of July 2011, pp. 1-41. government and NGOs 12 Ó hÓgartaigh, Ó 2012 ‘Irish property should pay for Irish Accounting History hÓgartaigh and poverty’: accounting for the poor Review Tyson in pre-famine Ireland

13 Walker 2014 Drought, resettlement and Critical Perspectives accounting on Accounting 14 Oktari, R.S., Fahlevi, 2017 Disaster budgeting of Banda IOP Conference H., Irawati, W. Aceh's local government: Trends Series: Earth and and analysis of post-tsunami Aceh Environmental 2004 Science

Thirdly, the types of studied disasters are very diverse for example earthquakes, droughts, floods, gas and famine. In addition, the format and style of delivery of issues is also not uniform considering the issue of this disaster is still relatively new and has not had a research method that is mutually agreed. Some of these articles focus on accounting roles in helping governments cope with the effects of disasters while others aim to describe the budgeting process in disaster events. Furthermore, the development of accounting and disaster research topics is relatively slow even though the topic is introduced by the 3 best reputable international journals in accounting. This can be seen from the number of citations from the 14 articles that have been collected and discussed. The highest article citation value is 32 citations and the lowest is 2 citations. Thus the average article is quoted no more than 12 times even though the article was published several years ago.

CONCLUSION

Based on the result of the research, it can be concluded that disaster discourse in accounting study is still in the early stages. This can be attributed to the typical research approach the study generally is qualitative, critical and in-depth analysis which is a new research method in the realm of accounting studies. Future research can be directed to the accountability practices of funds and budgets in several disaster-affected countries and accounting procedures and accounting systems in times of disaster.

REFERENCES

1. Baker, C.R., (2014) Breakdowns of accountability in the face of natural disasters: The case of Hurricane Katrina, Critical Perspectives on Accounting, 25:7, pp.620–632 2. Bert Van Wee & David Banister (2016) How to Write a Literature Review Paper?, Transport Reviews, 36:2, 278-288, DOI: 10.1080/01441647.2015.1065456 3. Jalali, S., & Wohlin, C. (2012, September 19–20). Systematic literature studies: Database searchers vs. backward snowballing. Paper presented at the international conference on Empirical Software Engineering and Measurement, ESEM’12, Lund, Sweden. Retrieved June 10, 2015, from http://www.wohlin.eu/esem12a.pdf 4. Lai, A., Leoni, G., Stacchezzini, R. (2014) The socializing effects of accounting in flood recovery. Critical Perspectives on Accounting, 25: 7, pp. 579–603 5. O’Regan, P. (2010) dense mass of petty accountability’: Accounting in the service of cultural imperialism during the Irish Famine, 1846–1847. Accounting, Organizations and Society 35 (2010) 416–430, 35, pp. 652–669

6. Oktari, R.S., Fahlevi, H. & Irawati, W. (2017) Disaster budgeting of Banda Aceh’s local government: Trends and analysis of post-tsunami Aceh 2004. Presented in AIWEST-DR 2016 Banda Aceh. IOP Conf. Series: Earth and Environmental Science 56 7. Sargiacomo, M. (2015) Earthquakes, exceptional government and extraordinary Accounting. Accounting, Organizations and Society, 42, pp. 67–89 8. Sargiacomo, M., Ianni L. Jeff Everett, J., (2014). Critical Perspectives on Accounting, Critical Perspectives on Accounting 25, 652–669 9. Stephen P.Walker, (2014) Drought, resettlement and accounting, Critical Perspectives on Accounting, 25:7, pp.604–619 10. Sumohon Matilal, Heather Höpfl, (2009)"Accounting for the Bhopal disaster: footnotes and photographs", Accounting, Auditing & Accountability Journal, Vol. 22 Iss 6 pp. 953 – 972 11. Yasuhiro Shimizu & Satoshi Fujimura (2010) Accounting in disaster and accounting for disaster: the crisis of the Great Kanto Earthquake, Japan, 1923, Accounting, Business & Financial History, 20:3, 303-316, DOI: 10.1080/09585206.2010.512711

NEAR INFRARED TECHNOLOGY: FAST AND SIMULTANEOUS DETECTION OF HAZARDOUS HEAVY METAL CONTAMINATIONS IN DISASTER AFFECTED AREA

AGUS ARIP MUNAWAR1*, MAULANA YUSUF2, MULKAN AZHARI1, ICHSAN1, SHAHRIL ANUAR BAHARI3

1Syiah Kuala University, Darussalam, Banda Aceh, 23111 Indonesia *[email protected] 2Special Task Force for Oil and Gas, Republic Indonesia, Jakarta, Indonesia 3University Technology Mara, Shah Alam, Malaysia.

Abstract. Soil contamination by heavy metals is one of major problem worldwide and need to be accessed as risk reduction. The need for rapid and effective technique to monitor soil health after natural disaster has led to the investigation of promising modern technologies. Near infrared (NIR) is one of these technology that can be used to detect heavy metal contamination. The main purpose of this present study is to investigate and evaluate the feasibility of NIR technology as a fast method in prediction of soil contamination by heavy metals (As, Cu, Fe and Pb) in disaster affected area. Transmission spectra in wavelength range from 1000 to 2500 nm were acquired for soil samples located in some disaster affected area in Aceh, while heavy metal concentrations were measured using absorption flame spectroscopy (AFS). A multiplicative signal correction (MSC) was applied as spectra enhancement algorithm. Further, soil contaminations were detected using principal component analysis (PCA) whilst their concentration amount were predicted using two different approaches: partial least square regression (PLSR) and artificial neural network (ANN). The results showed that NIR technology combined with PCA can detect and classify soil based on its health condition (contaminated and un-contaminated). Moreover, both PLSR and ANN were able to predict all those three heavy metal concentrations with maximum coefficient correlation 0.92 and residual predictive deviation (RPD) index 4.52. The overall obtained results conclude that NIR technology combined with proper mathematics approaches can be used as fast and effective method in monitoring soil contamination as a part of risk reduction.

Key words: health, rapid, infrared, disaster, spectroscopy.

INTRODUCTION

As all we know that a major function of soil is to provide fundamental natural resources for survival of plants, animals, and the human race (Shi et al., 2014). The functions soil depend on the balances of its structure and composition, well as the chemical, biological, and physical properties. These balances are, however, being disrupted by highly accumulated contaminations in soils, due to anthropogenic activities, such industrial pollutants, pesticides,

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia livestock wastewater, mine drainage, and petroleum contamination (Khan et al., 2008; Salazar et al., 2012). Human activities, such as mining, transportation, sewage disposal and fertilizing, have been posing an ongoing threat to the soil health (Wang et al., 2014). Moreover, the consumption of metal-polluted crops (e.g., rice, corn and soybean) grown in agricultural soils greatly raises the potential risks of food security and human health (Zhuang et al., 2009). The chemical, biological, and physical unbalance caused by soil contamination by hazardous materials may be detrimental to plant, animal, and human health. For example, the symptoms of reduced root growth, reduced seed sprouting, and seedling stunting, necrosis, and chlorosis appear susceptible plants growing in soils contaminated with heavy metals (Rodriguez et al., 2011). Agricultural crops (fruits, grains, and vegetables) for livestock human consumption, growing on contaminated soil, can potentially uptake and accumulate hazardous materials in their edible plant parts, and may be harmful to animal and human health through the food chains (Li et al., 2012). From this point of view, the determination of hazardous contamination on agricultural soils is necessary to monitor the health of agricultural soils and further to take preventative measures to avoid soil contamination. A reliable and environmentally friendly method is therefore needed to rapidly detect and survey the spatial distribution soil contaminations, to diagnose suspected contaminated areas as well as control the rehabilitation processes (Schwartz et al., 2011; Wang et al., 2014: Shi et al., 2014). The conventional method of obtaining the spatial distribution of soil contamination based on regular field samplings and subsequent chemical analyses the laboratory (e.g. wet chemistry), followed by geo-statistical interpolation. However, this method may be costly and time- consuming as a result of the intensive soil samplings in the field and the analyses in the laboratory. Moreover, such investigations can only provide limited information at specific locations and moments in time, and they cannot describe the spatial and temporal dynamics of contaminant concentrations over large areas (Liu et al., 2011; Wang et al., 2014). During the last few decades, infrared technology has been widely used and become most promising methods of analysis in many field areas including in soil science and agriculture due to its advantage; simple sample preparation, rapid, and environmental friendly since no chemicals are used. More importantly, it has the potential ability to determine multiple parameters simultaneously (Liu et al., 2010). Furthermore, laser technology also shown its advantages in determining quality parameters in food and agricultural products. Numerous studies had been performed to attempt and apply near infrared technology in some agricultural products, including soil (Knadel et al., 2017). In general, infrared technology works based on phenomena that every biological object has its own electro-optic properties that can be used to predict inner quality attributes of respective biological objects such as fruit, vegetables, milk, soils, meat and water. Yet, their prediction accuracy and robustness are depends on several things such as: structure aggregation, spectra correction method, used frequencies, wavelength resolutions, and sensor stability (Nicolai et al., 2007; Cozzolino et al., 2011).

OBJECTIVES

The main purpose of the present work is to systematically study the application of near infrared technology as a fast, simultaneous and non-destructive method for detecting and predicting hazardous heavy metal contaminations (As, Cu, Fe and Pb) on soil in disaster affected area. The prediction models were established based on IR spectroscopic data after scatter correction using principal component analysis (PCA), partial least square regression (PLSR) and artificial neural networks (ANN) approach.

METHODS

Spectra acquisition

The near infrared spectra of soil samples were collected as a bulk in form of transmittance or diffuse reflectance spectra using self-developed FTIR instrument. Soil samples, amounted 40 to 50 grams, were placed manually upon the cup sample holder as shown in Figure 1., multi- layered and piled with minimum air space among samples to minimize noises. This cup will set to rotates during spectra acquisition. Infrared spectra data in wavelength range of 1000 – 2500 nm with the increment of 0.2 nm resolution will be acquired 64 times and averaged.

FIGURE 1. Infrared spectra acquisition on soils

Infrared spectra pre-processing

Prior to prediction model development, multiplicative signal correction (MSC) was applied to the spectra data. The spectra data acquired from the FTIR instrument may contain spectra background information and noises which are interfered desired relevant attributes information. Interfering spectral parameters, such as light scattering, path length variations and random noise resulted from variable physical sample properties or instrumental effects need to be eliminated or reduced in order to obtain reliable, accurate and stable calibration models (Reich, 2005; Cen and He, 2007). Thus, it is very necessary to pre-process spectral data prior to modeling. This work presented prediction models to detect and predict soil contaminations derived from enhanced and corrected spectra data.

Heavy metals detection based on spectra data

Once spectra correction was completed, soil contamination were detected rapidly using corrected spectra data. These data were projected onto principal component analysis (PCA) in order to classify and distinguish soil samples between contaminated and un-contaminated.

Contaminants prediction models

Partial least square regression (PLSR) and non-linear regression approach (artificial neural networks-ANN) were used to develop the prediction model for As, Pb, Fe and Cu concentrations using soil samples spectra from calibration set. K-fold cross validation was applied during calibration to quantify the model performance and to prevent over fitting. The optimum wavelengths for each quality attributes prediction were selected based on regression coefficients curve derived from the calibration model (Cen and He, 2007; Sinelli et al., 2008). The capability of calibration models will be justified by predicting quality attributes using external samples from prediction dataset.

Prediction model performance evaluation

Predictive capabilities of these calibration models and their validation were evaluated by using several statistical parameters: (i) the coefficient of determination (R2) of calibration and validation representing the proportion of variance (fluctuation) of the response variable that is explained by the spectral features in the calibration or validation model. It also measure how certain one can be in making predictions from a certain models (Nicolai et al., 2007), (ii) the prediction error which is defined as the root mean square error of calibration (RMSEC), root mean square error of cross validation prediction (RMSECV) and the root mean square error prediction (RMSEP), (iii) the error difference between RMSEC and RMSECV or RMSEC and RMSEP (Jha, et al., 2006; Flores, et al., 2009), and (iv) the residual predictive deviation (RPD) providing the ratio between the standard deviation of the target variable and the standard error of prediction performance RMSECV or RMSEP. RPD is a commonly used to interpret and compare NIR calibration models (Fearn, 20d3

RESULTS AND DISCUSSIONS

Spectra features

Typical diffuse reflectance spectrum for soil samples in the NIR region (1000-2500 nm) is shown in Figure-2. The NIR spectrum indicates the presence of organic materials as derived from the bands that result from the interaction of molecular bonds of O-H, C-H, C-O and N-H with the incident radiation. These bonds are subject to vibrational energy changes in which two vibration patterns exist in these bonds including stretch vibration and bend vibration. Here, the presence of adequate water absorbance bands was observed at 1460 and 1940 nm because of O-H tone combination and its first overtone. Absorption bands at around 1400 nm and 1900 nm were previously assigned to water absorption. Moreover, the absorption bands in the range of 1950 – 2000 nm, 2200 - 2300 nm, are suggested to be related to C-H-O structures; around

1650 – 1700 associated with N-H structures whilst absorption bands at around 1200, 1800 and 2100 nm are associated with organic materials (Munawar et al., 2016).

FIGURE 2. Soil spectra features in near infrared region

Contaminations detection

The PCA result as for soil contamination detection is shown in Figure 3. It shows a significantly cluster based on soil characteristics. The first principal component accounts for as much of the variability in the data as possible, and each succeeding component accounts for as much of the remaining variability as possible. PCA is used as a tool for screening, extracting, compressing and discriminating samples based on their similarities or dissimilarities of multivariate data. The first PC (PC1) accounted 91% of all spectra data while remaining 7% was explained by the second component (PC2).

