Background and Objective
  The prevalence of non-communicable diseases (NCD) is increasing in low- and middle-income countries, imposing major public health and development threats. However, there is difference among countries with regard to the patterns of NCD metabolic risk factors. This study aims to categorize the pattern of metabolic risk factors in East Asia, Southeast Asia and Oceania.
Methods
  Age-standardized prevalence of obesity, raised blood pressure, raised blood glucose, and raised blood cholesterol for 2008 were obtained from the World Health Organization (WHO) Global Health Observatory Data Repository. We used hierarchical cluster analysis to categorize countries in East Asia, Southeast Asia and Oceania based on the prevalence of NCD metabolic risk factors of each country.
Results
  Three patterns of NCD metabolic risk factors were identified. The first pattern showed relatively high prevalence of raised blood cholesterol, while prevalence of obesity, raised blood pressure and raised blood glucose remain relatively low. Most high- and upper-middle-income Asian countries were included in this pattern. The second pattern presented relatively high prevalence of raised blood pressure, although prevalence of obesity, raised blood glucose, and raised blood cholesterol stay relatively low. Most low- and lower-middle-income Asian countries were categorized in this pattern. The third pattern presented high prevalence of obesity and relatively high prevalence of raised blood pressure and raised blood glucose. This pattern included most Pacific island countries.
Conclusions
  Policy makers in countries in East Asia, Southeast Asia, and Oceania should take into account for the features of the pattern they are in, when they set priorities for developing effective NCD control measures.

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Objective
  The authors were engaged in an adolescent peer leader project. While the main target of this peer education was adolescent students, evaluation of a ripple effect on local residents is a necessary step for the development of peer education activities. Accordingly, the object of this study was to assess whether adolescent peer education had improved the health consciousness and knowledge of the local residents of a rural area of Mexico.
Method
  The subjects were residents aged between 12 and 69 years living in the districts covered by 3 public health centers in the Poza Rica district, Veracruz State. A list of residents in this age group was prepared, and 50% of all the households in each area were randomly selected. From March to April 2010, before the start of the activities, an interview survey was conducted.
Results
  Regarding the question on self-esteem, the percentage of respondents who reported being as capable as most other people significantly increased (p < 0.001). On lifestyle, the percentage of people who reported consuming vegetables and fruits daily or once in 23 days significantly increased (p < 0.001). Regarding knowledge about STDs and contraception, the rate of correct answers about STDs decreased in the second measurement, while the percentage of correct answers about contraception significantly increased. On peer education, the percentage of people who had heard of the term “peer educator” significantly increased (p < 0.001).
Conclusion
  The current adolescent peer education activity undertaken in a rural area of Mexico improved self-esteem and health consciousness in other residents of the community. The ripple effect on the entire community was limited for knowledge of STDs and contraception. However it was suggested that the increase of motivation for attendance to health education in the community could be a stepping stone to the spread of knowledge.

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  This study analyzes Japanese nursing students’ perceptions before and after completing an international nursing practicum (INP).
  Students implementing INP in a developing country completed an anonymous, self-administered questionnaire. Results were analyzed using statistical and qualitative methods.
  66 students completed the pre-practicum questionnaire and 23 completed the post-practicum questionnaire.
  As a result of perceptions regarding INP, three factors “interest in international nursing,” “knowledge necessary for international nursing,” and “understanding of the characteristics of international nursing” were extracted; knowledge necessary for international nursing was found to be significantly higher. Students’ perceptions of benefits of INP for their nursing activities, which were answered through the open-ended question revealed “personal growth,” “cultivation of an international perspective,” “increased understanding of nursing,” “beginning of expansion of views on nursing and nursing activities,” and “interest in exploring the essence of nursing.”
  Perceptions regarding practicum overseas were revealed by three dimensions. Four factors “development of compassion,” “experience only in the practicum field,” “inspiration from achievement of international nursing activity,” and “living experience outside of Japan” were extracted from expectation and achievement. Three factors “environment,” “individual ability,” and “inevitable events in the developing country” were extracted from anxiety. Four factors “fundamentals for achieving INP goals,” “necessity of achieving INP goals,” “nursing knowledge and skill,” and “importance for implementation in the developing country” were extracted from need for preparation. Expectation and achievement regarding experience only in the practicum field was found to be significantly higher. Anxiety about individual ability and inevitable events associated with practicum in the developing country and need for preparation regarding nursing knowledge and skill were significantly lower.
  It was suggested that INP is an effective educational method for basic nursing education and an early exposure for fostering internationalism. Understanding the willingness of students and taking their anxieties into considering were also found to be effective approaches.

