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Objective: To assess the association between condom use and oral contraceptive consumption and the risk of cervical intraepithelial neoplasia (CIN)., Methods: A cross-sectional study was conducted in Perth clinics. A total of 348 women responded to the structured questionnaire. Information sought included demographic and lifestyle characteristics such as the use of condom for contraception, consumption of oral contraceptive, and duration of oral contraceptive usage. Crude and adjusted odds ratio (OR) and associated 95% confidence interval (CI) were calculated using unconditional logistic regression models and reported as estimates of the relative risk., Results: The prevalence of CIN was found to be 15.8%. The duration of oral contraceptive consumption among women with abnormal Papanicolaou (Pap) smear result indicating CIN was significantly shorter than those without abnormal Pap smear result (mean±SD, 5.6±5.2 years vs. 8.2±7.6 years; p=0.002). Comparing to ≤3 years usage, prolonged consumption of oral contraceptive for ≥10 years reduced the risk of CIN (p=0.012). However, use of condom for contraception might not be associated with a reduced risk of CIN after accounting for the effects of confounding factors (adjusted OR, 0.52; 95% CI, 0.05 to 5.11; p=0.577)., Conclusion: Use of oral contraceptives, but not condoms, for contraception appeared to be inversely associated with CIN. Prolonged use of oral contraceptive demonstrated its benefits of reducing the risk of CIN.

Objective: To determine the incidence of obstetric complications, the stillbirth rate, and the factors associated with cesarean delivery in central Nepal., Methods: A community-based prospective cohort study was undertaken in the Kaski district during 2011-2012. In total, 701 women who were at least 5 months pregnant were recruited and interviewed. Participants were followed-up and interviewed again within 45 days after delivery., Results: Of the 658 women who remained in the cohort after 43 were lost to follow-up, 12 (1.8%) had stillbirths. Cesareans accounted for 13.3% of the total deliveries. Age, urban residency, college-level education, and particularly presence of intrapartum symptoms significantly increased the likelihood of cesarean delivery. Prepartum, intrapartum, and postpartum symptoms were reported by 21.1%, 24.4%, and 10.2% of women, respectively. Common danger signs included prolonged labor, severe abdominal pain, swollen hand and body, and heavy bleeding., Conclusion: Obstetric complications and stillbirth rates were relatively high in central Nepal. Cesarean delivery appeared to meet obstetric need and was performed with medical indication, particularly after the onset of labor., (Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Isoflavones, mainly found in soy, have been shown to inhibit ovarian cancer cell proliferation. We hypothesized that soy consumption and isoflavone intake are related to the risk of ovarian cancer. A case-control study was conducted in southern China to ascertain this hypothesis. Five hundred incident patients with histologically confirmed cancer of the ovary and 500 controls (mean age 59 years) were recruited from four public hospitals in Guangzhou. Information on habitual consumption of soy foods, including soybean, soy milk, fresh tofu, dried tofu, and soybean sprout, was obtained face-to-face from participants through a validated and reliable semi-quantitative food frequency questionnaire. Isoflavone intakes were then estimated using the USDA nutrient database. The ovarian cancer patients reported lower consumption levels of individual and total soy foods (75.3 ± 53.6 g/day) compared to the controls (110.7 ± 88.8 g/day). Logistic regression analyses showed that regular intake of soy foods could reduce the ovarian cancer risk, the adjusted odds ratio being 0.29 (95% confidence interval 0.20 to 0.42) for women who consumed at least 120 g/day relative to those less than 61 g/day. Similarly, isoflavone intakes were inversely associated with the ovarian cancer risk, with significant dose-response relationships (P < 0.001). We concluded that consumption of soy foods is associated with a reduced risk of ovarian cancer in southern Chinese women., (Copyright © 2014 Elsevier Inc. All rights reserved.)

There is a growing use of dietary supplements in many countries including China. This study aimed to document the prevalence of dietary supplements use and characteristics of Chinese pre-school children using dietary supplements in Australia and China. A survey was carried out in Perth, Western Australia of 237 mothers with children under five years old and 2079 in Chengdu and Wuhan, China. A total of 22.6% and 32.4% of the Chinese children were taking dietary supplements in Australia and China, respectively. In China, the most commonly used dietary supplements were calcium (58.5%) and zinc (40.4%), while in Australia, the most frequently used types were multi-vitamins/minerals (46.2%) and fish oil (42.3%). In Australia, "not working", "never breastfeed", "higher education level of the mother" and "older age of the child" were associated with dietary supplement use in children. In China, being unwell and "having higher household income" were significantly related to dietary supplement usage. Because of the unknown effects of many supplements on growth and development and the potential for adverse drug interactions, parents should exercise caution when giving their infants or young children dietary supplements. Wherever possible it is preferable to achieve nutrient intakes from a varied diet rather than from supplements.