Un-contaminated

Site B Site A Contaminated

Site C

FIGURE 3. PCA based on infrared spectra for soil contamination detection

The differentiation of showed PCA classification is probably due to nutrient content and heavy metals contamination of related soil. Based on principal component analysis (PCA) results, it was obvious that NIRS method was able to distinguish and classify soil based on heavy metal contaminations. Soil spectral features in the infrared wavebands are highly correlated to the vibration modes of functional groups like the chemical bond of H and C, N, and O. These bonds are subject to vibrational energy changes in which two vibration patterns exist in these bonds including stretch vibration and bend vibration as shown in Figure 4. The nitrogen (N) content in the soil is a macro-element that plays an important role in soil nutrition along with Phosporus (P) and Kalium (K). The N content of soil was observed at around 950 – 1128 nm, whilst 1460 nm and 1920 nm were associated with soil moisture content. Soil organic matter can be predicted in wavelength range of 1230 – 1315 nm, 1580 – 1680 nm, and 2095 – 2200 nm.

FIGURE 4. Related wavelengths of specific soils parameter content based on loading plot of PCA

CONCLUSION

Achieved present study shows that infrared technology was feasible to use as a rapid, innovative and non-destructive method in soils quality properties classification and evaluation based on their contamination. Some selected heavy metals contamination such as Fe, As, Pb and Cu can be predicted with residual predictive deviation index maximum is 4.52 and coefficient correlation is 0.92.

ACKNOWLEDGEMENTS

We sincere gratitude and express our acknowledgement to the Ministry of Research, Technology and Higher Education for providing some part of this study through research funding via Riset Pengembangan IPTEK 2015 and 2016 scheme.

REFERENCES

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PRELIMINARY STUDY ON FALOAK BARK POTENCY FOR PREVENTION OF MICROBIAL INFECTION

TRIANA HERTIANI 1,*, PRISCI PERMANASARI1, HERLYANTI MASHAR1, SISWADI2

1Department of Pharmaceutical Biology, Faculty of Pharmacy, Universitas Gadjah Mada, Sekip Utara, Yogyakarta 55281; Balai Penelitian Lingkungan Hidup dan Kehutanan Kupang, Jl. Alfons Nisnoni No 7B, Airnona, Kupang *[email protected]

Abstract. Faloak (Sterculia quadrifida R.Br.) is an indigenous plant originated from East Nusa Tenggara, the eastern part of Indonesia.The reports on its pharmacological activitiy is still scarce regardless that the bark has widely used by the local people as part of traditional remedy against various health complaints. In an attempt to provide scientific support, we have explored for the faloak bark potencies for radical scavenging, immunomodulator as well as antimicrobial activities by in vitro techniques. The bark was macerated in ethanol followed by evaporation to yield ethanolic extract. The extract was subjected to DPPH radical scavening activity assay to gain the IC50 value. Immunomodulatory assay was performed on mice macrophages and lymphocytes. Antimicrobial activities were evaluated against the planktonic growth and biofilm of Candida albicans, Staphylococcus aureus and Escherichia coli by using microdillution technigues. Crystal violet was used to stain the formed biofilm. Results showed that the bark contains 34.43%GAE of total phenolics (equivalent gallic acid), 1.55% QE of total flavonoid (equivalent quercetin) and 84.07 µg/mL of DPPH radical scavenging activity (Vit C: 74.72 µg/mL). The stimulation index (SI) on mice lymphocyte was less than 2 sugggesting no stimulation which intended to show a repression by higher concentration tested. The extract enhanced macrophage phagocytosis activity which was in correlation to the concentration tested.The extract was relatively not toxic to Vero cells, however it also showed no potential antimicrobial activity against test microbes. As a conclusion, the faloak bark is a potential immunomodulator and antioxidant.

Keywords: Sterculia quadrifida, immunomodulator, DPPH radical scavenging

INTRODUCTION

Sterculia quadrifida R.Br (Sterculiaceuae) is an indigenous plant of the East Nusa Tenggara (NTT), Indonesia which has been used traditionally against various ailments such as liver disturbances, kidney disease, anemia, reumatic, and as post partum remedy (Siswady, 2015). Regardless its wide therapetic usages among the local people in the NTT, pharmacological activity reports on the plant is still lacking. Several reports on the closely related plants which has the same local name, faloak have been found, although the taxonomy was considered to may be interchangeable. Infusion of Sterculia urceolata Smith. has been reported to have hepatoprotective activity on CCl4 pretreated male mice which was given one a day for peroral

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia for 6 days ED50 5.24 g/kgBW (Rambung, 2002). The acetone extract of Sterculia comosa showed antibacterial activity against Staphylococcus aureus dan Bacillus cereus with inhibition zone of 15.17 mm and 16.17 mm, respectively (Ranta, 2011). Toyo (2003) also reported that the bark of Sterculia urceolata contains flavonoid, anthraquinone, saponin, cardenolide, and tannin (Toyo, 2003), while Ranta (2011) reported the presence of saponin and triterpenoid in the acetone extract of S. comosa bark. Epicathecin, and procyanidin B2 have been isolated from the bark of Sterculia tragacantha (Orisakeye and Olugbade, 2014); while lupeol, a triterpenoid has been isolated from the bark of Sterculia striata (Costa et al., 2010). Epicatechin and procyianidin B2 stimulated the lymphocyte proliferation (Zhao et al., 2007), while lupeol isolated increased the macrophage phagocytosis activity (Sutomo et al., 2013). In order to provide scientific supports for Faloak bark as traditional medicine, we screen the ethanol extract for possible bioactivities in relation to the traditional usage by using in vitro techniques. This research is a preliminary step aiming to find a potential bioassay guidance to direct the research of isolating bioactive marker from the Faloak bark.

METHODOLOGY

Materials

Samples were collected from Kupang, NTT on May-June 2014. Taxonomy identification was conducted in the Research Centre for Biology, Indonesian Institute of Sciences (Nr. 373/IPH.1.02/If.8/III/2012. Samples were sun-dried followed by oven dried and pulverized. The powder was macerated in ethanol in 1:5 and followed by remaceration. The combined macerates were evaporated to yield thick-solvent-free extract. Laboratory materials used were as follows: precoated TLC silica gel F254 plates (Merck, Germany); ethyl acetate, toluene (pro analyse, Merck, Germany); RPMI (Roswell Park Memorial Institute ) (Sigma-Aldrich, Germany), Fetal Bovine Serum (FBS) (Gibco, South America), Fungizone (Gibco, South America), penicillin-streptomycin (Pen-Strep) (Sigma-Aldrich, Germany), latex (3 µm ) (Sigma-Aldrich, Germany), Phosfat Buffer Saline (PBS) (Gibco, South America), and Giemsa (Merck, Germany). Equipments Oven (Memmert, Germany), freeze dryer (Benchtop Pro, USA), TLC scanner (Camag, Switzerland), laminar air flow (Labconco, Kansas, USA), micropipette (Socorex, Switzerland), vortex (Shimadzhu, Japan), centrifugation (Sorvall, USA), hemocytometer (Neubauer, Germany), microplate 24 wells (Nunc, England), CO2 incubator 5% (Heraeus, Germany), a light microscope (Olympus, Germany), microscope inverted (Olympus, Germany), and the cover slips (SPL, Korea).

Antimicrobial susceptibility testing, a microdilution method

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia controls (cells + media + antibiotic – streptomycin or nystatin for C. albicans), and media controls. All plates were incubated overnight at 37 °C. Readings of the optical density were conducted at 595 nm. All tests were performed in triplicate. The formula from Pirbalouti et. al. was used to determine the MIC (11): Inhibition % = [(ODc –ODt) / ODc] ×100 ODc is the OD595 of the negative control at 24 h post-inoculation and Odt is the OD595 for the tested samples tested at 24h post-inoculation. The essential oils concentration caused growth inhibition of microbes by at least 50% was considered as the MIC50 (11).

Biofilm formation inhibition assay (7)

Cultures of S. aureus and E.coli (0.1÷108 CFU ml-1 in BHI) and C. albicans in BHI, were dilution until 107 CFU ml-1. Assays were taken place on sterile flat-bottom 96-well polystyrene micro titer plates and used Brain Heart Infusion (BHI) broth medium and incubated 90 minutes at CO2 incubator. Controls were prepared as follows, negative controls (cells + media), positive controls (cells + media + antibiotic – streptomycin or nystatin for C. albicans), and media controls. All plates were incubated overnight at 37 °C. Following overnight incubation, the wells were poured off. After 3 times rinsing with distilled water, the plates were left to dry at room temperature for 45 min. Staining was conducted by adding 100 µL crystal violet 1%, left for 45 min. After the staining was being discarded and rinsed with tap water 350 µL to eliminate excess stain, 200µL ethanol 95% was added to the wells, incubated at temperature room 45 min. Optical density at 595 nm was measured and the results were used to determine the % inhibition and the minimum biofilm inhibitory concentration, MBIC values. The inhibition percentage was calculated as the average of OD of the control wells in comparison to that of the sample wells, as defined by the following formula: [(ODcontrol – Odsample) / ODcontrol] x 100

Effect on phagocytosis activity of macrophages (9)

Measurement of phagocytosis activity was conducted by using 3 µm latex beads (2.5 × 106 mL-1 suspended in PBS). After 24h incubation, culture of peritoneal macrophages in wells equipped with cover slips was washed twice with RPMI 1640 and then added to a serial dilution of samples ranging from 10-40 µg/mL. Incubation was taken place in a 5% CO2 incubator at 37 ° C for 4h. After rinsing the cells three times with PBS, suspension of latex beads (200 µL/well) was added. Further incubation was performed in 5% CO2 incubator at 37 ° C for 30 min. The latex beads were removed by rinsing the cells three times with PBS. Following fixation with 300 µL/well methanol for 1 min and then poured off, the cover slip was allowed to dry, and 300 µL Giemsa dye 10% v/v was added and left for 20 minutes. After the dye was being discarded, rinsed with distilled water and dried, the macrophage phagocytic index was counted under light microscope. The phagocytic index was calculated according to the following formula (12):

total number of active macrophage in each 100 macrophages

number of macrophages engulfed cells or beads

The animal handling has been approved by the Ethical Clearance Commission for Preclinical- Studies of the LPPT-UGM.

Cytotoxicity assay (6):

Vero cells ware cultured at 37°C under a humidified atmosphere containing 5% CO2 in 25 cm2 plastic culture flask containing M199 medium of which 10% FBS, 100 U/mL penicillin, and 100 µg/mL streptomycin were supplemented. Culture medium was removed when the cell reached 90% confluence. Trypsin EDTA was dispensed to the cell cultures for detaching cells from the flask. The cells suspension having density of 1 × 104 cells/well in 100µl medium and incubated overnight in a CO2 incubator at 37°C. Afterwards, 100µl of each serial dilution samples (unformulated massoia oil and its nanoemulsion) was dispensed into each well. After 24 h of incubation period, the media were removed from the plate. Cell viability was identified using MTT reagent [3 (4, 5-dimetyltiazol-2- yl) -2.5-diphenyl tetrazolium bromide]. One hundred micro-liters MTT was dispensed onto each well. Following 4 h incubation, 100µl stopper solution (10% SDS) was added. After 24 incubation, the optical density was measured by micro titer plate reader at a wavelength of 595 nm and calculated as follows:

Percentage of viable cells = [(OD Treatment– blank) / (OD control-blank)] x 100% IC50 : (50-a)/b which is a : intercept, b : slope from Ln C vs percentage of viable cells curve.

RESULTS

The faloak extract showed high phenolic content (34.43% GAE) of which some are determined as flavonoid (1.55% QE). The phenolic content may contribute to a prominent DPPH radical scavenging activity as shown by IC50 value of 84.07 µg/mL which was only slightly lower than the IC50 shown by the positive control (Vitamin C) i.e. 74.72 µg/mL. The extract showed a promising effect on the non specific immune response, as described by a concentration dependant macrophage phagocytosis stimulatory effect (table I). However, it was observed a negative corelation of the sample concentration to the lymphocyte stimulatory index (Fig. 1).

TABLE 1. Macrophage phagocytosis effect

Treatment Phagocytosis % Active Phagocytosis No (µg/mL) capacity macrophage Index 68.00 1 1000 11.84 ±0.44 ±1.76 270.00 ±17.15 31.00 2 700 11.20 ±0.12 ±0.67 115.67 ±2.12 28.67 ± 3 500 10.15 ±0.80 1.35 96.67 ±8.83 21.33 4 300 11.31 ±0.27 ±1.07 81.00 ± 6.08 18.33 5 100 10.94 ±0.10 ±1.07 67.00 ± 4.33 Negative control 11.16±0.33 9.67±0.19 36.00±1.53

FIGURE 1. Proliferation Index

In order to evaluate to toxicity, the extract was subjected to Vero cell lines. It was observed lower inhibitory effect of the cell proliferation in comparison to negative control, and significantly lower than doxorubicin as positive control. Table II shown that IC50 extract

(462.99 ppm) lower than doxorubicin (137.15) which has indicated the extract more safety than doxorubicin.

FIGURE 2. Toxicities activity in Vero Cells

TABLE 2. Toxicity in Vero Cells

No Sample Concentration cells viability (%) IC50 (ppm) (ppm) 1 Doxorubicin 31.25 – 500 46.4 – 56.6 137.15 2 Extract 15.625 – 2000 27.2 – 143.2 462.99

We also evaluate the extract potential to be develop as antiinfective. Therefore the extract was subjected to antimicrobial testing covering antibiofilm and anti planktonic growth. Model organisme from Gram positive and Gram negative microbes (Staphylococcus aureus and Escherichia coli) as well as a yeast, Candida albicans was tested. Unfortunately, no promising effect observed on the tested organisms (Table 3).

