Guidelines for Complementary Feeding of Infants in the Asia Pacific Region: APACPH Public Health Nutrition Group.

Good nutrition in the first "1000 days," including breastfeeding and appropriate complementary foods, prepares for a healthy childhood and adult life, also contributes to the prevention of the double burden of malnutrition. Exclusive breastfeeding provides all required nutrients until an infant is around 6 months of age when complementary foods are needed. A literature review was undertaken of complementary foods in the Asia Pacific region. The foods being used at present are often of low nutrient density may provide insufficient amounts of some critical nutrients, and generally the variety is limited. Guidelines for complementary feeding are provided to assist in education and in public health planning.

Infant Feeding Guidelines for the Asia Pacific Region.

Good nutrition for infants, during the first 1000 days from conception, is one of the most important determinants of a healthy long life. Breastfeeding is the most important component of infant nutrition and reduces morbidity and mortality. With the changes to the climate currently occurring, issues of nutrition and food supply are only going to increase in importance. The Sustainable Development Goals of the United Nations, place nutrition at the forefront of world development and a sustainable planet. The vision of Asia-Pacific Academic Consortium for Public Health (APACPH) is to "achieve the highest possible level of health of all the people of the nations of the Asia-Pacific region." Much of the burden of disease, early deaths, and disability in the Asia Pacific region could be reduced with public health efforts to address the major risk factors, including nutrition-related causes and smoking. The United Nations Decade of Action on Nutrition 2016-2025 has recently been launched with the aim of reducing the global burden of inappropriate nutrition. The goals include increasing rates of exclusive breastfeeding to 6 months, reducing wasting and stunting, and reducing the rates of low birthweight. This is the position endorsed in these guidelines along with the principles of the Baby Friendly Hospital Initiative. These guidelines expand the information on infants that was included in the 2016 APACPH Dietary Guidelines. APACPH covers many different environments, geographical areas, cultures, and socioeconomic groups. These guidelines are generally applicable to all infants in our region, specific local advice may sometimes be needed.

Dietary Guidelines for the Asia Pacific Region.

Nutrition is a major determinant of health throughout all stages of life and together with smoking is the most important risk factor for morbidity and mortality in the Asia Pacific Region. The workshop participants examined Dietary Guidelines and Food Guides that are in use in our region, together with additional materials from the World Health Organization, UNICEF and the World Cancer Research Foundation. The resulting set of guidelines is meant as a reminder of the main issues to be covered in a general public health education program. It may also be of value in reminding public health practitioners, educators, administrators, and policy makers of current nutrition issues. It may additionally be useful as a checklist of the issues to be considered in public health programs and regulations. The main areas of nutrition that are included in the Guidelines are eating a variety of foods, including vegetables, fruits, whole grain cereals, and nuts. Choose fish, poultry, and meats grown in a sustainable way. Appropriate growth, including avoiding obesity, and physical activity are important. Breastfeeding is the basis of infant nutrition and nutrition of mothers is an important public health measure. Negative factors in the Asian diet include salt, refined sugar, alcohol and fats. The APACPH Dietary Guidelines will need to be kept under review and modified to meet regional differences in food supply. The Guidelines will be useful as a checklist of the issues to be considered in public health programs, addressing both acute and chronic diseases.

Using Annual Data to Estimate the Public Health Impact of Extreme Temperatures.

Short-term associations between both hot and cold ambient temperatures and higher mortality have been found worldwide. Few studies have examined these associations on longer time scales. Age-standardized mortality rates (ASMRs) were calculated for 1976-2012 for Hong Kong SAR, People's Republic of China, defining "annual" time periods in 2 ways: from May through April of the following year and from November through October. Annual frequency and severity of extreme temperatures were summarized by using a degree-days approach with extreme heat expressed as annual degree-days >29.3°C and cold as annual degree-days <27.5°C. For example, a day with a mean temperature of 25.0°C contributes 2.5 cold degree-days to the annual total. Generalized additive models were used to estimate the association between annual hot and cold degree-days and the ASMR, with adjustment for long-term trends. Increases of 10 hot or 200 cold degree-days in an annual period, the approximate interquartile ranges for these variables, were significantly (all P's ≤ 0.011) associated with 1.9% or 3.1% increases, respectively, in the annual ASMR for the May-April analyses and with 2.2% or 2.8% increases, respectively, in the November-October analyses. Associations were stronger for noncancer and elderly mortality. Mortality increases associated with extreme temperature are not simply due to short-term forward displacement of deaths that would have occurred anyway within a few weeks.