Objective: The objective of this study was to investigate knowledge and community perceptions of breastfeeding in Western Australia using a factor analysis approach., Methods: Data were pooled from five Nutrition Monitoring Survey Series which included information on breastfeeding from 4,802 Western Australian adults aged 18-64 years. Tetrachoric factor analysis was conducted for data reduction and significant associations identified using logistic, ordinal and poisson regression analyses., Results: Four factors were derived for benefits (it's natural, good nutrition, good for the baby, and convenience), barriers (breastfeeding problems, poor community acceptability, having to go back to work, and inconvenience) and for enablers (breastfeeding education, community support, family support and not having to work). As assessed by standardized odds ratios the most important covariates across benefit factors were: importance of breastfeeding (ORs range from 1.22-1.44), female gender (ORs range from 0.80 to 1.46), being able to give a time for how long a baby should be breastfed (ORs range from 0.96 to 1.27) and education (less than high school to university completion) (ORs range from 0.95 to 1.23); the most important covariate across barrier factors was being able to give a time for how long a baby should be breastfed (ORs range from 0.89 to 1.93); and the most important covariates across all enabling factors were education (ORs range from 1.14 to 1.32) and being able to give a time for how long a baby should be breastfed (ORs range from 1.17 to 1.42)., Conclusions: Being female, rating breastfeeding as important, believing that babies should be breastfed for a period of time and education accounted for most of the statistically significant associations. The differences between male and female perceptions require investigation particularly in relation to returning to work.

Background: Breastfeeding is viewed as the optimal method of infant feeding that provides many benefits to both the infant and the mother. The monitoring and reporting of breastfeeding indicators are essential for any country to plan and implement effective promotion programs for sustainable breastfeeding. The aim of this review is to examine the available studies and data on breastfeeding in Saudi Arabia, and determine the potential factors that affect breastfeeding practices and duration in this country., Methods: The databases of Web of Knowledge, Science Direct and PubMed were searched using the relevant key words. Only studies that reported breastfeeding practices, rates and indicators in Saudi Arabia were included. Standard WHO definitions for breastfeeding categories were used in this review., Results: Seventeen cross-sectional studies were identified and reviewed and five stated they used standard definitions. The self-administered questionnaire as a measurement tool was the predominant method of data collection. Infants' ages range from less than six months up to five years. Initiation rates were high (mostly above 90%), but a few studies reported low rates of timely initiation (within the first hour). The exclusive breastfeeding rate could not be accurately determined as rates range from 0.8% to 43.9% among studies due to the lack of clear definitions and the nature of study design. The partial (mixed) feeding method was common and the category of 'any breastfeeding' has generally high rates. The mean duration of breastfeeding has showed a progressive decline over time from 13.4 months in 1987 to 8.5 months in 2010. Factors associated with a high prevalence of breastfeeding and longer duration include increased maternal age, low educational levels, rural residence, low income, multiparity and avoiding contraceptives. The most common reason for breastfeeding cessation was insufficient breast milk. Other reasons include sickness, new pregnancy and breastfeeding problems., Conclusions: Breastfeeding indicators in Saudi Arabia could not be monitored or compared relying on the available data because no longitudinal studies have been conducted in this country. A cohort study design would be the most appropriate procedure to rigorously assess and report valid results on breastfeeding practices and patterns in the Saudi society.

For infants' optimal growth and development, the introduction of nutritionally suitable solid foods at the appropriate time is essential. However, less attention has been paid to this stage of infant life when compared with studies on breastfeeding initiation and duration. The practice of introducing solid foods, including the types of foods given to infants, in the Asia Pacific region was reviewed. In total nine studies using the same questionnaire on infant feeding practices were analysed to gain a better understanding of trends in the introduction of solid foods in this region. All studies showed less than optimal duration of exclusive breastfeeding indicating an earlier time of introduction of solid foods than recommended by the WHO. Most mothers commonly used rice or rice products as the first feed. In many studies, the timing of introducing solid foods was associated with breastfeeding duration. Compared with the Recommended Nutrient Intakes for infants aged above six months, rice/rice products are of lower energy density and have insufficient micronutrients unless they have been fortified. Although the timing of introducing solid foods to infants is important in terms of preventing later health problems, the quality of the foods should also be considered. Recommendations to improve the introduction of solid foods include measures to discourage prelacteal feeding, facilitating breastfeeding education and providing better information on healthier food choices for infants.