TABLE 3. Planktonik and Biofilm Inhibition Percentage with several concentration

No Consentration Microbe Inhibition percentage (%) Biofilm Inhibition percentage (%) (ppm) Staphylococcus Escherichia Candida Staphylococcus Escherichia Candida aureus coli albicans aureus coli albicans 1 312.5 32.52 12. 94 -19.76 -6.62 4.79 -4.74 2 625 22.63 18.96 -27.18 -6.06 6.23 -32.00 3 1250 45.48 2.75 -41.74 18.14 -1.06 -31.11 4 2500 -5.86 -2.71 -55.11 33.37 3.65 19.31 Positive control 74.85 88.33 80.57 51.64 61.07 33.48

DISCUSSION

Faloak extract have antioxidant activity from flavonoid compound which is one of extract compounds. Flavonoid can be reduce DPPH with hydrogen transferred into molecules as phenolic compounds3. Antioxidant activity can stimulate innate immune system, such as macrophage. Our research have been found increase in macrophage activity which dependent to sample concentration. Macrophage has been activated by endogenous compounds such as T helper 2 (Th2) cytokines, interleukin 4 (IL-4), interleukin 13 (IL-13) and interferon-γ (IFN- γ) 6. In complex immune system, macrophage activity could been stimulated by lymphocyte T cells. Which it can be produce IFN- γ, ILN-2. IFN- γ which is released would be induce the expression of MHC class II and activated macrophage. Otherwise, IL-2 played a role in other immune cells proliferation, such as NK cells and B cells2. However, index proliferation value from Lymphocyte cells did not correlate with macrophage activity. Thus the compounds in the extract were possible only affect for increase innate immune. We also found that faloak extract did not cause normal cell toxicity from the value of IC50. The higher IC50 value indicated that extract have lower ability to inhibit normal cells proliferation.

CONCLUSSION

The extract has been known to have antioxidant activity which may increase the innate immune system (macrophage) but has not been able to improve the adaptive immune system (lymphocyte cells). In addition, the extract has also known to be not toxic to Vero cells, however antimicrobial activities were not exerted.

ACKNOWLEDGMENTS

Authors thanks Faculty of Pharmacy UGM for funding part of the research through “Hibah Penunjang Penelitian Dasar” 2016.

REFERENCES

1. Costa, D.A.; Chaves, M.H.; Silva, W.C.S.; Cost, C.L.S. 2010. Constituintes químicos, fenóis totais e atividade antioxidante de Sterculia striata St. Hil. et Naudin. Acta Amazonica, 40: 207-212. 2. Ening Wiedosari. Proliferation of Mice Lymphocyte Cells Activity In Vitro of Garlic (Allium sativum) Extracts. Seminar Nasional Teknologi Peternakan dan Veteriner 2013. 3. Iriyani, Tatang., Puspitasari, Andayana., Suryani, Ema. The Activity Of Radical Scavenging Of 2,2-Diphenyl-1-Pycrilhydrazil By Ethanolic Extracts Of (Tinospora crispa (L.) Miers) Stem And Its Fractions. Majalah Obat Tradisional, 16(3), 138 – 144, 2011

4. Orisakeye OT, Olugbade TA (2014) Epicatechin and Procyanidin B2 in the Stem and Root bark of Sterculia tragacantha Lindl (Sterculiaceae). Med chem 4:334-337. doi: 10.4172/2161-0444.1000161 5. Orisakeye OT,Olugbade TA (2012) Studies on antimicrobial activity and phytochemical analysis of the plant SterculiatragacanthaLindl. Middle-East Journal of Scientific Research 11: 924-927 6. Permanasari P, Hertiani T, Yuswanto A. Immunomodulatory Effect of Massoia Bark Extract and the Cytotoxicity Activity Against Fibroblast and Vero Cells in Vitro. International Journal of Pharmaceutical and Clinical Research 2016; 8(5)Suppl: 326-330. 7. Pierce CG, Priya U, Amanda RT, Floyd LW, Eilidh M, Gordon R, Jose LLR, 2008, A Simple and Reproducible 96-Well Plate-Based Method for the Formation of Fungal Biofilms and Its Application to Antifungal Susceptibility Testing. Nature Protocols. 9: 1494–1500. 8. Ranta, F. 2011. Sifat Antimikroba Zat Ekstraktif Pohon Faloak (Sterculia comosa Willich). 9. Triana Hertiani, Sylvia Utami Tunjung Pratiwi, Agustinus Yuswanto, Prisci Permanasari. 2016. Potency of Massoia Bark in Combating Immunosuppressedrelated Infection. Pharmacognosy Magazine. DOI: 10.4103/0973-1296.185771

PHYSICAL PROPERTIES OF POLYPROPYLENE ITACONATE-SILICATES COATING MATERIAL

ATMANTO HERU WIBOWO1*, LISTYANINGRUM1, MAULIDAN FIRDAUS1

1Chemistry Department, Sebelas Maret University, Jl. Ir. Sutami 36A, Surakarta, Indonesia, 57126 *[email protected]

Abstract. The purposes of the study is to insert tetraethyl ortho silicate (TEOS) into PPI in order to improve physical properties of PPI. TEOS carried out the condensation reaction together with IA and 1-3-propanediol in the reaction. The changes of the transparency and specific bonding between silicate/TEOS and polyester occurred have been investigated. The insertion of silicates was done by the addition of various 1, 2, 3, 4, and 5% mole of TEOS (1.05 moles) during the reactions. The coating formation was done on the glass with thermal method at 170oC for 8 hours and with 1000 watt UV lamp for overnight. In situ insertion of silicate on the PPI successfully reduced the yellowish colour of the origin and improved the transparency of PPI coating for both with thermal and UV curing method. The bonding between TEOS and IA is via hydroxyl group of PPI. The sum of silicates in the polyester affected the transparency of the PPI/TEOS coating. The in situ silicate insertion of silicate/TEOS offers the practical method for the improvement of the polyester and stronger bonding between additives and polyester.

Keywords: PPI, silicates/TEOS, in situ, itaconic acid

INTRODUCTION

Coating is as thin layer that could be acted as solid, adhesive, protector and decorative (Rai et al., 2015). In year 2013, the global market reached 41.75 million tonnes with the value $ 127.3 billion (Dai et al., 2015). One kind of the polymer that are available in the market is polyester that are commonly used for coating material (Jung et al., 1997) due to fast solidified, resistance towards organic substrate, temperature, and with good flexibility and adhesive (Slama., 1996). Coatings are produced conventionally using organic and volatile solvents (Chen et al., 2011) and also produced from fuel sources (Cousinet et al., 2015). However, these coatings cause the problems in the term of the availability limitation until 2040 (Okkerse et al., 1999) and the environmental damage. Nowadays, the coating industries begin to transform to the greener production. Alternative solution for the problem is the use of regenerative materials and greener technology such as curing with radiation, using water solvent, and high solids (Chen et al., 2011). Recently, modification to improve thermal and optic properties by inserting inorganic material into the organic polymer has been used. The addition of inorganic material might yield the combination of two components. Recently, silicate is has attracted attentions as one of potential additive materials. Silicate could be inserted into the polymer by some means, such as mixing, sol-gel, in situ polymerisation and others (Zou et al., 2008). Tetraethyl ortho silicates (TEOS) are one of silicate source that could be used as additive in the coating materials.

EXPERIMENTAL

Reagents and chemicals

1,3 Propenediol (PDO) ≥ 98 % p.a was from Merck. Itaconic acid (IA) ≥ 99 % p.a, tetraethyl orthosilicate (TEOS), 2-Hydroxy-4′-(2-hydroxyethoxy)-2-methylpropiophenone (Irgacure 2959), triethanol amine (TEA) p.a were from Aldrich. Zn acetate p.a ( Zn(CH3COO)2.2H2O), hydroquinone, toluene p.a was from Merck, NaHCO3 p.a was from Riedel-de Haen.

Methods

The main synthesis is based on the previous study. PPI-silica coating material with the composition of 0%, 1%, 2%, 3%, 4% dan 5% TeOS was obtained with the mixing of IA and PDO with the mole ration of 1 : 1,05. Hydroquinone was added in the reaction of 1 % of total IA, PDO and TeOS. 0,25% Zn acetate was also added into the acid and 0.75 mL toluene into the reactor. The formation of PPI was done as following. The viscous polyester of 0.5 g PPI/TeOS was put on the glass plate and distributed homogeneously with doctor blade method about 0.5 cm thickness and then heated with oven at 170°C for 8 hours. UV Curing was done by adding 2 g PPI/TeOS with NaHCO3 and mixing promptly at 50°C until homogeny solution occurred. At pH 7, the solution was then added with small amount aquadest. Photo initiator of irgacure 2959 and 2% TEA accelerator was added into the viscous solution of PPI/TeOS. The solution was then distributed on the glass in order to get the thickness about 0.5 cm as done with thermal curing. The curing was done with the 1000 W UV lamp at 365 nm for 3 minutes with the UV-light distance of 15 cm above of the plate

RESULT

3.1 Characterisation of PPI/TeOS

Based on the figure 1, absorption peak at about 3500 cm-1 is hydroxyl group of the itaconate backbone. These peaks might be unreacted group remains after the polycondensation or might be water impurities that are not vacuumed during the reaction. C-H stretching of the itaconate backbone was observed on the absorption peak at 2967 cm-1 and 2968 cm-1 , and C=O stretching at 1728 cm-1 . C=C stretching was observed at about 1638 cm-1 and 819 cm-1. The shifting from 1300 cm-1 to 1040 cm-1 indicated that formation of esther group occurred.

FIGURE 1. FTIR spectra of (A) TeOS (B) PPI (C) PPI/1%TEOS (D) PPI/2%TEOS (E) PPI/3%TEOS (F)PPI/4%TEOS, (G)PPI/5%TEOS

Analysis of carbonyl adsorption of PPI and PPI/TeOS showed no shifting to smaller wavenumber. It indicated that IA and TEOS was bonded via hydroxyl group of PPI (Frings et al.,1998). The bonding of polyester and TEOS was described on the figure 2.

(a) Si-O-Si

(b)

FIGURE 2. (a) Reaction between polyester and TeOS (b) FTIR of PPI/TeOS (a) 0%, (b) 1%, (c) 2%, (d) 3%, (e) 4%, and (f) 5%

Absorption peak at 1092 cm-1 showed the stretching of Si – O – Si in the polyester indicated that the bonding between Si and O occurred due to the increase of the silicates in the polyester.

(a)

(b)

FIGURE 3. FTIR spectra of (a) PPI/TeOS 0% and 5% before and after photopolymerisation and (b) PPI/TeOS 0% and 5% after photopolymerisation after magnificent.

PPI/TeOS with the UV curing showed new peak indicating that the polymerisation occurred. Si-O-Si peak resulted from the UV curing process was seen at 1095 cm-1. In the thermal curing process, Si-O-Si peak was seen at 1096 cm-1. Si-O-Si bending was seen at 474 cm-1. Si-O-Si symmetric was seen at 711 cm-1. C=C stretching of PPI/TeOS 0% was still seen at 1643 cm-1 and disappeared on the PPI/TeOS 5% with UV curing. The disappearance of the peak indicated that curing reaction optimally was accomplished.

UV-Vis analysis

Figure 4 showed that red shifting of PPI/TeOS occurred due to the silicate addition. UV curing showed the maximum absorption at 299 and 294 nm and thermal curing at 320 – 326 nm. The yellowish colour of the coating resin using UV curing was faderer than of with thermally curing. It was due to the more disappearance of double bond as chromophor group by UV-curing than thermal curing.

FIGURE 4. The UV absorbance of PPI/TEOS after UV and thermal curing

(a) (b )

(c)

FIGURE 5. Transmittance (%T) of PPI/TeOS (a) 0%, 1%, 2%, 3%, 4%, and 5% with thermal curing (b) 0 and 5 % with UV curing (c) all PPI/TeOS with thermal and UV curing

PPI/TeOS 5% showed the biggest transmittance ( 97.9%) at 650 nm. Homogenous silicate dispersion of silicate and the sum of silicates affected the highest transparency. Table 1 showed the % transmittance of PPI/TeOS.

TABLE 1. % Transmittance of PPI/TeOS

TEOS in PPI T (%) 0% 93.9 1% 96.6 2% 97.2 3% 94.3 4% 94.5 5% 97.9 0% (uv) 95.5 5% (uv) 96.1

Agglomeration of silicates in the PPI with 3 and 4% TeOS caused the transmittance of PPI/1 and 2% TEOS higher than of 3 and 4%. The different of the transmittance in the table 1 might occur due to the different density of the PPI/TeOS after curing process.

CONCLUSION

The content of silicate in the PPI has reduced successfully the yellowish colour of the origin and improved the transparency of PPI coating for both with thermal and UV curing method. The bonding between TEOS and IA is via hydroxyl group of PPI and the sum of silicates affected the transparency of the PPI/TEOS coating. In general, UV curing is more potential to be applied for the formation of PPI/TEOS coating.

ACKNOWLEDGEMENT

Researchers would like to thank to Universitas Sebelas Maret for the PNBP research funding 2017.