Progress in island health in the Asia-Pacific region.

The Asia-Pacific region contains many islands, perhaps up to 100 000. The provision of public health and health care to small isolated groups poses particular challenges in the 21st century. The health of island populations has improved over the past 3 decades, but maintaining and improving current levels of health is made more difficult by emigration and the difficulty of maintaining communications.

Risk perception of nuclear power plants among university students in Northeast Asia after the Fukushima nuclear disaster.

To examine the perception of nuclear energy risks among Asian university students following the Fukushima nuclear disaster, a standardized questionnaire survey was conducted since July 2011 after the Fukushima disaster. A total of 1814 respondents from 18 universities in China, Japan, Korea, and Taiwan participated in this survey. It showed that students with the following characteristics had a higher preference for "a clear schedule to phase out nuclear power plant (NPP)": females (adjusted odds ratio [aOR] = 1.84, 95% confidence interval [CI] = 1.44-2.34), in Japan (aOR = 2.81, 95% CI = 2.02-3.90), in China (aOR = 1.48, 95% CI = 1.04-2.09), and with perceived relative risks of cancer incidence greaterthan 1 (aOR = 1.42, 95% CI = 1.07-1.88). "If nuclear energy were phased out," the opinions on potential electricity shortage were as follows: Japan, aOR = 0.53, 95% CI = 0.40-0.69; China, aOR = 2.46, 95% CI = 1.75-3.45; and associated with academic majors (science/technology, aOR = 0.43, 95% CI = 0.31-0.59; medicine/health science, aOR = 0.64, 95% CI = 0.49-0.84). The results carried essential messages for nuclear energy policy in East Asia.

Ethical issues in infant feeding after disasters.

In the aftermath of many disasters the silence is punctuated by the crying of infants, hungry infants. The aim of this paper is to discuss ethical issues in feeding infants after disasters. The Asia Pacific region generates 25% of the world's GDP, but experiences 45% of natural disasters and 42% of the economic losses due to disasters. The region has 61% of the world's population, but 86% of the population affected by disasters. Breastfeeding, exclusive to six months and continuing thereafter, is important for growth and the health of the infant in the short term and later in life. In most natural disasters, mothers and infants will both suffer, but in some disasters, such as earthquakes and building collapses, infants can survive in small spaces. Infants separated from mothers require a wet nurse (rarely available) or feeding with infant formula and sterile water. Formula companies often donate supplies of infant formula but distribution should follow ethical principles. Mothers who are injured or short of food can still continue breastfeeding and don't need formula. Where formula must be used, health workers need to follow the highest ethical standards to avoid promoting infant formula to vulnerable communities in the post recovery phase.

Progress in infant health in Okinawa, Japan.

The infant mortality rate (IMR) and neonatal mortality rate (NMR) defined as the number of infant and newborn deaths per 1000 live births, respectively, are widely accepted as population indicators of the level of perinatal and postnatal health. Since the end of World War II, Japan has made substantial progress in reducing its IMR and NMR. This resulted from improving living standards and the provision of universal maternal and child health care (MCH) services. Okinawa, the island prefecture that is the furthest from mainland Japan, had the third highest IMR and the highest low-birth-weight rate (LBW) among all prefectures when its statistics were integrated into Japan in 1973. Even though the LBW rate in Okinawa has remained higher than the all-Japan average, Okinawa has shown a considerable improvement in IMR and NMR. The aim is to review the trends in IMR, NMR, and LBW in Japan and Okinawa and to discuss sociodemographic trends, economics, and the provision of health care services. The IMR and NMR in Okinawa decreased during that time from 14.8 to 2.4 and from 7.5 to 0.8, respectively. The LBW rate decreased until the mid-1980s, but since then it has increased to 11.5 (Okinawa) and 9.6 (Japan) in 2009. Okinawa's public health and primary health care model for infants has been very successful and may be applicable to child health in island nations of the Asia-Pacific region.

Community-based screening for infantile anemia in an okinawan village, Japan.