Prostate cancer is the second most common cancer in men worldwide and a leading cause of mortality. Incidences continues to rise and vary substantially between populations. Although the prevalence of prostate cancer is relatively low in Vietnam, some hospital-based reports have shown an upward trend in recent years. While certain non-modifiable factors such as age, race and genetics are known to be mainly responsible, the literature has also suggested that environmental exposures can delay the onset of this disease. The present study provides a review of the epidemiology of prostate cancer in Vietnam by systematically searching several electronic databases. The results confirm an increasing trend of prostate cancer over the past decade, with age-standardised rate more than doubled from 2.2 per 100,000 men in 2000 to 4.7 per 100,000 men in 2010. However, no study has been found on modifiable risk factors, with the exception of one in vitro experiment that showed the inhibitory effect of garlic on the growth of prostate cancer cells. The lack of epidemiological information poses a difficulty to develop public health interventions to prevent this emerging malignant disease in Vietnam.

Introduction: Mastitis is a common problem encountered by breastfeeding mothers. This study investigated the incidence and risk factors of lactation mastitis among Chinese women., Subjects and Methods: A prospective cohort study on infant feeding practices was conducted during 2010 and 2011 in Jiangyou, Sichuan Province, China. Poisson regression analysis was performed to determine factors influencing the incidence of mastitis within 6 months postpartum., Results: Of the 670 Chinese mothers who were breastfeeding at discharge, 42 women (6.3%) experienced at least one episode of mastitis during the first 6 months after delivery. The cumulative incidence of mastitis was 10.3%. Mothers with a cracked and sore nipple (incidence rate ratio 2.24; 95% confidence interval 1.38, 3.63) and those who felt stressed (incidence rate ratio 3.15; 95% confidence interval 1.56, 6.37) appeared to sustain more episodes of mastitis., Conclusions: The incidence of lactation mastitis was low among Chinese mothers. To further reduce the risk of mastitis, instructions on the correct positioning of the baby during breastfeeding should be emphasized. Providing new mothers with guidance on how to cope with stress may also prevent the recurrence of the condition.

In 2001 the World Health Assembly adopted the infant feeding strategy which included the recommendation for exclusive breastfeeding until 6 months of age with continued breastfeeding while complementary foods are introduced. This recommendation has been endorsed by many national authorities, professional organisations and most countries in the Asia Pacific Region. Reviews by WHO, the US Surgeon General, Agency for Healthcare Research and Quality, US Department of Health and Human Services and others have documented the many benefits of breastfeeding. The introduction of solid foods before six months of age is associated with increased rates of infection, reduced breastmilk production, disruption to the microbiome and possibly obesity. If solids are introduced at around six months (by 26 weeks) there is no evidence of increases in allergic diseases.

Objective: To investigate the association between fruit and vegetable consumption and the risk of epithelial ovarian cancer in southern Chinese women., Methods: A case-control study was undertaken in Guangzhou, Guangdong Province, between 2006 and 2008. Participants were 500 incident ovarian cancer patients and 500 hospital-based controls. Information on habitual fruit and vegetable consumption was obtained by face-to-face interview using a validated and reliable food frequency questionnaire. Unconditional logistic regression analyses were performed to assess the association between fruit and vegetable intakes and the ovarian cancer risk., Results: The mean fruit and vegetable daily intakes of ovarian cancer patients (324.2g (SD 161.9) and 582.7 g (SD 250.2)) were significantly lower (p<0.001) than those of controls (477.3g (SD 362.1) and 983.3g (SD 739.9)). The adjusted odds ratios were 0.30 (95% confidence interval (CI) 0.21 to 0.44) and 0.07 (95% CI 0.04 to 0.12) for more than 490 g of fruits and 970 g of vegetables per day, relative to at most 320 g and 690 g per day, respectively. With the exception of lycopene, substantial risk reductions were evident for a variety of nutrients derived from fruits and vegetables., Conclusion: Consumption of fruits and vegetables was inversely associated with the incidence of epithelial ovarian cancer in southern Chinese women., (© 2013.)