REFERENCES

1. Chen, Zhigang, Jennifer, F.W., Shashi, F., Katie, J. 2011. Soy Based, High Biorenewable Content UV Curable Coatings. Progress in Organic Coatings, 71 : 98-109 2. Cousinet, Sylvain, Ali, G., Etienne, F., Frederic, L., Jean, P.P., Daniel, P. 2015. Toward Replacment of Styrene by Bio-based Methacrylates in Unsaturated Polyester Resins. European Polymer Journal, doi : http://dx.doi.org/10.1016/j.eurpolymj.2015.02.016 3. Dai, Jinyue, Songqi, M., Xiaoqing, L., Lijing, H., Yonggang, W., Xinyan, D., Jin, Z. 2015. Synthesis of Bio Based Unsaturated Polyester Resins anf Their Application in Waterborne UV Curable Coatings. Progress in Organic Coatings, 78 : 49-54 4. Frings, S., Mainema, H.A., Van Nostrum, C.F., Van de Linde, R. 1998. Organic – Inorganic Hybrid Coatings for Coil Coating Application Based on Polyesters and Tetraethoxysilane. Progress in Organic Coatings, 33 : 126 – 130

5. Jung, Soon-Joon, Sang-Jin, L., Won-Jei, C., Chang-Sik, H. 1997. Synthesis and Properties of UV-Curable Waterborne Unsaturated Polyester for Wood Coating. Journal of Applied Polymer Science, 69 : 695-708. 6. Okkerse, C., and H., van Bekkum. 1999. From Fossil to Green. Green Chemistry : 107-114. 7. Slama, W.R. 1996. Polyester and Vinyl Ester Coating. Journal of Protective Coating & Lining, 88 - 109 8. Rai, Sandeep and Snehal, L. 2015. Important Aspect Involved in Pilot Scale Production of Modern Paint and Coatings. Intelligent Coatings for Corrosion Control : Elsevier 9. Wojcik, Anna, B., Lisa, C. K. 1995. Transparant Inorganic/Organic Copolymer by the Sol-Gel Process : Copolymer of Tetraethyl Orthosilicate (TeOS), Vinyl Triethoxysilane (VTES) and (Meth)acrylate Monomers. Journal of Sol-Gel Science and Technology, 4 : 57 - 66 10. Zou, H., Shishan, W., Jian, S. 2008. Polymer/Silica Nanocomposites : Preparation, Characterization, Properties, and Applications. Chemical Reviews, 108 (9) : 3893 – 3957

MORINDA CITRIFOLIA L (NONI) FRUIT AS A SOURCE OF IMMUNOSTIMULANT : THE INFLUENCE OF ALTITUDE CULTIVATION AREA TO BIOACTIVE SUBSTANCE (POLYSACCHARIDE) CONTENT

EDIATI SASMITO1, RUMIYATI1, ENDANG LUKITANINGSIH1*

1Pharmaceutical Chemistry Department, Faculty of Pharmacy, Gadjah Mada University Jalan SekipUtara, Jogjakarta, 55281, Indonesia *[email protected]

Abstract. Imunostimulant is one of the activities of drug ingredients to boost immunity. The human immune often decrease when in stress condition or in an unhealthy environment as in the post disasters. Noni or Morinda citrifolia L is a plant that has been used as a traditional medicine to treat some diseases such as infections, intestinal worms and tumors. It has been reported that the Noni fruit has also activity as an immunostimulant or strengthen the immune system. One of the active compounds which acts as immunostimulant is polysaccharide compound. This study aimed to determine the influence of cultivation area of Noni to bioactive compounds content which having as immunostimulant activity. In this study, the bioactive compound target is Polysaccharide. The selected cultivation areas for Noni are Purworejo (33.18 m asl), Yogyakarta (114 m asl) and Malang (800 m asl). Polysaccharide content was analysed using High Performance Liquid Chromatography (HPLC) after maceration of dried noni fruit powder in ethanol. The result showed that there is no significant differences of polysaccharides content from three difference areas. Noni fruit obtained from Yogyakarta has highest polysaccharide (about 5.42%) compared from other areas. Based on the result, Noni can be cultivated at an altitude of about 114 m above sea level in order to obtain the maximum content of bioactive substance (Polysaccharide) as a source immunostimulant. It was recommended to plant noni in Aceh where the area has height about 114 m (asl).

Keywords: Morinda citrifolia L, polysacharide, immunostimulant

INTRODUCTION

Indonesia has many natural resources that can be used as drug materials. One of the plants that have active compounds as drug material is Morinda citrifolia L (Figure 1). or also known as Noni or Mengkudu (in Indonesia), which is found throughout the archipelago. Since thousands of years ago Noni has been used by the public for the treatment of various diseases. It has also been reported that Noni has antibacterial, antitumor, antiviral, antihelmin, analgesic, hypotensive, antiinflammatory and immune-boosting activities (Singh, 2012; Wang et al., 2006; Ediati et al., 2015). Not only fruit, leave of Noni has also evaluated about its safety, both acute and subchronic toxicity (Lagarto et al., 2013).

In previously study, it has been reported that animals given drinking water containing 10% Noni juice, there was appearance a magnification of their thymus gland weighing 1.7 times compared to the control group. Noni juice has high concentration of polysaccharide (Bui et al., 2006). The thymus gland is an important organ in the immune system that produces T lymphocytes, so Noni juice is thought to be potentially as an immunostimulator (Wang & Su, 2001; Ediati et al., 2015). Ediati et al. (2011) has reported that Noni juice in concentration of 0.625% can increase the proliferation of lymphocyte cells in cultures given hepatitis A vaccine, but not increase the number of antibodies (Ediati et al., 2015). The study conducted by Hirazumi and Furusawa (Hirazumi et al., 1999; Hirazumi et al., 1996) suggest that alcohol fraction of mucilago fruit can extend the lifespan of rat trated LLC (Lewis Lung Carcinoma) to 75% compared with the control group. This fact may be caused by many polysaccharides content in mucilago fruit of Noni. These polysaccharides were able to activate the host's immune system, thus suppress the growth of tumor cells (Hirazumi et al., 1994). The Noni fruit polysaccharide fraction in concentration of 50 ppm obtained by ethanol precipitation method can increase macrophage phagocytosis index in vitro (Ediati et al., 2011). Reported also by Ediati et al. (2015), Noni fruit polysaccharide may improve the immunosuppressant side effects of Doxorubicin administration. The results of these studies indicated that the polysaccharide compounds in Noni fruit juice can be potentially as immunostimulant.

FIGURE 1. Noni fruit used in this study

Based on the results of research on Noni activities, it is possible that mengkudu fruit is cultivated and used as a drug for pharmaceutical production. To get the same properties of the mengkudu extract, quality of raw materials must be maintained, as well as processing procedures of extraction. The height of cultivation area is also an important factor that influences the quality of the active compound content in fruit. In this research, the evaluation of

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia polysaccharide content in ethanol fraction of Noni fruit obtained from three various areas has been examined. The areas are Yogyakarta region representing medium height area, Purworejo representing a coastal area and Malang representing a high altitude area.

EXPERIMENTAL

Reagents and chemicals

Noni fruit is obtained from three different areas in April 2016. The selected fruit is old but not yet ripe. Reagents and chemicals used, if not otherwise stated, have a quality pro-analysis, including glucose and rhamnose (HPLC grade, Sigma Aldrich), 96% ethanol, toluene, Folin Ciocalteau, ethyl acetate, anisaldehyde, sulfuric acid, lactose, aquadest , thin layer chromatography plate (TLC) Silica gel GF 254 (E-Merck, Darmstadt Germany)

Methods

Noni fruits that already ripe with greener yellow colour as shown in Figure 1, were collected on April 2016 from three difference areas, i.e. Yogyakarta, Malang and Purworejo. Noni fruits washed, sliced and dried to obtain a form crispy slices without mushrooms grown and stink. Drying was done using oven at 50°C to provide heat evenly and maintained in order to avoid caramelization, because the content of the polysaccharides in Noni fruit is quite high. There are monosaccharides found in Noni fruits, either in free form or bind with other compounds, such as arabinose, galactose, galacturonic acid and rhamnose (Bui et al., 2006; Singh, 2012). The drying process takes time, considering the water content in the Noni fruit is high up to 90% (Singh, 2012). After drying process, then Noni fruits was grilled and sieved with a mesh size of 30, resulting uniform and smooth powder. Uniformity of particle size can affect the content of active substances which can be extracted. Polysaccharides of the Noni fruit were extracted by maceration process using hot water at 75 ° C with a ratio of powder and solvent as much as 1:20. This comparison influences the effectiveness of maceration. Polysaccharides are a polar compound, so it will be dissolved easily in water. The water extract also contains other compounds in addition to the polysaccharide, so it needs to be purified. Purification can be conducted by water evaporation to obtain a viscous extract and then added ethanol. Polysaccharide will not be dissolved in ethanol, so that it can be precipited and can be removed from ethanol by filtration. Soluble compound in water was calculated and assumed as polysachharide content. In addition, glucose and rhamnose content was analyzed using HPLC that prepared in optimum conditioning. C18 column used as stationary phase; mobile phase cosisted of methanol-water (50:50) and detected using Refractive Index Detector.

RESULT

Noni fruits have been collected from three different areas that representing differences of height or altitude. These areas were Purworejo (33.18 m asl), Yogyakarta (114 m asl) and Malang (800 m asl). Conditioning of these areas can be read in Table 1. Purworejo has lowest

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia in pH value and humidity, however it has highest in sunlight intensity. pH soil in Malang is not different with it in Yogyakarta, catagorized as a neutral soil.

TABLE 1. pH soil, sunlight intensity and humidity of Malang, Purworejo and Yogyakarta

Parameters Malang Purworejo Yogyakarta pH soil 7.0 ± 0,5 6.4 ± 0,7 7.0 ± 0,3 Sunlight intensity (x 2000) 658.5 ± 51.5 855 ± 66.1 733.3 ± 15.3 Humidity 81.0 ± 1.0 63.0 ± 5.8 77.7 ± 3.8

Rendemen of polysaccharide fraction were 11.74%; 24.23 % and 24.85 %, respectively for Malang, Purworejo and Yogyakarta. Noni fruit sample from Yogyakarta has highest rendemen. Polysaccharides content in purified fraction of Noni fruit from three different areas has been determined. Result of this step can be shown in Table 2. Yogyakarta is the best area for Noni cultivation, because Noni form this area has the highest polysaccharide content among others area (35.27 %).

TABLE 2. Determination of total soluble compound in water and in ethanol

Parameters Malang Purworejo Yogyakarta Soluble Compound in Water 25.42% 28.11% 35.27% Soluble Compound in Ethanol 12.80% 17.43% 22.52%

Analysis of glucose and rhamnose content in polysaccharide fractions have been conducted using HPLC. Figure 2 is a chromatogram of glucose and rhamnose in Noni polysaccharide fractions, while the the concentration of glucose and rhamnose can be seen in Table III.

FIGURE 2. HPLC Chromatogram of glucose and rhamnose standard (left) and purified polysaccharide fraction of Noni from Yogyakarta (right)

Between rhamnose and glucose can be sparated using HPLC under the optimum conditioning. Glucose has retention time at 10.19 min, while rhamnose at 11.75 min. Concentration rhamnose and glucose in purified fraction has been calculated using caliberation curve of both standards as in Figure 3 and Table III displayed the result of glucose and rhamnose content in fractions.

TABLE 3. Glucose and Rhamnose Concentration in Sample collected from Malang, Purworejo and Yogyakarta.

Parameters Malang Purworejo Yogyakarta Glucose 1.82 % 1.90 % 5.42 % Rhamnose , 1.12 ppm 1.02 ppm NDD

Caliberaon Curve of Glucose

120000000 100000000 80000000 60000000 Area 40000000 y = 75074x - 1716.3 R² = 0.99973 20000000 0 0 200 400 600 800 1000 1200 1400 1600 Concentraon of glucose (ppm)

Caliberaon curve of rhamnose

120000000

100000000

80000000

60000000 Area 40000000

20000000 y = 68137x + 191819 R² = 0.99974 0 0 200 400 600 800 1000 1200 1400 1600 Concentraon of rhamnose (ppm)

FIGURE 3. Caliberation curve of glucose and rhamnose

Glucose in polysaccharides fraction obtained from Yogyakarta has highest concentration than from other regions. According to the data, Noni fruit from Yogyakarta was chosen as the best fruit that can be used as raw material for medicine.

CONCLUSION

Noni fruit collected from Yogyakarta has concentration of soluble compound in the water of 35.2% and concentration of glucose of 5.42%, the highest concentration among the other samples. Noni can be cultivated at an altitude of about 114 m above sea level in order to obtain the maximum content of bioactive substance (Polysaccharide) as a source immunostimulant.

ACKNOWLEDGEMENT

Researchers would like to thank to the Health Ministry of the Republic Indonesia that has provided research funding through the Program of Development and Enhancing Capacity Raw Materials for Drugs and Traditional Medicine (Program Pengembangan dn Peningkatan Kapasitas Bahan Baku Obat dan Bahan Baku Obat Traditional) in 2016.

REFERENCES

1. Singh, D.R. Morinda citrifolia L. (Noni): A review of the scientific validation for its nutritional and therapeutic properties. J. Diabetes Endocrinol. 3(6) (2012) : 77-91 2. Wang YY., Khoo KH., Chen CC., Wong CH., Lin CH., Chen HS., et al., 2006, Immuno- modulating Antitumor Activities of Ganoderma lucidum (Reishi) Polysaccharides, US patent,713583. 3. Ediati, S., Triana, H., Senda K., Faradhyta, M.P., Vania, S and Longina, N. Optimization of Polysaccharide-Rich Fractionation from Morinda Citrifolia L Fruit Based on Imunostimulatory Effect in Vitro, Indonesian J. Pharm. 26(2) 2015 : 78 – 85 4. Lagarto, A., Bueno, V., Merino, N., Piloto, J., Valdes, O., Aparicio, G., Bellma, A., Couret, M., Vega, Y. Safety evaluation of Morinda citrifolia (noni) leaves extract: assessment of genotoxicity, oral short term and subchronic toxicity. J Intercult Ethnopharmacol. 2(1) (2013) :15-22 5. Bui AKT, Bacic A, Pettolino F. Polysaccharide composition of the fruit juice of Morinda citrifolia (noni). Phytochemistry 67 (2006) :1271-1275. 6. Wang, M.Y., Su, C., 2001, Cancer preventive effect of Morinda citrifolia (Noni), Annals of the New York Academy of Sceinces 952, 161-168. 7. Ediati, S., Triana, H., Tiya, N.R., Brata J.L., 2015b, Polysaccharide-Rich Fration of Noni Fruit (Morinda citrifolia L.) as Doxorubicin Co-Chemotherapy: Evaluation on Catalase, Macrophage and TCD8+Lymphocyte, Sci Pharm. 2015; 83: 479–488 8. Ediati, Yuniarti, N., & Soegihardjo, CJ., 2011, Mekanisme Imunomodulator Ekstrak Buah Mengkudu (Morinda citrifolia, L.) pada Mencit Balb/C yang Diinduksi Vaksin Hepatitis B, Majalah Obat Tradisional, ISBN 1410-5918.

