Compliance with Perioperative Administration of Antimicrobials: An Infection Control Team Intervention / 日本農村医学会雑誌

　　With a view to preventing surgical site infection (SSI), administration of antimicrobial agents during surgery should be performed every 3-4 hours after the first administration before surgery begins. In our hospital, the infection control team (ICT) tried to intervene with surgeons and all operating room staff to improve compliance with the administration of antimicrobial agents. The purpose of this study was to evaluate the impact of this intervention by the ICT on correct administration of antimicrobial agents during surgery. In total, 435 surgeries which included ≥ 210 min under anesthesia or 180 min of the operation were analyzed. All antimicrobial agents were first administered within 60 min before the start of surgery. At some point, the ICT intervened, recommending that antimicrobials be administered every 3 h during surgery. The compliance rate (CR) of surgeries for the correct administration of antimicrobial agents was investigated. Differences in CR were evaluated (1) among departments (gastroenterology and general medicine [GM], orthopedic surgery [OR], otorhinolaryngology [OL], gynecology [GY], and urology [UR]), (2) whether intervention of ICT was carried out or not, and (3) in terms of specific procedures (endoscopy and laparoscopy). Total CR was 51.0% (GM: 67.0%, OR: 27.1%, OL: 40.5%, GY: 45.5%, and UR: 37.5%). CR was significantly higher in GM than in any other departments. CR with and without intervention was 69.9% and 42.7%, respectively, and this was statistically significant. CR in endoscopy was 25.8%, which was significantly lower than that in other surgeries (55.2%). CR in laparoscopy was 63.1%, which was significantly higher than that in other surgeries (47.3%). Intervention by the ICT resulted in significant improvement of CR for correct administration of antimicrobial agents. However, CR was low in some situations. This could be improved by more careful dialogue with surgeons and operating room staff.

Review of current situation and future strategies on prevention and control of Noncommunicable diseases (NCDs) in the Pacific Island States / 国際保健医療

<p>  In the Pacific island states, in addition to the traditional health issues common in developing countries, such as maternal and child health and communicable diseases, the increase in noncommunicable diseases (NCDs), e.g., obesity and diabetes, has become a serious problem. NCDs account for 80% of all deaths in this region, and the increase in early deaths of people younger than 70 years old is of particular concern. It has also been pointed out that the cost of countermeasures against NCDs are constricting government finances, and enhancing a health system that supports such countermeasures is also an urgent challenge. However, with respect to international health cooperation in Japan, the present status of NCDs and the associated statistical data in the Pacific island states are not likely to be addressed. Therefore, in this report, we comprehensively explain the present status of and approaches to NCDs around the world based on the World Health Organization (WHO), including those in the Pacific island states. By taking advantage of health indicators, we confirm the disease structure present in the 10 Pacific island states that cooperate bilaterally with Japan and then discuss the approaches in these states. As a result, although countermeasures against NCDs have been actively implemented in the Pacific island states in accordance with the WHO strategies, no tendency for the prevalence of NCDs to improve has been seen. To promote countermeasures against NCDs in the Pacific island states in the future, it will be necessary to engage in analysis and discussion of the present situation, to develop human resources, taking into consideration the region-specific characteristics of the islands, and to accumulate sufficient numbers of successful local stories consistent with the local strategies.</p>

A review of trends in food and nutrition policy framework and Dietary Reference Intakes formulated by international organizations since the 1990s / 国際保健医療

<b>Objectives </b><BR>  Recently, there has been an increasing focus on nutrition in international health cooperation. However, little attention has been paid on global nutrition issues and their methodologies in Japan. One of the possible reasons is that the whole picture cannot be clearly grasped, because nutrition issues and actions have been considered separately at international organizations such as WHO, FAO, and UNICEF. Therefore, the aim of this study was to examine the trends in food and nutrition policy framework, dietary recommendations and nutritional requirements formulated by international organizations through a review of published nutrition policy guidelines and standards since the 1990s.<BR><b>Method</b><BR>  Policy guidelines, technical reports, annual reports, and other relevant materials published between 1990 and 2015, available on the WHO, FAO and UNICEF websites, were reviewed. Then, we extracted the study focused on nutrition problems and their solutions. The purpose and contents of each document and guidelines were identified and categorized in a summary table, so as to investigate their feasures and time trend.<BR><b>Results</b><BR>  This study identified 22 statements on food and nutrition policy frameworks, 14 dietary recommendations and nutritional requirements, and 5 information systems. It was revealed that, in the 1990s, the focus was to develop and standardize the methods for nutritional assessment of children. The goal during this period was to achieve food-based security through improvement in energy and nutrient intakes such as proteins and vitamin A, so as to reduce severe child malnutrition and maternal mortality. Later, various recommendations were formulated on double burden of malnutrition, the importance of breastfeeding and the context of the food system and nutrition in the 2000s, and on noncommunicable disease prevention and control policies and practical methodologies to reduce nutrition disparities after 2010. Several information systems were established, which have been utilized as the evidence database to develop policy frameworks.