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  In recent years, many low- and middle-income countries are experiencing public health reforms, and Vietnam is one of those leading countries moving towards universal health coverage. Nevertheless, the government is currently facing challenges in sustaining health finance and reaching the entire population due to issues surrounding the design of the scheme and organisational practice.
Objectives
  This paper has two objectives. The first objective is to summarise the history of the health insurance scheme and its design by collecting information from official documents in order to provide up-to-date information for a better understanding of the Vietnamese health system. The second objective is to review existing reports and related literature to identify the challenges and problems arising from the design of the health insurance system including premiums, benefit packages and payment rules, and organisational practices such as health service delivery.
Method
  To collect information, decrees and laws as well as existing documents and reports by Vietnamese government agencies and related literature are thoroughly reviewed.
Results
  We found that the government needs major revision of premiums and subsidies in terms of complexity of the design such as subdivided premiums for different statuses and large subsidies that could lead to unsustainable health finance. Also, hidden distorted incentives of health service providers such as unnecessary expensive technologically advanced medical treatment and inappropriate prescription of drugs are challenges. These embezzlements have increased both OOP payment and the financial burden on the health insurance budget.

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Objective
To identify the lifestyles of upper grade primary school students in urban and rural areas of Vanuatu
Methods
  All 415 students (urban, 194; and rural, 221) from 6th, 7th, and 8th grade students of primary school from one in the urban area and three in the rural area of Vanuatu participated in this survey. We conducted a self-administered questionnaire survey that included items addressing food consumption, exercise, smoking and drinking experience, health knowledge, attitudes toward health practices, guardians’ parenting attitudes related to health, prevalence of family employment, and number of household possessions. Urban and rural areas were compared on each item by performing chi-square tests for categorical data and Mann-Whitney U tests for ordinal data. Analysis was conducted manually and subsequently checked using SPSS version 18 for Windows. The significance level was set at p < .05.
Results
  A response rate of 100% was obtained from a total target sample students. All responses were valid. Comparisons between urban and rural areas revealed that consumption frequencies of rice, bread, fresh meat, soft drinks, and sweets were higher in urban areas, while root crops, fresh fish, and fruits were consumed more frequently in rural areas. The percentage of students who had ever tried alcohol was significantly higher in urban areas than in rural areas, as were levels of health knowledge related to noncommunicable diseases, favorable health attitudes, the availability of health advice from guardians, the number of family members employed, and the number of household possessions.
Conclusion
  The results indicated that significant differences exist between urban and rural areas for frequency of food consumption, drinking experience, health knowledge, attitudes toward health practices, guardians’ parenting attitudes related to health, the prevalence of family employment, and household possessions.

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Objective
  The purpose of this study was to examine health professionals’ perceptions of barriers to medication adherence in patients with non-communicable diseases (NCDs) in Fiji.
Methods: Interviews were conducted with 25 health professionals (physicians and pharmacists) treating patients with NCDs in Fiji. The interview contained questions regarding barriers to medication adherence for specific NCDs.
Results
  Health professionals’ perception of these barriers were identified and divided into patient-related and non-patient-related factors. The patient-related factors included lifestyle, knowledge, technique, language, and beliefs and culture. The non-patient-related factors were cost and access to medication, therapy-related factors, and support from other people.
Conclusion
  Traditional medical beliefs, medication access and affordability, negative lifestyle habits, and insufficient knowledge about illnesses, medical devices, and medications were identified as barriers to medication adherence in Fiji. Barriers to medication adherence differ according to diagnosis. Knowledge was considered an important factor with respect to adherence to medication regimens, particularly for patients with asymptomatic conditions (e.g., diabetes, hypertension, and stable asthma).

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