9. Hirazumi, A., & Furuzawa, E., 1999, An Immunomodulatory Polysaccharide-Rich Substance from the Fruit Juice of Morinda citrifolia (Noni) with Antitumour Activity, Phytoter Res.13: 380–387 10. Hirazumi A., Furusawa E., Chou SC., Hokama Y., 1996, Immunomodulation contribute to The anticancer activity of Morinda citrifolia (noni) fruit juice, Proc West Pharmacol Soc, 39, 7-9. 11. Hirazumi A., Furusawa E., Chou SC., Hokama Y., 1994, Anticancer activity of Morinda citrifolia (Noni) on intraperitoneally implanted Lewis lung carcinoma in syngeneic mice, Proc West Pharmacol Soc, 145-6.

RELATIONSHIP BETWEEN GENDER WITH SPUTUM AFB CONVERSION IN PULMONARY TUBERCULOSIS PATIENTS IN PRIMARY HEALTHCARE BANDA ACEH

NOVITA ANDAYANI

Pulmonology Department, Faculty of Medicine, Syiah Kuala University/ RSUDZA [email protected]

Abstract. Gender and sputum AFB conversion are two interrelated factors, where the gender will affect the conversion and the success of treatment in patients with TB. Gender is a non-reversible factor that affects conversion. This conversion rate is usually assessed at the end of intensive treatment. The high prevalence of TB is caused by the low rate of success of treatment and the high number of infection transmission by positive AFB droplets.8 The success of TB treatment can be seen from weight gain and sputum AFB conversion. Sputum AFB conversion is a change from AFB positive to AFB negative after intensive treatment.9 Sputum AFB conversion in AFB positive pulmonary tuberculosis patients happens after intensive treatment phase. Sputum AFB conversion is a change of smear positive sputum to a smear negative sputum after intensive phase treatment. AFB conversion during treatment can be a preliminary predictor of treatment outcomes and to know the performance of direct monitoring of medication ingestion. Factors affecting sputum AFB conversion in TB are; irregularity of medicine consumption, medication side effects, smoking, diabetes mellitus, old age, gender, early sputum positivity level and HIV.12,13,14 Factors that all TB patients have are age, gender and early sputum positivity. The purpose of this study was to investigate the association of gender with sputum conversion after treatment. The instrument that was used in this research was the research sheets for recording the necessary data and medical records containing patient data, gender and sputum conversion after treatment. Analysis of this research was univariate and bivariate analyses. Univariate analysis was performed on dependent and independent variables. This analysis was conducted to assess descriptively the distribution and frequency of the observed variables. Univariate analysis is done by descriptive statistic method. Bivariate analysis was used to test the hypothesis at α: 0.05. The bivariate analysis used is Chi- Square statistical test. Out of the 62 respondents, in male, the conversion happened in 28 people (68.3%) and those who did not experience a sputum conversion was 13 people (31.7%), while in female, the conversion happened in 16 people (76.2%) and those who did not experienced a sputum conversion was 5 people (23.8%). Because it did not meet the criteria of chi-square test, then Fisher test was used, showing a P value of 0.570 (P value> 0.05) in which the researcher stated that there is no significant relationship between gender with sputum conversion after treatment in pulmonary tuberculosis patients in all Public Health Centers of Banda Aceh in 2015.

Keywords: gender, sputum AFB conversion, tuberculosis

INTRODUCTION

Tuberculosis is a chronic infection caused by Mycobacterium Tuberkulosa (M.tb) bacteria. It is estimated that one third of the world population is infected by M.tb, but most have never been becoming an active tuberculosis (TB) (CDC, 2012). According to World Health Organization (WHO) data in 2014, 2 to 3 billion people are infected with TB, 9 to 10 million of the world population suffer from TB and 2.7 million TB patients died. Indonesia is the second highest TB burden country in the world after India, surpassing China in the world (Isacc et al., 2015; WHO, 2015). Tuberculosis is the second infectious disease that causes death in the world after the Human Immunodeficiency Virus (HIV) disease. Based on data from the Ministry of Health of the Republic of Indonesia, the prevalence of Indonesian population diagnosed with pulmonary TB by health workers is 0.4% and tends to increase with age. The five provinces with the highest pulmonary TB prevalence were West Java (0.7%), Papua (0.6%), Jakarta (0.6%), Gorontalo (0.5%), Banten (0.4%), West Papua (0.4%) (WHO, 2014). Based on data from the Ministry of Health of the Republic of Indonesia in 2013 the prevalence of the disease in Aceh was around 0.3% of all TB cases in Indonesia (Depkes RI, 2013). In 2012 the incidence of Acid-Fast Bacillus (AFB) was 96/100.000 population. While the deaths from smear positive pulmonary TB were 1.6/100.000 population. The highest prevalence of TB cases in Aceh province is in Southwest Aceh District (Suprijino, 2005). The high TB prevalence is due to the low treatment success and high droplet transmission rate by smear positive patients. Sputum AFB conversion is a change of smear positive sputum to a smear negative sputum after intensive phase treatment (Dinkes Aceh, 2012). AFB conversion during treatment can be a preliminary predictor of treatment outcomes and to know the performance of direct monitoring of medication ingestion. Factors affecting sputum AFB conversion in TB are; irregularity of medicine consumption, medication side effects, smoking, diabetes mellitus, old age, gender, early sputum positivity level and HIV (Depkes RI, 2011; Babalik et al., 2012; Mota et al., 2012). Factors that all TB patients have are age, gender and early sputum positivity. Gender is a factor that always affects several diseases including pulmonary TB patients. Gender will affect someone's immune system. Based on the above review it is said that sputum conversion after treatment is influenced by gender. Therefore, the authors are interested in doing research on gender with sputum AFB conversion after treatment in patients with pulmonary TB.

RESEARCH METHODOLOGY

This research is a type of observational analytic research with cross sectional design with the aim to see the relationship of gender with sputum conversion after treatment of tuberculosis patients. The population of this study was all pulmonary TB patients in all Primary Healthcare in Banda Aceh in 2015 with 127 people from 11 primary healthcare. The sample of this study was chosen based on nonprobability sampling method with total sampling type, taking samples until it met the number of samples that had been determined. After the research, the sample criteria were 62 samples. The instrument that was used in this research was the research sheets for recording the necessary data and medical records containing patient data, gender and sputum conversion after treatment. Analysis of this research was univariate and bivariate analyses. Univariate

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia analysis was performed on dependent and independent variables. The bivariate analysis that was used was Chi-Square statistical test.

RESULT AND DISCUSSION

TABLE 1. Frequency Characteristic Distribution of Research Sample

Frequency Percentage

(n) (%) Age (year) 17-25 4 6,5 26-35 15 24,2 36-45 18 29,0 46-55 18 29,0 56-60 7 11,3 Gender Male 41 66,1 Female 21 33,9 Education Level No education 0 0 Elementary School 6 9,7 Junior High School 14 22,6 Senior High School 31 50 University 11 17,7

Based on table 1, it was found that the majority of the respondents in this study were 36-55 years old, 36 respondents (58%), 41 respondents were male (66,1%), senior high school respondents were 31 respondents (50% ) and seen from the job of the respondents, entrepreneur were 22 respondents (35%). The study found that majority of respondents aged 46-55 (29%) and also aged 36-45 (29%). This research is in line with research conducted by Mulyadi et al in the coast of Southwest Aceh that pulmonary tuberculosis disease has 75.68% susceptibility level to productive age group, that is group with mean age 15-54 years. This is because the productive age group has a broad intercommunication and the activities carried out are also numerous so that the group with the average age is more often exposed by factors causing tuberculosis both originating from the environment as well as from themselves.

TABEL 2. Gender Frequency Distribution before Treatment

Gender Frequency (n) Percentage (%) Male 41 66,1 Female 21 33,9 Total 62 100

Based on Table 2 it is found that men are more likely to experience tuberculosis than women. This may be due to unhealthy lifestyles such as smoking and less care of their health.

TABEL 3. Sputum AFB Conversion Frequency after Treatment

Sputum Conversion Frequency (n) Percentage (%) Conversion 44 71 Non-conversion 18 29 Total 62 100

Based on Table 3, the frequency of TB patients who experienced conversion is more than patients who did not experience a conversion. This is consistent with the research conducted by Lutfi, L in RSUDZA Banda Aceh which has conversion is 70.2%.(35) Research conducted by Yauma found that there was 98.6% who experienced conversion of 92 subjects.(36) Research conducted by Dinda in Nabela in 2014 stated that coastal TB patients who experienced sputum AFB conversion were as much as 54% compared to those who experienced conversion failure as much as 45.9%.(37) Sputum conversion determines the success of treatment. Sputum conversion in the intensive phase will indicate high treatment success and low probability of MDR. The failure of sputum smear conversion is closely related to medication adherence, while medication adherence is influenced by the level of knowledge of patients with pulmonary TB.

RELATIONSHIP BETWEEN GENDER AND SPUTUM AFB CONVERSION IN NEW PULMONARY TB PATIENTS

Crosstab Chi-Square Tests Value df Asymptotic Exact Sig. (2- Exact Significance (2- sided) Sig. (1- sided) sided) Pearson Chi-Square ,420a 1 ,517 Continuity Correctionb ,124 1 ,724 Likelihood Ratio ,429 1 ,512 Fisher's Exact Test ,570 ,367 Linear-by-Linear ,414 1 ,520 Association N of Valid Cases 62 a. 0 cells (0,0%) have expected count less than 5. The minimum expected count is 6,10. b. Computed only for a 2x2 table

Based on statistical test, Chi-Square value did not meet the criteria, which means Fisher test was used. Fisher test showed a significance value of 0.570, which means there was no relationship between the sputum AFB positivity level before treatment with sputum AFB conversion after treatment because the significance was smaller than the tolerance limit of 5%. It turned out that female was more affected by sputum conversion than male, which was influenced by hormones. The estrogen hormone in women increased the secretion of INF- gamma and activated macrophage while in men testosterone inhibited the immune system.

REFERENCE

1. Center for Disease Control and Prevention (CDC). Tuberculosis 2012 [maret 2016]. Available from: http://www.cdc.gov/tb/topic/basic/default.htm 2. Isacc, M. Faans, S,Hendrik,V. Anne, G. Devolepment and evaluation of a rapid multiplex- PCR based system for Mycobacterium tuberculosis diagnosis using sputum sample. Journal of Microbiological Methods. 2015.5-13 3. World Health Organization (WHO). Global Tuberculosis Report 2015. 20thed. Geneva.2015.5-7 4. World Health Organization (WHO). Global Tuberculosis Report 2014.Geneva: WHO Press. 2014;7-38. 5. Departemen Kesehatan Republik Indonesia (Depkes RI) Riset Kesehatan Dasar 2013. Jakarta. 2013;69-71. 6. Suprijino D. Faktor resiko yang berpengaruh terhadap kejadian konversi dahak setelah pengobatan fase awal pada penderita tuberkulosis bakteri tahan asam positif, fakultas kesehatan masyarakat. Semarang :Universitas Diponegoro. 2005. Tesis.:14-17 7. Dinas Kesehatan Provinsi Aceh. Profil Kesehatan Aceh 2012. Banda Aceh. Dinas Kesehatan Provinsi Aceh. 2012;12 8. Departemen Kesehatan Republik Indonesia (KemenKes RI). Pedoman Nasional pengendalian Tuberkulosis.KemenKes RI. Jakarta.2011. 7. Babalik A., Kiziltas S., Arda H., Oruc K., CelintasG.,Callaletin H .,et al. factor affecting smear Conversation in tuberculosis management. Medicine science.2012;1(4);351-62. 9. Mota P.,et al predictor of delayed sputum smear and culture conversation among A Portuguese population with pulmonary tuberculosis. Portuguase journal of pulmonology 2012;18(2);72-79. 10. Departemen Kesehatan Republik Indonesia (KemenKes RI). Pedoman Nasional Pengendalian Tuberkulosis.KemenKes RI. Jakarta.2011. 11. Triyani Y.,Parwati.,Sjahid I.,Gunawan J.E. Peralihan (konversi) sputum BTA Antara Pemberian Dosis Baku (Standar) dan Tinggi Rifampisin pada pengobatan (Terapi) Anti Tuberkulosis Kelompok (kategori) l. Indonesian Journal Of Clinical Phatology and Medical Laboratory;2007;14;1-6. 12. Tiwari, S., Amod,K.,Kapoor,SK. Relationship between sputum smear greading and sear conversation rate and treatment outcome in the patien of 13. pulmonarytuberculosis undergoing dots-a prospective cohort study. Indian J Tuberc;2012;59;135-140. 14. Kurniati, I. Angka konversi penderita tuberculosis paru yang di obati dengan obat anti tuberkulosis (OAT) paket kategori I di BP4 garut.MKB;2010;42;33-36.