This study recorded maternal perceptions of preschool children's weight in Chinese mothers living in Australia and China. A survey was undertaken of 1951 mothers living in Chengdu and Wuhan, China and 89 Chinese mothers living in Perth, Australia. All participants were mothers with children aged 2-4 years. The children's weight and height were measured and their weight status were classified using the International Obesity Task Force 2012 revised international child body mass index cut-offs. The prevalence of overweight or obese in children was 16.7% in China and 8% in Australia. The overall percentages of correct maternal perception of the child's weight were 35% in underweight children, 69.2% in normal weight children but only 10.8% in overweight/ obese children. Among the overweight/obese children, only 14% in Australia and 10.8% in China were classified as overweight/obese by their mothers. Within the group of underweight children, normal weight mothers (p=0.004) and mothers with older age children (p=0.015) were more likely to correctly classify children's weight status. A higher percentage of overweight/obese mothers (p=0.002) and mothers who over-estimated her own weight status (p<0.001) have correct perception of the weight status of their overweight/obese children, compared to their counterparts. There was a high prevalence of incorrect maternal perception of preschool children's weight status in Chinese mothers, especially those with overweight/obese children. To address the obesity epidemic in children, future health promotion programs should put improved efforts to educate parents about obesity and its health consequences in order to reduce misperceptions.

Objective: To ascertain the relationship between dietary fibre intake and risk of oesophageal cancer in remote northwest China, where the cancer incidence is known to be high., Methods: A case-control study was conducted during 2008-2009 in the Urumqi and Shihezi, Xinjiang Uyghur Autonomous Region of China. Participants were 359 incident oesophageal cancer patients and 380 hospital-based controls. Information on habitual foods consumption was obtained by face-to-face interview, from which dietary fibre intakes were estimated using the Chinese food composition tables., Results: The oesophageal cancer patients reported lower intake levels of total dietary fibre and fibre derived from vegetables and fruits than those of controls. Overall, regular intake of fibre was inversely associated with the oesophageal cancer risk, the adjusted odds ratio being 0.47 (95% confidence interval 0.32-0.69) for the highest (>27 g) versus the lowest (<16 g) tertile of daily intake, with a significant dose-response relationship (p=0.004). Similar reductions in risk were also apparent for high intake levels of vegetable fibre and fruit fibre, but to a lesser extent for cereal fibre., Conclusion: Habitual intake of dietary fibre was associated with a reduced risk of oesophageal cancer for adults in northwest China., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Issue Addressed: Physical activity affects the immune system, which in turn may modify the risk of cervical intraepithelial neoplasia (CIN). The effect of sitting on CIN is unknown. This study investigated the relationship between sitting time, physical activity and the risk of CIN., Methods: Community-dwelling adult women within metropolitan Perth, Western Australia, who had had a Papanicolaou (Pap) smear test at any of five clinics and medical centres, were approached by their general practitioners. In total, 348 women were recruited and interviewed for information on sitting time, physical activity level and lifetime physical activity exposure using the International Physical Activity Questionnaire (IPAQ)--short form. Associations of exposure variables with CIN risk were assessed by unconditional logistic regression analyses., Results: The prevalence of abnormal Pap smear status indicating CIN was found to be 15.8%. Women with prolonged sitting duration (≥42 h per week) had significantly increased risk of CIN (adjusted OR 3.49, 95% CI 1.12-10.88) than women who sat less than 24.5h per week. Although the effect of total physical activity level was non-significant (P=0.408), being always involved in physical activity during the entire life appeared to be inversely associated with the CIN risk (P=0.036)., Conclusions: Prolonged sitting time was significantly associated with increased risk of abnormal Pap smear status indicating CIN. SO WHAT?: This preliminary investigation highlights a new prospect for health-promotion intervention to reduce the risk of CIN. Health practitioners should encourage women to reduce their sitting time and maintain physically active throughout their life course.

Background: Exclusive breastfeeding for infants is recommended for the first six months for optimal health, development and growth. However, there is limited data on infant feeding practices and nutrition status of infants in Nairobi., Objective: To assess infant growth and nutritional status and compare with feeding practices in the first six months of life in selected hospitals, Nairobi Province., Design: Prospective cohort design, Setting: Five major hospitals in Nairobi namely; The Aga Khan, Pumwani Maternity, Mater Misercordiae, St Mary's Langata and Jamaa Hospitals., Subjects: A sample of 692 mother-infant pairs were recruited at birth and followed up until six months., Intervention: There was no direct experimental intervention, but there was observation of infant feeding practices, weight and height measurement was recorded every four weeks and determination of nutrition status of the infants for a period of six months., Main Outcome Measures: Nutritional status and infant feeding practices in the first six months., Results: Slightly more than half (58.8%) of the mothers were formally employed and the rest were self employed. The mean age of the mothers was 28.3 ± 4.9 years. The mean income was KES 26,360 ± 34,696. The mean birth weight of infants was 3.24 ± 0.43 kg and 53.3% of all infants were male. Above 80% of infants were within normal weight based on weight for age Z-scores (WAZ) at 6, 10, 14 and 23 weeks. The prevalence of overweight based on WAZ was 9.5%, 11.6%, 11.9% and 11% at 6, 14, 19 and 23 weeks, respectively. There were no significant (P > 0.05) differences in WAZ between infants on different feeding methods., Conclusions: There was no significant difference in weight or length gain among children that were fully breastfed in comparison to those who were given infant formula or had mixed feeding. However, there was concern over the proportion of overweight infants, as the condition may lead to long term health problems.