Infancy is a vulnerable age group for anemia throughout the world. However, community-based screening for infantile anemia is seldom reported. This study determined the prevalence of anemia among infants in an Okinawan village from 2003 to 2008, in relation to secondary prevention of the condition. The prevalence among infants aged 3-5, 6-12 and 16-23 months was 12.3%, 15.8%, and 4.2%, respectively, based on cross-sectional surveys (n = 3070), and was 11.0%, 17.2%, and 3.9% according to another retrospective cohort study (n = 511). The relatively low prevalence of anemia at early childhood suggested that previous detection and treatment through early and late infantile screening had been successful.

Intimate partner violence among general and urban poor populations in Kathmandu, Nepal.

Comparative studies are lacking on intimate partner violence (IPV) between urban poor and general populations. The objective of this study is to identify the prevalence and risk factors of physical IPV among the general and poor populations in urban Nepal. A cross-sectional study was conducted by structured questionnaire interview. Participants included 905 ever-married women in Kathmandu aged 15 to 49 years. Of the 905 participants, 680 were randomly selected from general population and 225 were recruited from urban poor population, who lived in purposively selected two communities. The prevalence and association between ever experiencing physical IPV and sociodemographic variables were examined. Results showed that the prevalence of physical IPV was 33.8% among the urban poor population (n = 225) and 19.9% among the general population (n = 680; p < .01). Several factors were significantly associated with physical IPV in both populations: the frequency of the husband's drinking, polygyny, and lower household economic status. However, two factors were associated with physical IPV only among the general population: the husband's lower educational level and early marriage. The conclusions of this study are that compared to the general population, the urban poor population showed a significantly higher prevalence of physical IPV and differences in the associated risk factors. The urban poor population requires focused data collection as well as tailored interventions to reduce IPV.

Competency-based learning program in system analysis and design for health professionals.

This study aims to evaluate the effectiveness of a competency-based learning (CBL) approach to an e-learning course on systems analysis and design (SAD). The competency of 18 students who registered for an SAD course was measured at different 3 times during the semester with the use of a competency diary. The changes in the competency scores through the semester were analyzed by a Friedman test, and the factors affecting learning effectiveness were identified by multiple regression. The competency scores increased as the semester progressed. The factors that had a significant effect on learning effectiveness were course management and learning materials. The authors found that the CBL approach worked well for this particular e-learning course on SAD and that nontechnical aspects of the instruction, such as course management and lecture materials, were more important than the technical aspects even in this Internet environment.

Island health: hope and challenges for public health.

The Asia-Pacific region is a region of small islands, perhaps 100 000 of them. The health, communication, and development problems of islands present difficult challenges for the delivery of health care. The discussions at the Okinawa Symposium centred on how health can be provided to all in the region, not only those in metropolitan areas, but also the poor in rural areas and those on living on far-flung island archipelagos. It is important to apply principles of "public health" and "primary health care" so that all island residents may have a reasonable expectation of health care. Schools of public health have a special responsibility to educate those who are responsible for the delivery and management of health care in these remote locations. The development of telehealth systems will be important to support health workers in remote locations and to deliver continuing education programs.

Declining longevity advantage and low birthweight in Okinawa.

The prefecture of Okinawa is known for the longevity of its population, for 30 years it had the longest life expectancy of all prefectures in Japan. However this advantage was lost in 2000 and male longevity is now ranked 26th among the 47 prefectures of Japan. The aim of this study was to explore whether the recent decline in Okinawan life expectancy advantage is due to the cohort effect of low birthweight infants becoming middle- and older- aged Okinawans. This is an observational study using existing demographic and health statistics. Data on life expectancy, mortality and low birthweight rates were obtained from the Okinawan Prefectural Department of Health and Welfare and the Japanese Ministry of Health, Labour and Welfare. In the year 2000 the longevity advantage of Okinawan males over the Japanese mainland was lost and the relative life expectancy of females declines. The mortality ratio for heart disease has reversed showing a cohort effect, with younger Okinawans having higher death rates than those living in the rest of Japan. The low birthweight rate for Okinawa is 20% greater than mainland Japan. As the post World War cohort of low birthweight infants reaches middle age, the longevity advantage of Okinawans has been lost. The loss of the longevity advantage of Okinawa over the rest of Japan may be due to the increase in non-communicable disease in the post war cohort that has experienced a higher low birthweight rate.