15. Suprijino D. Faktor resiko yang berpengaruh terhadap kejadian konversi dahak setelah pengobatan fase awal pada penderita tuberkulosis bakteri tahan asam positif, fakultas kesehatan masyarakat. Semarang :Universitas Diponegoro. 2005. Tesis.:14-17 16. Babalik A., Kiziltas S., Arda H., Oruc K., CelintasG.,Callaletin H .,et al. factor affecting smear Conversation in tuberculosis management. Medicine science.2012;1(4);351-62.

ANTI-AGING COMPOUND OF MORINDA CITRIFOLIA BASED ON IN SILICO REVERSE DOCKING

MOHAMAD AMIN1, RENI ISTININGRUM2, ENDANG SUARSINI1 , BETTY LUKIATI1, AHYA ZHILALIKBAR AMIN3 AND UMIE LESTARI1

1Biology Study Program, State University of Malang1 Alumni of Postgraduate Program, Study Program Biology, State University of Malang2 Student in SMA Negeri 3 Malang *[email protected]

Abstract. Aging is a natural process and can’t be avoided by humans grow older, but it can be slowed in a proper way. One of them is to use cosmetics, but the use of cosmetics in the long term is not the best solution because it has negative effects. The use of natural compound from natural plant is the solution. Based on reports from previous studies that Morinda citrifolia has potential as an anti-aging (scopoletin). This study aims to predict whether Scopoletin compound can inhibit aging in humans using in silico approach and reverse docking method. The result for the target protein Scopoletin which function in the process of aging is CA1. Scopoletin and L-Phenylalanine is inhibitor and activator that works complementary to maintain the balance of CA1.

Key words: anti ageing, CA1, in silico, reverse docking, scopoletin

INTRODUCTION

Aging occurs due to the progressive decline in the capacity of cellular metabolism and proliferation activity coupled with the potential loss of gene expression, the accumulation of somatic mutations, as well as the structure and function of the skin elasticity decreases (Muenchen, 2010). One effort that is often done to suppress the occurrence of aging is the use of chemical-based cosmetics which unwittingly actually be bad for health. The chemicals will be absorbed by the skin harmful to the body system, the body's immune system, the nervous system, or respiratory system (NIOSH, 2011). In addition POM (2007) has found 27 cosmetics that contain substances for use in cosmetics i.e: mercury (Hg), hydroquinone, rhodamine B, for Red K10 and K3 (the synthesis of dyes commonly used as dying in paper, textiles or ink industires). The negative effects of these harmful substances is causing black spots on the skin, allergies, skin irritation. The using of high doses can cause permanent damage to the brain, kidney, fetal developmental disorders, lung damage, cancer and others. Cosmetic products made from chemicals that are declared safe to be used, but if they are used continuously in the long periode will cause negative effects to the body (Gattuso, 2011). Using of natural materials would be more safe for the body and in Indonesia there are also abunandt biodiversity so it make easier to find these plants. Plants used as medicinal plants such as binahong, betel nut,

2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia bitter, ginger, turmeric, ginger, noni will certainly be safer for the body because they are derived from natural ingredients (Tajoedin, 2002). Morinda citrifolia plant can grow almost in whole Indonesian region, so we can find abunandtly (Thomas, 2012). Based on data from Agriculture Ministry in 2012 states that the national need reached 354.774 m2 Morinda citrifolia that produces as much noni fruit 8.96775 million kg/year. The results of research on the biological activity of noni phytochemicals show the effect of antibacterial, antiviral, antifungal, antitumor, anthelmintic, analgesic, hypotensive, anti-inflammatory and strengthens the immune system (Singh, 2012). Besides noni also contains antioxiandts which can counteract free radicals (Suhartono, 2005). One of the causes of aging is free radical (Fisher, 2007), so by using of noni is expected to retard aging. Morinda citrifolia can produce scopoletin as a natural biactive. Hornick et al (2003) reported that scopoltein acts as an anti-angiogenic activity of Morinda citrifolia in an in vitro angiogenesis assay. In addition the results of in vivo tests conducted by Beh et al (2010) on the noni fruit, scopoletin was identified as one of the chemical elements responsible for the anti-angiogenic activity using animals experiment. The process of angiogenesis is involved in the development and progression of various pathological conditions such as tumor growth and metastasis, cardiovascular disease, inflammatory disease and psosiaris. By using a bioinformatics approach expected to be able to predict scopoletin which bind the target protein in the body that is suitable and its effects in the human body. It can reinforce the notion that scopoletin contains anti-aging and safe to be use for human body.

PURPOSE

The purpose of this study is to predict whether the compound scopoletin can inhibit aging in humans by using reverse docking method.

METHOD

This research is in silico using reverse docking method, using database, web server, and the software that can support this research. The stages of this research are: 1. Choose the 3D structure of compound scopoletin in Morinda citrifolia from PubChem Database Three dimention (3D) structure scopoletin compound used in this study were taken from PubChem (https://pubchem.ncbi.nlm.nih.gov/) in a format Sybil Data Files (.sdf), as well as knowing Smiles of the scopoletin.

2. Specify a target Protein for compounds scopoletin by using Web Server SwissTarget Prediction, PharmMapper, and SuperPred By entering the 3D structure of the compound scopoletin using PharmMapper webserver (http://59.78.96.61/pharm mapper /) can be detected target protein to scopoletin, and enter Smiles on the webserver Swiss Target Prediction (http://www.swiss targetprediction.ch /) and SuperPred (http://prediction.charite.de/) will be known to the target protein candidates for scopoletin compound. Then seen through the third webserver the name of protein target the same.

3. Validation of the target protein function After obtaining the similarity of target protein the results of the third webserver then the result of the same candidate is validated target proteins through Goggle search egine literature as well as the information presented in the database Uniprot (http://www.uniprot.org?).

4. Collection of 3D structure of the target protein and activator / inhibitor protein targets with PDB and PubChem Collection of 3D structures of activators / inhibitors obtained from PubChem through (https://pubchem.ncbi.nlm.nih.gov). Data is stored in a format Sybil Files (.sdf). For the collection of the 3D structure of the target protein is obtained from PDB through (http://www.rcsb.org/pdb/home/home.do), saved in the Protein Data Bank Files format (.PDB).

5. Scopoletin docking with the target protein activator / inhibitor using PyRx 0.8 By using PyRx 0.8 can be detected the highest binding affinity to a potential target of a drug

6. Visualization of interaction between scopoletin, Target and Activator Protein / Inhibitor using PyMOL and to determine the hydrogen bonds and hydrophobic interactions in 2D between ligand-protein using LigPlus +. Visualization of interaction between scopoletin, Target and Activator Protein / Inhibitor using PyMOL to know how the bonding of the third, and to more strengthen the bond because of the similarities alleged hydrogen bonds and hydrophobic and constituent amino acids using LigPlus +.

RESULTS AND DISCUSSION

The beginning stage of this research is to collect the 3D structure scopoletin obtained from PubChem through (https://pubchem.ncbi.nlm.nih.gov). Scopoletin has chemical structure under Canomical Smiles: COC1 = C (C = C2C (= C1) C = CC (= O) O 2) O and Gen ID 5280460. The results of the 3D structure of scopoletin can be seen in Figure 1 stored in a format Sybil Data Files (.sdf) , To view the 3D structure that had been downloaded can be viewed via the Discovery Studio 4.1 (Picture 1 a) or PyMOL (Picture 1 b).

(a) (b) FIGURE 1. 3D structure Scopoletin viewed through: (a) Discovery Studio 4.1, (b) PyMol

The second stage is to enter the 3D structure / Smiles scopoletin into the webserver to predict a target protein of scopoletin with PharmMapper, SuperPred and STP (Swiss Target

Prediction). The results of the webserver PharmMapper by entering the 3D structure scopoletin through http://59.78.96.61/pharmmapper/ obtained 300 protein to the target protein candidate in scopoletin. The next is to enter Canomical Smiles on a webserver SuperPred (http://prediction.charite.de/) and Swiss Target Prediction (http://www.swisstargetprediction.ch/) gained 47 protein candidates for scopoletin and protein targets on 15 protein candidates for protein targets on scopoletin. Then by using database Uniprot whether there is a similarity in the names of these proteins, then the result of the third webserver seen whether there is similarity in name. The third stage is the validation of the target protein function by searching for the name similarity protein in the third webserver. After obtaining the similarity of protein targets from the webserver third result is carbonic anhydrase 1 (CA1) and carbonic anhydrase 2 (CA2). The results from the same candidate validated target proteins through Goggle search egine literature as well as the information presented in the database Uniprot (http://www.uniprot.org?). According Muenchen (2010), the function of carbonic anhydrase for humans is changing intracellular excess CO2 is converted into bicarbonate and protons. The formation of carbon dioxide is produced as a waste of decomposition of sugar and fat in respiratory, so it must be transported through the body to the lungs. In the process of respiration biochemical energy is converted into ATP, CO2 is produced in all animals. This process accompanied by the production of free radicals, which damage proteins and causing gene mutations. In normal skin condition CA1 and CA2 play an important role in regulating the amount of bicarbonate in the cytoplasm and the basolateral membrane, epithelial cells spinosum and basal layers. Data proteomics connecting 2-D gel electrophoresis, mass spectrometry and western blot analysis of 2-D produces that PEBP and CA1 number increased with age the skin. The results of the data analysis of microarray and RT-PCR from human tissues indicate that PEBP and CA1 is one of the proteins responsible for skin aging. Based on Maresca (2009) Coumarin is an inhibitor of carbonic anhydrase. This is also supported on the data obtained from Uniprot that coumarin is an inhibitor to CA1, which coumarin scopoletin included in the class. In addition, According to Kaeberlein (2016) et al CA1 serves as aging on the human body. Having in mind that scopoletin is an inhibitor to CA1, for the next stage is to find an activator of CA1. Temperini et al (2006) in the experiment explained that L-Phenylalanine is a strong activator of CA1. This is also supported from the data of Uniprot showed that L-Phenylalanine is one of the good activator for CA1. The fourth stage is to collect the 3D structure of the target protein and activator protein targets with GDP and PubChem. How to collect the 3D structure of L-Phenylalanine obtained from PubChem through (https://pubchem.ncbi.nlm.nih.gov). The results of the 3D structure of L-Phenylalanine can be seen in Figure 2 which stored in a format Sybil Data Files (.sdf). To view the 3D structure that has been downloaded can be viewed via the Discovery Studio 4.1 (Figure 2 a) or PyMOL (Figure 2 b). For the collection of the 3D structure of a compound / protein in the form of the ligand / mikromolekul obtained by using PubChem, for collection of 3D structures of compounds / protein in the form of macromolecules using PDB (Protein Data Bank). For the collection of the 3D structure of carbonic anhydrase 1 (CA1) is obtained from PDB through (http://www.rcsb.org/pdb/home/home.do). The results of the 3D structure of CA1 can be seen in Figure 3 which stored in the Protein Data Bank Files format (.PDB). To view the

3D structure that had been downloaded can be viewed via the Discovery Studio 4.1 (Figure 3 a) or PyMOL (Figure 3 b).

(a) (b) FIGURE 2. 3D structure L-Phenylalanine viewed through: (a) Discovery Studio 4.1, (b) PyMol

(a) (b) FIGURE 3. 3D structure CA1 viewed through: (a) Discovery Studio 4.1, (b) PyMol

The fifth stages mendocking compound scopoletin with CA1, L-Phenylalanine by using PyRx CA1 0.8. By using PyRx 0.8 can be detected the highest binding affinity against potential drug targets. The results docking between scopoletin with CA1 and L-Phenylalanine with CA1 can be seen in Table 1. In Table 1 we can see the highest binding affinity (binding pose is the best) on the results of docking scopoletin with CA1 is -6.2 (KCA / mol) mode 0 , while the results of L- Phenylalanine docking with CA1 is -5.8 (kca/mol) mode 0.

TABLE 1. Reverse Docking scopoletin compound with CA1 and L-Phenylalanine by CA1 use software PyRx 0,8

Ligand Binding Affinity (kcal/mol) Mode Scopoletin -6,2 0 Scopoletin -6,2 1 Scopoletin -5,8 2 Scopoletin -5,7 3 Scopoletin -5,6 4 Scopoletin -5,6 5 Scopoletin -5,5 6 Scopoletin -5,5 7 Scopoletin -5,5 8 L-Phenylalanine -5,8 0 L-Phenylalanine -5,5 1 L-Phenylalanine -5,3 2 L-Phenylalanine -5,3 3 L-Phenylalanine -5,2 4 L-Phenylalanine -5,1 5 L-Phenylalanine -5,0 6 L-Phenylalanine -5,0 7 L-Phenylalanine -4,9 8

The sixth stages is a visual interaction with CA1 scopoletin compound, L-Phenylalanine by CA1 using PyMOL and to determine the hydrogen bonds and hydrophobic interactions in 2D between ligand-protein by using LigPlus+. In Figure 4 (a) may be a 2D structure of scopoletin and 4 (d) a 2D structure of L-Phenylalanine obtained from PubChem. The result of the interact between CA1 and scopoletin were visualized by using LigPlus+ viewable hydrogen bonds and hydrophobic interactions. Hydrogen bonding interactions occur at amino acid Asn11, Gln242, His243 and bonding hydrophobic amino acid Ser231, Met241, Gly63, His64, Gly6, Asp8 (Figure 4 (b)). The result of the interaction between CA1 with L-Phenylalanine visualized using LigPlus+ viewable hydrogen bonds and hydrophobic interactions. Hydrogen bonding interactions occur at amino acids Gln242, Pro240, Ser231, His64, His243, and bonding hydrophobic amino acid Asn11, Gly6, Tyx7, Met241, Asp8 (Figure 4.e). Visualization of results PyRx 0.8 by using PyMOL in Figure 4.c is the result of docking between CA1 (pink) with scopoletin (green) binding affinity of -6.2 (KCA / mol) mode 0 and the results of docking between CA1 (pink) with L -Phenylalanine (white) the binding affinity of -5.8 (KCA / mol) mode 0. Figure 4.c can be seen clearly between scopoletin (green) and L- Phenylalanine (white) are in the same indentation in CA1 (pink) shows that good binding, so it can be predicted that working scopoletin and L-Phenylalanine is inhibitor and activator that works complementary to maintain the balance of CA1. It is also supported by the equation hydrogen bonds and hydrophobic bonds between the results of CA1 interactions with scopoletin and L-Phenylalanine (Table 2). The table can be seen on the similarity of hydrogen bonding at Gln242 and His243, and Met241 similarity in the hydrophobic bond, Gly6, Asp8. The second similarity strengthens the bond between the binding of CA1 with scopoletin and L- Phenylalanine.