Background: Studies have identified numerous factors affecting breastfeeding initiation and duration, including maternal education, mode of delivery, birth weight, socioeconomic status, and support of the infant's father., Objective: The objective was to investigate the effects of an antenatal education session and postnatal support targeted to fathers., Methods: The Fathers Infant Feeding Initiative (FIFI Study) is a randomized controlled trial to increase the initiation and duration of breastfeeding that was conducted in 8 public maternity hospitals in Perth, Western Australia. A total of 699 couples were randomized within hospitals to either intervention or control groups. The intervention consisted of a 2-hour antenatal education session and postnatal support provided to fathers., Results: The any breastfeeding rate for the intervention group was significantly greater at 6 weeks: 81.6% in the intervention group compared to 75.2% in the control group, odds ratio 1.46 (95% CI, 1.01-2.13). After adjustment for age and hospital, the odds ratio for any breastfeeding in the intervention group was 1.58 (1.06-2.35) and for socioeconomic status (SES), 1.56 (1.06-2.30). The infants of older fathers were more likely to be breastfed at 6 weeks compared to infants of younger fathers (P < .01), and infants of fathers with high SES more likely than infants of fathers with low SES (P = .013)., Conclusion: Even a small increase in breastfeeding rates brings public health benefits. In this study, a minimal intervention was found to significantly increase any breastfeeding at 6 weeks: 81.6% in the intervention group compared to 75.2% in the control group.

Background: There are several barriers for pregnant women to deliver in a health care facility. This prospective cohort study investigated factors affecting facility delivery and reasons for unplanned place of delivery after implementation of the safer mother programme in Nepal., Methods: Baseline interviews using a validated questionnaire were conducted on a sample of 700 pregnant women representative of the Kaski district in central Nepal. Follow-up interviews of the cohort were then conducted within 45 days postpartum. Stepwise logistic regression analysis was performed to determine factors associated with the facility delivery outcome., Results: Of the 644 pregnant women whose delivery location had been identified, 547 (85%) gave birth in a health care facility. Women were more likely to deliver in a health facility if they were educated especially with higher secondary or above qualification (adjusted odds ratio (OR) 12.39, 95% confidence interval (CI) 5.09 to 30.17), attended 4 or more antenatal care visits (OR 2.15, 95% CI 1.25 to 3.69), and lived within 30 minutes to the facility (OR 11.61, 95% CI 5.77 to 24.04). For the 97 women who delivered at home, 72 (74.2%) were unplanned, mainly due to quick precipitation of labour making it impossible to reach a health facility., Conclusions: It appeared that facility delivery occurs more frequent among educated women and those who live nearby, even though maternity services are now freely available in Nepal. Because of the difficult terrain and transportation problem in rural areas, interventions that make maternity service physically accessible during antenatal period are needed to increase the utilisation of health facility for child birth.

Objective: to assess birth preparedness in expectant mothers and to evaluate its association with skilled attendance at birth in central Nepal., Design: a community-based prospective cohort study using structured questionnaires., Setting: Kaski district of Nepal., Participants: a total of 701 pregnant women of more than 5 months gestation were recruited and interviewed, followed by a second interview within 45 days of delivery., Measurements: outcome was skilled attendance at birth. Birth preparedness was measured by five indicators: identification of delivery place, identification of transport, identification of blood donor, money saving and antenatal care check-up., Findings: level of birth preparedness was high with 65% of the women reported preparing for at least 4 of the 5 arrangements. It appears that the more arrangements made, the more likely were the women to have skilled attendance at birth (OR=1.51, p<0.001). For those pregnant women who intended to save money, identified a delivery place or identified a potential blood donor, their likelihood of actual delivery at a health facility increased by two to three fold. However, making arrangements for transportation and antenatal care check-up were not significantly associated with skilled attendance at birth., Conclusions: intention to deliver in a health-care facility as measured by birth preparedness indicators was associated with actual skilled attendance at birth. Birth preparedness packages could increase the proportion of skilled attendance at birth in the pathway of meeting the Millennium Development Goal 5., (© 2013 Elsevier Ltd. All rights reserved.)