Needs assessment on training programs and materials in the field of international nutrition according to one’s career stage / 国際保健医療

<B>Introduction</B><BR>This study was undertaken to identify needs of training and educational materials on international nutrition by career stage.<BR><B>Methods</B><BR>Focus Group Discussions (FGD) and a questionnaire survey were conducted in September and October 2008. In FGD, the participants were divided into three groups; undergraduate students who can potentially be involved in future nutrition activity for international cooperation (“students”), graduate students in international health or young workers involved in international cooperation through researches or programs on nutrition (“young”), and the experts who have worked for international nutrition cooperation (“experienced”). The results of FGD and questionnaire survey were categorized using the modified KJ methods.<BR><B>Results</B><BR>The numbers of FGD participants were two for “students”, four for “young” and seven for “experienced”. The questionnaires were completed by 119 undergraduate students. The specific issues they expected to learn in the field of international health and nutrition were the current situation in developing countries for the “students” and the process to identify the specific problems for the “young” and “experienced” The skills they would like to acquire were English proficiency for the “students” and “young” and understanding of the working fields as well as communication skills for the “young” and “experienced”. As for the necessary experience to get a job of international cooperation, working experience as a dietitian in Japan was stated by all groups. Additionally, the “young” mentioned overseas experience and the “experienced” suggested adaptability to different cultures as well as interpersonal skills.<BR><B>Conclusions</B><BR>This study identified communication skills as the needs common to all groups, while different needs were also identified by one›s career stage; especially educational needs among the “students” and training needs among the “young” and “experienced”. It is urgently required to develop training and educational materials on international nutrition that would meet the needs of each career stage.

Community based Training program: / 国際保健医療

<Dl><b>Purpose:</b><br>To investigate characteristics of community-based issues in nutrition and to assess the effectiveness of a training programme developed to address them.<br><b>Design:</b><br>The JICA trainee was the chief of the nutrition section of the Nepali Ministry of Health. The project was undertaken after reviewing, in co-operation with JICA, the aims and expected results of the programme. The Nepali trainee alone determined the theme of the programme after considering results of an issue analysis. A programme was then designed to link policy with community realities, incorporating lectures, discussion, and on-site practice. Educational materials employed were those already in use in nutrition programmes both within Japan and in other countries. To create a plan of action, the trainee undertook an analysis of the Nepali communities' institutional and human resources. <br>Evaluation of the training programme took place on two levels. The trainee self-evaluated her own issues analysis, community resource assessments, and action plan. Additionally, comments made by the trainee during the training period were recorded, categorized and evaluated.<br><b>Results:</b><Dt>1. The trainee's analysis of the action plan:<br><Dd>1-1. Community issues were analyzed with support of the Japanese staff. The theme of the training was "Awareness of community resources is an essential part of any nutritional programme".<br>1-2. Through the analysis of institutional and human resources, the "Tea Shop" was found to be key to the community's nutritional improvement.<br><Dt>2. Staff analysis of the trainee's comments:<br><Dd>2-1. Five stages in the change of the trainee's attitude were observed.<br>  First stage: Shouldn't the responsibility for resolving nutritional issues be with local workers and organizations?<br>  Second stage: What are the needs of the local citizens?<br>  Third stage: What are the responsibilities of the leaders?<br>  Fourth stage: What is needed for me to fulfill my duties?<br>  Fifth stage: What is the first thing I should do after returning to my office?<br><Dd>2-2. Support by staff was thought to be effective in making clear the tasks required of the trainee, in providing a framework for understanding the issues from the community viewpoint, identifying methods for establishing links between community and government and making government-produced materials relevant to the community, informing the process of educational materials development, and analyzing community resources.</Dl>