FIGURE 4. (a) 2D structure of scopoletin, (b) Result LigPlus+ from CA1 with Scopoletin, (c) Result docking between CA1 (pink), scopoletin (green) and L- phenylalanine (white) visualized with PyMol, (d) 2D structure of L- phenylalanine, (e) Result LigPlus+ between CA1 and L-phenylalanine

TABLE 2. Results of hydrogen bonds and hydrophobic interactions in 2D between the scopoletin CA1 and CA1 with L-Phenylalanine

The result of the interaction The result of the interaction Amino acids between CA1 and Scopoletin between CA1 and L-Phenylalanine Asn 11 + √ Ser231 √ + Met241 √ √ Gly63 √ - His64 √ + Gly6 √ √ Asp8 √ √ Gln242 + + Pro240 - + His243 + + Tyx7 - √ Information: + : hydrogen bonding √ : hydrophobic bond

CONCLUSION

The target protein to scopoletin which serves in the process of aging is CA1. Scopoletin and L-Phenylalanine is activator and inhibitor that work complementary to maintain the balance of CA1.

REFERENCES

1. BPPOM RI. 2007. Kenalilah Kosmetika Anda, Sebelum Menggunakannya. Jakarta: Info POM. 2. Beh, Hooi-Kheng, Seow,Lay-Jing, Asmawi, Mohd Zaini, Shah Abdul Majid, Amin Malik, Murugaiyah, Vikneswaran, Ismail, Zhari and Ismail, Norhayati. 2010. Antiangiogenic Activity Of Morinda Citrifolia Extracts And Its Chemical Constituents. Malaysian Journal of Pharmaceutical Sciences, Supplement No. 1. 3. Gattuso, Anda Joel. 2011. The True Story of Cosmetic. Washington DC.: Competitive Enterprise Institute. 4. Fisher, G.J., Choi, H.C., Batta-C., Sorgo Z., Shao, Datta, ZQ., Kang, W.S. and Voorhess, J.J. 2007. Ultraviolet Irradiation Increase Matrix Metalloproteinase-8 Protein in Human Skin Invitro. Journal Invest Dermatol 117-26. 5. Hornick, CA., Myers, A., Sadowska-Krowicka H., Anthony CT., Woltering EA . 2003. Inhibition of angiogenic initiation and disruption of newly established human vascular networks by juice from Morinda citrifolia (noni). Angiogenesis 6(2):143-149. 6. Laimer, Martin, Kocher, Thomas, Chiocchetti, Andreas, Trost, Andrea, Lottspeich, Friedrich, Richer, Klaus, Hintner, Helmut, Bruner, Johan W, Onder, Kamil. 2010. Proteomic profiling reveals a catalogue of new candidate proteins for human skin aging. Journal Experimental Dermatology Vol. 19, p. 912-918.

7. Maresca, Alfonso, Temperini, Claudia, Vu, Hoan, Pham, Ngoc B., Poulsen, Sally Ann, Scozzafava, Andrea, Quinn, Ronald J., and Supuran, Claudiu T. 2009. Non-Zinc Mediated Inhibition of Carbonic Anhydrases: Coumarins Are a New Class of Suicide Inhibitors. Journal of the American Chemical Society, no 131, p. 3057-3062. 8. National Institute for Occupational Safety and Health (NIOSH). 2011. Effects of Skin Contact with Chemicals. Unites States America: Centers for Disease Control and Preventio. 9. Pangastuti, Ardini, Amin, Ihya Fakhrurizal, Amin, Ahya Zhilalikbar, and Amin, Mohammad. 2016. Natural Bioactive Compound From Moringa Oleifera against Cancer Based On In Silico Screening. Jurnal Teknologi (Sciences &Engineering), Vol 78:5, p. 315-318. 10. Singh.D.R. 2012. Morinda citrifolia L. (Noni): A review of the scientific validation for its nutritional and therapeutic properties. Journal of Diabetes and Endocrinology Vol. 3 (6), pp 77-91. 11. Thomas A.N.S. 2012. Tanaman Obat Tradisional 1. Yogyakarta: Kanisius. 12. Tisdall, J. 2001. Beginning Perl for Bioinformatics. Publisher: O'Reilly. First Edition.

LESSON LEARN FROM EARTHQUAKE & TSUNAMI HIT ACEH IN 2004

PRIA AGUSTUS YADI

Digestive Sub Division, Department of Surgery – Meuraxa Districk Hospital, Banda Aceh [email protected]

A disaster is a disruption of the human ecology of a severity and magnitude that often results in deaths, injuries, and property damage, overwhelming the existing available resources. Thus to be a mass casualty event it needs to disrupt normal emergency and health care services. It is a phenomenon that cannot be managed through the routine procedures and resources of government. Disasters differ from the more routine and daily emergencies, the ramifications and complex problems posed by disasters are unique and are rarely encountered by daily emergencies It is a common misconception to consider “good disaster response ”as“ merely an extension of good, routine, daily emergency procedures”. Our experience during Earthquake followed by Severe Tsunami hit Aceh in 2004, saw us, a lot of limitation did we have, lack of information about which was the Strong Earthquake will followed by Tsunami, a few miss-coordination among our internal governtment to prevent the more victims dead and lost. It was because of the major escalation of that destroyed disaster, more and more than what we had, what we prepared, what we knew and what we thought. The aim of disaster medicine is that with proper information and training, the medical staff has the skills and knowledge to reduce the loss of life, health, and psychosocial suffering associated with disasters. Thus, there are three major goals of disaster medicine: to reduce or prevent loss of life during the disasters and its aftermath, to provide immediate and appropriate assistance to victims, and to help the victims achieve rapid and durable recovery. The underlying philosophy of disaster management focused on the needs of the many outweighing the needs of the few. This is vital to ensure the survival of the maximum number of victims. In this setting, difficult triage decisions must be made to ensure all assets are used in the most efficient and pragmatic manner. These decisions need to be made in a timely fashion and thus preparedness will prepare you for the moment when that arrives.

COORDINATION OF HUMANITARIAN RELIEF IN DISASTER

ZAFRULLAH KHANY JASA*

Anesthesiology and Intensive Care Department of Zainoel Abidin Hospital and Medicine Faculty of Syiah Kuala University [email protected]

BACKGROUND

Disasters are occuring more frequently around the globe. Indonesia is geographically located at the junction among active tectonic. Indonesia is one of the disaster prone area from natural disaster to human-made disaster. Various humanitarian problems caused by disasters caused loss of life disturbance and human livelihood. The prevention of health problems is often in demand by different organizations and non-governmental organizations, but overall the efforts are uncoordinated. This situation does not succeed in achieving the expected goals. Overlapping activities and the assistance provided has often been deemed ineffective and inefficient aid allocations (including type and quantity of aids). Improving coordination and management of mitigation in disaster-prone areas is one of the priorities of preparedness efforts.

OBJECTIVE

This paper aims to evaluate the implementation of humanitarian assistance coordination in disaster affected area. The coordination should be supported by a regulation or agreement to achieve the cooperation of various organizations that provide humanitarian assistance and to improve the effectiveness, efficiency, and harmonization of both the emergency response and rehabilitation after the disaster.

METHOD

Coordination of humanitarian assistance to disaster in Indonesia is stipulated in the Regulation of Head of BNPB Number 7 the year 2008 concerning the procedure of giving basic needs fulfillment for disaster victims that fulfill minimum standard so that it can be used as reference by government, local government, non-government institution, both regional, national, and international. Besides, foreign assistance is also regulated in the Minister of Home Affairs Regulation No. 38 of 2008. For regional areas in Southeast Asia (ASEAN countries) has agreed on the coordination mechanism for disaster assistance in the Agreement on the Establishment of the ASEAN Coordinating Center for Humanitarian Assistance on Disaster

Management. In the global context, the UN also provides a standard in the coordination of humanitarian assistance compiled by the Office for the Coordination of Humanitarian Affairs (OCHA) in 2005. This paper discusses the implementation of the coordination of humanitarian assistance in the great disaster in Indonesia, namely Earthquake in West Sumatra 2009, Mount Merapi eruption in 2010, Earthquake in Central Aceh District in 2013 and Earthquake in Pidie Jaya Regency in 2016 as the implementation of various regulations and agreement in coordinating aid.

RESULTS According to the four disaster events in Indonesia, the study found that information on the condition immediately after the disaster was reported by BNPB 24 hours after to provide basic data on immediate need in the emergency situation. The various aid which is then received immediately distributed by Local Government and related Agencies that coordinate directly with disaster management agency which immediately formed to overcome problem arising within the period of 1 week after the incident. There is still more than one coordinator of disaster management and the direct transfer of assistance by various government and non-government agencies to make some of the aid provided unevenly achieved. From the perspective of disaster-affected communities, disaster data collection is often inaccurate with actual data resulting in the sense of dissatisfaction over the distribution of humanitarian aid.

CONCLUSIONS

Good coordination of various humanitarian assistance is conducted on a standardized basis, optimizing minimum needs for the survival of disaster victims accurately, quickly and with dignity. The principles of providing basic needs assistance are fast and precise, priority, coordination, and integration, efficient and effective. Transparency and accountability, partnership, empowerment, non-discrimination, and non-proletion. Coordination of humanitarian assistance is not yet possible in a short time so it is expected to be a lesson for disaster preparedness that may occur in the future.

Keywords: Disaster, Coordination, Humanitarian Relief

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MEDICAL FOR PIDIE JAYA EARTHQUAKE 7 DECEMBER 2016 IN BANDA ACEH, INDONESIA

SAFRIZAL RAHMAN 1, ANDRIA SAPUTRA 2*, PANJI ANUGERAH3

1Orthopaedic and Traumatology Division, Dept. of Surgery, Faculty of Medicine, Syiah Kuala University, Banda Aceh 2Resident, Dept. of Surgery, Faculty of Medicine, Syiah Kuala University, Banda Aceh 3Medical Student, Dept. of Surgery, Faculty of Medicine, Syiah Kuala University, Banda Aceh *[email protected]

BACKGROUND

Earthquakes are one of the most dangerous, destructive and unpredictable natural hazards, which can leave everything up to a few hundred kilometres incomplete destruction in seconds. Indonesia has a unique position as an earthquake prone country. It is the place of the interaction for three tectonic plates, namely the Indo-Australian, Eurasian and Pacific plates. Pidie Jaya district with an area of 1162.84 km and is located on 04¹06’ – 04¹47’ NL 95¹56’ – 96¹30’ EL and consists of 8 districts of 34 residence, 222 villages and with the population 145.548 people. In December 7th 2016 there has been earthquake with 6.5 richter scale. This earthquake has caused severe damage to many infrastructures such as schools, hospitals, mosques, and houses in the district of Pidie Jaya and surrounding areas.

CASE REPORT

We reported the case of the earthquake in Pidie Jaya, at the incident 103 people died (97 people from Pidie Jaya, 2 people from Bireuen, and 4 people from Pidie). Besides that there are 395 victims including 303 severe cases and 92 moderate cases. From 395 victims, 113 had to be operated, which is 65 operations were conducted in Sigli, 25 operations in Banda Aceh, and the rest in Bireun, Bereunuen and Pidie Jaya. Internal displacement people there are 134 locations including 85.256 people. At emergency phase was involved 58 specialist (28 from Unsyiah), 241 General practitioner (70 from Unsyiah), 50 Pshycologist (25 from Unsyiah), 188 Medical supporting person, and 408 Paramedic. 60% of the Pidie Jaya general hospital are collaps. Our concern to support interim by containerised Hospital, Visiting Spesialis, and Capasity building for medical staff. The central government plans to build a new hospital and interim hospital with 50 beds in it.

Keywords: earthquake, Pidie Jaya, disaster management

REFERENCES

1. Government Pidie Jaya 2. National Disaster Management Authority (BNPB) 3. Statistic Pidie Jaya (BPS)

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DYNAMIC SIMULATION MODELING ON HEALTH DISASTER POLICY AND MANAGEMENT IN INDONESIA

ELLY WARDANI

Nursing Department, Universitas Syiah Kuala Banda Aceh, Indonesia [email protected]

BACKGROUND

The potential impacts of health problems are frequently high following the chaos after disaster. To tackle such risks required a complex yet multidisciplinary approaches that lead to multiple relationships between systems and decision makers. Difficulty in planning fit and proper interventions is unavoidable due to these interactions. Dynamic modeling is expected to fill this gap since conventional assessment and modeling methods, unfortunately, failed to address broader analysis and impacts of the policies and interventions.

PURPOSE

This paper intends to explore further upon the application of dynamic simulation modeling on health disaster policy and management in Indonesia.

METHODS

A review of literatures was conducted to identify the effectiveness of dynamic modeling on health disaster management in Indonesia. The search strategy aimed to locate recently published studies in dynamic modeling in disaster in Indonesia. Peer-reviewed and governmental databases were explored.