Objective: To investigate the level of support among Western Australian adults for food control policies to improve diet, reduce obesity and protect the environment., Methods: Attitudes towards government food control policies on food labelling, food advertising, and the supply of environmentally friendly food data were pooled from two Nutrition Monitoring Survey Series telephone surveys of 2,147 adults aged 18-64 years collected in 2009 and 2012. Descriptive and logistic regression analyses were conducted using survey module of STATA 12., Results: The majority of adults believe it is important that government regulates food policy options under consideration: nutrition information on food labels (97% versus 2% who think it is not important); health rating on food labels (95% versus 3%); food advertising (83% versus 11%); and the supply of environmentally friendly food (86% versus 9%)., Conclusions: Community perception is that government control or regulation of food labelling, food advertising and the supply of environmentally friendly food is important., Implications: Curbing excess weight gain and related disease burden is a public health priority. Australian governments are considering food regulatory interventions to assist the public to improve their dietary intake. These findings should provide reassurance to government officials considering these regulatory measures., (© 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.)

Objective: This study aimed to investigate the association between mushroom consumption and risk of epithelial ovarian cancer in southern Chinese women., Methods: A hospital-based case-control study was undertaken in Guangzhou, Guangdong Province, from 2006 to 2008. Participants were 500 incident patients with epithelial ovarian cancer and 500 controls, with a mean (SD) age of 59 (6) years. Information on habitual mushroom consumption was obtained by face-to-face interview using a validated and reliable food frequency questionnaire. Unconditional logistic regression analyses were performed to assess the association between mushroom intake and the ovarian cancer risk., Results: The patients with ovarian cancer consumed less mushrooms (mean [SD], 28.48 [37.45] g/d) than did controls (mean [SD], 30.75 [41.85] g/d). Apparent reductions in cancer risk were found at high levels of intake, especially for the common white button mushroom with adjusted odds ratios 0.68 (95% confidence interval, 0.52-0.89) for women consuming more than 2 g per day relative to those who consume less than that (P = 0.005). Decreases in risk at high levels of intake were also observed for serous and mucinous subtypes of epithelial ovarian tumors., Conclusions: Intake of mushrooms, particularly white button mushroom, seemed to be inversely associated with the incidence of epithelial ovarian cancer in southern Chinese women.

The structure and provision mechanism of maternity services in Nepal appears to be good, with adequate coverage and availability. Utilization of maternity services has also improved in the past decade. However, this progress may not be adequate to achieve the Millennium Development Goal to improve maternal health (MDG 5) in Nepal. This paper reviews the factors that impede women from utilizing maternity services and those that encourage such use. Twenty-one articles were examined in-depth with results presented under four headings: (i) sociocultural factors; (ii) perceived need/benefit of skilled attendance; (iii) physical accessibility; and (iv) economic accessibility. The majority of the studies on determinants of service use were cross-sectional focusing on sociocultural, economic and physical accessibility factors. In general, the education of couples, their economic status and antenatal check-ups appeared to have positive influences. On the other hand, traditional beliefs and customs, low status of women, long distance to facilities, low level of health awareness and women's occupation tended to impact negatively on service uptake. More analytical studies are needed to assess the effectiveness of the Safer Mother Programme, expansion of rural birth centres and birth-preparedness packages on delivery-service use. Moreover, it is important to investigate women's awareness of the need of facility delivery and their perception of the quality of health facilities in relation to actual usage.

Background: The World Health Organization recommends that newborn infants be breastfed within the first hour of life, a practice that improves infant health and reduces neonatal mortality. The objectives of this study were to report the rate of breastfeeding initiation within 1 hour of birth in Jiangyou, China, to determine its impact on "full breastfeeding" at discharge, and to investigate factors associated with early breastfeeding initiation., Methods: A prospective cohort study of infant feeding practices was undertaken during 2010 and 2011 in Jiangyou, 2 years after an earthquake caused extensive damage. A total of 695 mothers were recruited from hospitals and health centers and interviewed at discharge., Results: In this study, 9.1 percent of women began breastfeeding within 1 hour postpartum. Mothers who initiated breastfeeding early were more likely to be fully breastfeeding at discharge (OR 2.10, 95% CI 1.23-3.60). Multivariate logistic regression analysis revealed that giving birth at a health center was associated with delayed breastfeeding initiation (OR 0.11, 95% CI 0.04-0.32), whereas attending antenatal classes (OR 2.57, 95% CI 1.36-4.87) and receiving encouragement from hospital staff to initiate breastfeeding (OR 5.60, 95% CI 2.31-13.55) were correlated with putting the baby to the breast soon after delivery., Conclusions: Early breastfeeding initiation rate was low and the use of prelacteal foods was widespread in Jiangyou. Early breastfeeding initiation was associated with higher "full breastfeeding" rates at discharge. It is important to educate doctors and nurses to assist mothers with early breastfeeding initiation and to discourage the use of non-breastmilk prelacteal feeds., (© 2013, Copyright the Authors, Journal compilation © 2013, Wiley Periodicals, Inc.)