RESULTS

Simulation modeling are used to design and provide mathematical representations of processes and systems interaction and examine interventions, scenarios, and their impacts over time in order to develop understanding of the systems, communicate findings, inform management and policy design. The model has been applied widely but limited reports available on its effectiveness on Indonesia’s health disaster policy and management. It is a complex challenge to formulate and-at the same time-evaluate the effectiveness of policy towards health disaster management since each social systems involved (e.g., government, health practitioners, or economists) has its own dynamic in facing situations. Several potential approaches to evaluate interventions were available but it is likely less advantageous to apply on analyzing complicated systems of health disaster policy and management. Dynamic simulation thus has been argued as an advance model that able to simulate impact of system

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2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia interventions without the need for experimentation. As the results, this would enable stakeholders to anticipate effectiveness of policies/interventions in health disaster circumstances in Indonesia.

CONCLUSION

An intense interdependent between social systems towards disaster is most likely lead to multiple decisions and interventions. Thus, modeling this dynamic interaction under such condition is plausible to offer. Dynamic simulation is not only helpful to forecast and compare the effectiveness of decisions and interventions but also able to facilitate policy makers to understand why a system behaves the way it does.

Keywords: Dynamic simulation and modeling, health disaster, Indonesia

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EPIDEMIOLOGY AND LABORATORY DATA OF DENGUE CASES IN 2016 IN SEMARANG CITY INDONESIA

ANTO BUDIHARJO1,2, DEA HAPSARI3, RETNO MURWANI4, NUR ENDAH WAHYUNINGSIH5*

1Biology Department, Faculty of Sciences and Mathematics, Diponegoro University, Jl. Prof. Soedharto SH, Semarang – Central Java, Indonesia, 50275 2 Central Laboratory of Research and Services, Diponegoro University, Jl. Prof. Soedharto SH, Semarang – Central Java, Indonesia, 50275 3 Department of Pediatrics, Kariyadi hospital, Jl. Dr. Sutomo, Semarang – Central Java, Indonesia, 50244 4Faculty of Animal Science and Agriculture, Diponegoro University, Jl. Prof. Soedharto SH, Semarang – Central Java, Indonesia, 50275 5 Public Health Faculty, Diponegoro University, Jl. Prof. Soedharto SH, Semarang – Central Java, Indonesia, 50275 * [email protected]

BACKGROUND

Globally 1.8 billion people in South East Asia and West Pacific suffered from 75% dengue fever disease. Thirty countries are the most endemic and Indonesia was the second after Brazil [1]. Dengue has caused economic burden, reaching 4.2 Trillion IDR or equal to 323, 163 U$ [2]. Dengue hemorrhagic fever (DHF) is caused by dengue virus transmitted by Aedes aegypti mosquito. Seventy years have passed since the intensive use of insecticide and Aedes aegypti as the culprit of the disease has been the center of the approach. In spite of this, the incidence of DHF has increased 30 times compared to the initial incidence [1]. Therefore, a question has arisen if it is necessary to solve the problem not only from the vector but also from patients and environmental sides. From patient side, we thought there is possibility that the determination of dengue suspect is not specific enough.

PURPOSE

To investigate the existing epidemiology and laboratory data of infants and adults patients of dengue fever from three main hospitals in Semarang from March to April 2016 (the highest month of DHF incidence). Additional data i.e. urine pH were measured to complete the existing medical records of dengue cases. All data will be examined to seek if the parameters can be used as determinants of dengue diagnosis and hence dengue incidence.

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METHODS

Respondents of dengue patient were obtained from 3 Hospitals in Semarang city which had the highest dengue cases and have given permit to use data from their patients. A total of 105 Dengue patients consisted of 39 (37.1%) from A-hospital, 22 (21%) from B hospital, and 44 (41.9%) from C hospital. Dengue patients were hospitalized patients who were tested positive for dengue by doctors or specialists and supported by the results of laboratory tests and recorded in the medical record Hospital during March-May 2016. A total of 53 healthy respondents were obtained from level II military cadets in Magelang. All respondents were asked to approve informed consent prior to urine and blood sampling. Sampling was done twice i.e. at the highest body temperature and when the temperature began to decline. Epidemiology and laboratory data obtained from the hospital consisted of age, IgG, IgM, platelets, hemoglobin, hematocrit and body temperature, while the pH of urine was obtained by examining the urine sample directly. Data for age, platelets, urine, and temperature were only available for 96 respondents from a total of 105 respondents. The first and second retrieval platelets data were obtained from 101 and 94 respondents; urine was obtained from 20 and 40 respondents, body temperatures from 75 and 65 respondents respectively. The remaining respondent data were not accessible. All data were obtained from the medical record of the respondents, except urine and temperature were measured directly. Data were analyzed descriptively and assisted by SPSS version 17.5.

RESULTS

Dengue Patients Patients had a range of ages from a few months to 59 years with a mean age of respondents was 12.8 years. Based on the classification of age, most respondents at the age of 4-15 years (60%) and 15-25 years (17%). Patients Platelets The first platelets collection of patients ranged from 11 X103 - 241X103 with a mean ± SD: 55.6 x 103± 39.2 X103, the next collection of platelets have a higher range ranged between 11x103 - 279 X103 with mean ± SD 82.2 X103± 58.4 X103. Based on the classification of the number of platelets, in the first collection, 85% of respondents had a platelet count <100,000 and 15%> 100,000, while from the second collection were 60% of respondents had <100,000 platelet count, and 40% of respondents with > 100,000 platelet count. On the second collection, respondents with > 100,000 platelets increased by 20% compared with the first collection. Body temperature of patient Range of body temperature between the first and second collection of patients with DHF and DSS showed an interesting phenomenon, where the body temperature of dengue patients from the first collection ranges between 36.0 - 38.8 ° C (the difference of 2.8 ° C), while the second collection ranges from 36.0-37.8 ° C (the difference between 1.8oC) , whereas patients with DSS showed a narrower temperature difference that the first and second collection of DSS patients between 35.7-38.0 ° C (difference 2,3oC) and between 36.0-37.0 ° C (the difference between 1.0oC) respectively. Urine pH of patients

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Ph urine of patients with dengue of the first and second collection was in the range of acidic to alkaline which were 6.0 - 9.0. There were range expansion of urine pH in the second collection, from pH 5.0-9.0, with a mean ± SD of urinary pH of dengue patients in the 1st and 2nd collection were 6.75 ± 0.93 and 7.40 ± 1.12, increased range of mean and SD urine pH between first and second collection

CONCLUSION

The aim of identification of epidemiological and laboratory data of dengue cases was to find the parameters that influenced the incidence of dengue hemorrhagic fever in infants and adults. Results showed that all Dengue Shock Syndrome (DSS) patients were children under 12 years. All of 105 patients were determined and confirmed as dengue with ages between 0 - 59 years. One case (1%) was classified as Dengue Fever (DF), 91 (86.7%) as DHF, and 13 (12.4%) as DSS. Platelet counts ranged from 11000-279000, temperatures between 35.7-38.8oC and urine pH between 5 - 9. In DHF patients the temperature at first sampling and second sampling were 36.0 - 38.8 °C and 36.0-37.8 °C and in DSS respondents were 35.7-38.0 °C and 36.0-37.0 °C respectively. In DHF respondents the pH at first sampling and second sampling were 6.0-9.0 and 5.0-9.0 and in DSS respondents were 6.0-7.0 and 6.0-8.0 respectively. There was a narrowing in the range of temperature and urine pH of DSS respondents compared to DHF respondents which needed further studies.

Keywords: dengue, epidemiology, laboratory, urine pH, platelet, temperature

REFERENCES

1. World Health Organization 2012. 2O12–2O2O Global Strategy For Dengue Prevention And Control 2. D. S. Shepard, E.A. Undurraga, and Y.A. Halasa, PLOS Neglected Tropical Diseases, 7, Issue 2, e2055 3. C. Rose , A.Parker, B. Jefferson, and E.Cartmell, Crit Rev Environ Sci Technol. 2015 45(17): 1827–1879..

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THE ROLE OF HOSPITAL DURING PIDIE JAYA EARTHQUAKE: A LESSON LEARNT

AZHARUDDIN1*, DIAZ NOVERA2

1Department of Surgery, Zainoel Abidin General Hospital/Faculty of Medicine Syiah Kuala University Banda Aceh 2 Emergency and First Aid Division, Indonesian Red Crescent – Jakarta Branch, Jakarta *[email protected]

BACKGROUND

7 December 2016 was a date that Pidie Jaya citizen will not forget as an earthquake with the magnitude of 6.5 shook the people just before daybreak. The Local Disaster Management Body (BPBD) was quickly notified as hundreds of victims pouring in to health centres in the area. At that point, rumours began to spread. Information regarding the number of casualties, help needed, and meeting points were unclear. Rapid response team was formed consisting of the police, military personnel, doctors, nurses and other civil organizations from unaffected neighbouring region immediately try to assess and contain the situation. The rapid response team then established a one-channel communication, define the location of crisis management centre, and set a chain of command to coordinate the aiding parties. The chaotic situation was resolved in less than 6 hours and resources available were managed efficiently.

PURPOSE

The purpose of this review is to evaluate the role of referred hospital in a cluster system of disaster management that was used during Pidie Jaya Earthquake. We hope that our experience should better prepare other hospitals in facing disasters.

METHODS

During the earthquake, the government advises field officers to use cluster system in managing the victims. The cluster systems formed are: Medical Service, Pharmacy and Logistics, Reproductive Health, Health Promotion and Prevention, Food and Nutrition, Water and Sanitation, Mental Health, and Disaster Victim Identification. The health crisis centre then determines which healthcare facilities are still available to assist in delivering the clustered services.The Medical Services cluster provides the medical treatment to victims in need, evacuation for further medical treatment and records field data of casualties and mortalities. Pharmacy and Logistics supports the Medical Services cluster in receiving, filtering and distribution of drugs, disposables and other medical equipment to posts providing medical

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2017 Conference on Health Management in Post Disaster Recovery “Strengthening Healthcare System Capacity to Disaster: Towards a Sustainable Risk Reduction” 22nd – 23rd May 2017 in Banda Aceh, Indonesia treatments. Health Promotion and Prevention controls the health status in refugee camps while mitigating the emerging diseases coming from within the camp. Water and Sanitation ensures the availability of clean water in the refugee camps and health posts, while Food and Nutrition provides food for both victims and officers in the area. Mental Health and Reproductive Health provide supports for specific populations and Disaster Victim Identification are responsible for identifying casualties in the field. Hospitals were an integral core in the cluster systems. Trained medical professionals from the hospitals were sent to the field to manage the mass casualty and initiate triage system. The referred hospital then prepares to accommodate the incoming patients. The health crisis centre then set up a network of coordination among hospitals in the area to ensure that the patients are distributed effectively and in accordance with each hospitals capability and capacity. In theory, the receiving hospital disaster management plan should be activated to anticipate surge capacity. One operating theatre should be dedicated for emergency operation, all available personnel should be called in, recalling personnel on leaves and distribute voluntary manpower to assist the incoming surge. It is acceptable to discharge patients prematurely, postpone elective operations or admissions and set up temporary beds to increase the hospital’s capacity. However, it is imperative that the hospital still keep their security high to protect the patient’s safety and privacy amidst the increased capacity. As victims coming in, the interest of information regarding the number of casualty and deaths follows. Hence, a policy regarding release of information should be in place to prevent the spread of misinformation. Once the surge period had resolved, hospitals should re-evaluate their capabilities in handling mass casualty incidents. Trainings to anticipate disasters should be provided to all staff and simulations regarding disasters should be performed periodically to ensure each person knows their role in managing mass casualty and minimize errors should the actual event occurs.

RESULTS

During the earthquake, the head of Aceh Public Health Services immediately assumes command of health crisis centre, formed the clusters as required, coordinates with the head of hospitals of neighbouring region in preparation for victim evacuation, and installs health posts within the affected area. The health crisis centre then coordinates incoming aids from other regions and establishes cluster system to ensure the resources were distributed accordingly. Within 20 days of Response phase, the cluster system was proven effective in providing adequate relief to the affected area. The biggest challenge that was found was managing the overwhelming number of volunteers and ensuring the sustainability of services provided until the period has ended. Pidie Jaya General Hospital was heavily afflicted from the earthquake as some facilities were collapsed and became inaccessible. However, the support received from network of hospitals from neighbouring area ensures that surge capacity and mass casualty were dealt effectively. Medical service delivered on the field was performed efficiently and no overcapacity was reported by receiving hospital. Patient’s continuity of care ensues and no post- disaster medical complication was reported.

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CONCLUSION

Hospitals are one of the most crucial infrastructures in disaster management and mitigation plan. Hence, it is inevitable that hospitals should be equipped with preparations to anticipate disasters. The cluster system was effective in delivering care to the field with the involvement of surrounding hospitals. While each hospital should be aware of their own limitation, capacity and capability, communication with other hospital should be constantly maintained to distribute burden evenly and prioritize the victim’s need.

REFERENCES

1. Yurianto. Peran Kluster Kesehatan dalam Pengurangan Risiko Bencana dan SPGDT Bencana. Presented at Rapat Koordinasi Klaster Kesehatan Pusat Krisis Kesehatan Kementerian Kesehatan Republik Indonesia; 2017; Surabaya. 2. Herlina. Evaluasi Penanggulangan Krisis Kesehatan Akibat Bencana Gempa Bumi di Kab. Pidie Jaya – Aceh. Presented at Rapat Koordinasi Klaster Kesehatan Pusat Krisis Kesehatan Kementerian Kesehatan Republik Indonesia; 2017; Surabaya. 3. Murray, R, Elmes P, Fly D. Hospital Disaster Preparedness Self-Assessment Tool; America College of Emergency Physician. [Cited 2017 May 18] Available at

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