Objective: To investigate the association between consumption of preserved foods and risk of epithelial ovarian cancer in southern Chinese women., Methods: A hospital-based case-control study was undertaken in Guangzhou, Guangdong Province, from 2006 to 2008. Participants were 500 incident epithelial ovarian cancer patients and 500 controls, with a mean age 59 years. Information on habitual food consumption was obtained by face-to-face interview using a validated and reliable food frequency questionnaire. Logistic regression analyses were performed to assess the association between preserved foods intake and the ovarian cancer risk., Results: The ovarian cancer patients consumed more preserved foods (median 15.5, interquartile range (IQR) 18.2g/day) than controls (median 13.8, IQR 20.5 g/day), p<0.001. The adjusted odds ratios of ovarian cancer was 1.78 (95% confidence interval 1.35 to 2.34) for women consuming more than 13.5 g of preserved vegetables and preserved meats per day relative to those below. Similar two-fold increases in risk at high level of intake were also evident for serous and mucinous subtypes of epithelial ovarian tumours., Conclusion: Intake of preserved foods was positively associated with the incidence of epithelial ovarian cancer in southern Chinese women., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Breastfeeding practices might be influenced by migration to another country. Although the "healthy migrant effect" is commonly reported in epidemiology, evidence for it in breastfeeding practices is weak., Objectives: This study aimed to compare the initiation and duration of breastfeeding between Chinese Australian migrants and Chinese mothers in mainland China and test the healthy migrant effect in Chinese Australian migrants in Perth, Western Australia., Methods: A survey was undertaken of 239 Chinese mothers living in Perth and 1844 mothers living in Chengdu, Sichuan Province, PR China, with a response rate of 96.7% and 87.8%, respectively., Results: The breastfeeding initiation rate in Chinese Australian mothers (94.1%) was higher than in mothers in China (86.2%, P < .001). Chinese Australian mothers also had a longer breastfeeding duration, greater "full breastfeeding" rate at 6 months, and greater "any breastfeeding" rates at 6 and 12 months. After controlling for potential confounding variables, the results of the binary logistic regression analysis showed that the location of the mother (Australia or China) was associated with breastfeeding practices. Chinese mothers living in Chengdu were less likely to initiate breastfeeding (odds ratio = 0.47, 95% confidence interval, 0.25-0.89) and breastfeed their babies at 12 months (odds ratio = 0.48, 95% confidence interval, 0.33-0.69) than Chinese mothers in Perth., Conclusion: The higher breastfeeding initiation and longer breastfeeding duration by Chinese migrant mothers in Perth than mothers in Chengdu suggest a "healthy migrant effect."

Background: Factors associated with breastfeeding need to be explored in the northwest of China., Objective: This study aimed to measure the full duration of breastfeeding and identify factors associated with breastfeeding in Shihezi City in Northwest China., Methods: A prospective cohort study was undertaken to obtain details of child feeding practices using structured questionnaires in 2007-2010. Before discharge from hospitals, 681 mothers were randomly recruited and interviewed in maternity units for breastfeeding. After discharge, the mothers were contacted by telephone at monthly intervals within the first 6 months and then at 2-month intervals until discontinuation of breastfeeding., Results: The breastfeeding initiation rate was 95.9%. The breastfeeding rates then declined to 69.6% at 6 months, 29.7% at 12 months, and 2.3% at 24 months. The median duration of "any breastfeeding" was 9 months. The exclusive breastfeeding rate was low because of the high rate of prelacteal and early complementary feeding. Cox regression analyses revealed that mothers who had preterm babies believed that breast milk could not meet infants' needs and intended to breastfeed for less than 6 months, and mothers with late onset of lactogenesis II and whose parents lived in Xinjiang were more likely to stop breastfeeding. Younger maternal age, employment, and suffering from illness were also associated with a shorter duration of breastfeeding., Conclusion: The duration of "exclusive" and "any breastfeeding" was below the Chinese and World Health Organization breastfeeding goals. Shorter duration of breastfeeding was associated with having grandparents residing within the same province, maternal age, illness and employment, gestational age, and delayed onset of lactogenesis.

Background: Community attitudes toward breastfeeding in public influence how comfortable women feel about continuing breastfeeding. Knowledge of the social context helps target breastfeeding-promoting interventions., Objective: To examine trends in Western Australian adult attitudes toward breastfeeding in public places., Methods: As part of 5 cross-sectional surveys from the Western Australian Nutrition Monitor Survey Series conducted between 1995 and 2009, 5496 adults aged 18 to 64 years were asked whether it was acceptable for mothers to breastfeed their babies in public places, including shopping centers, workplaces, and restaurants, and on public transport. Descriptive statistics and multinomial regressions were used to describe factors associated with attitudes toward publicly breastfeeding., Results: There was no change in the acceptance of breastfeeding in shopping centers, restaurants, and workplaces and on public transport over time, but in 2009, significantly fewer people said that it was unacceptable to breastfeed in public compared with 1995. Women, people older than 44 years, those born outside Australia, and the less educated were those most likely to say that breastfeeding in public was unacceptable. In the years that the question was asked, more than 97% of respondents said that breastfeeding was acceptable if a separate room was provided., Conclusions: Making breastfeeding acceptable and pleasant for mothers in public spaces is a key policy recommendation. Women, people older than 44 years, and those born outside Australia were most likely to respond that breastfeeding in public was unacceptable unless a room was provided. Given that, on average, 70% of the population said that breastfeeding in public was acceptable, investigation into why some women do not think so is warranted.

Objective: To investigate the association between reproductive factors and the risk of ovarian cancer among southern Chinese women., Methods: A hospital-based case-control study was undertaken in Guangzhou, Guangdong Province, between 2006 and 2008. A structured questionnaire was used to obtain information on parity, oral contraceptive use and other reproductive factors in a sample of 500 incident ovarian cancer patients and 500 controls (mean age, 59 years). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression models., Results: High parity was inversely associated with ovarian cancer, with an adjusted OR 0.43 (95% CI, 0.30 to 0.62) for women who had given birth to 3 or more children compared to women who had given no more than one birth. Ever use of oral contraceptives was also protective against ovarian cancer; adjusted OR 0.56 (95% CI, 0.40 to 0.78). No association was found for hormone replacement therapy, menopausal status, hysterectomy and family history of ovarian and/or breast cancer., Conclusion: High parity and oral contraceptive use are associated with a lower risk of ovarian cancer in southern Chinese women.

Objectives: Identify the extent of under-reporting of energy intake and the characteristics associated with implausible intakes in elderly women., Design: Dietary intake was assessed using a 3-day weighed food record. Protein intake was validated by 24-hour urinary nitrogen. To examine under-reporting, participants were grouped according to their energy intake and compared to the Goldberg cut-off equation. Logistic regression was performed to assess the influence of body mass index (BMI) and social-demographic factors on under-reporting., Setting: Community dwelling elderly women from Perth, Western Australia., Participants: 217 elderly women aged 70-80 years., Results: Under-reporters had a higher physical activity level (p<0.001) compared with acceptable-reporters. The under-reporters also had a higher body weight (p=0.006), body mass index (BMI) (p=0.001), waist (p=0.011), hip circumference (p<0.001), whole body fat mass (p<0.001) and percentage body fat (p<0.001) than acceptable-reporters. Under-reporters had a significantly lower intakes of protein, fat, carbohydrate and alcohol (p<0.001) and fewer reported food items, compared with acceptable reporters. However, 24-hour urinary nitrogen was only marginally different between the two groups (p=0.053). Participants with a higher BMI were more likely to under-report their energy intake (BMI=25-29.9: odds ratio=2.98[95% CI=1.46-6.09]; BMI≥30: 5.84[2.41-14.14])., Conclusion: Under-reporting energy intake in elderly women was associated with a higher BMI, body fat and higher self-reported physical activity levels. A higher BMI (≥25) appears to be most significant factor in determining if elderly women will underreport their food intake and may be related to body image. These results have implications for undertaking surveys of food intake in elderly women.

Background: Ovarian cancer is an important neoplasm that is difficult to diagnose and treat; therefore, prevention is the preferable strategy. Growing evidence indicates a protective effect of breastfeeding on ovarian cancer risk., Objective: The objective was to investigate the association between lactation and the risk of ovarian cancer among southern Chinese women., Design: A case-control study was undertaken in Guangzhou, Guangdong Province, between August 2006 and July 2008. A validated and reliable questionnaire was used to obtain information on the months of lactation and number of children breastfed in a sample of 493 incident ovarian cancer patients and 472 hospital-based controls (mean age: 59 y). Logistic regression analyses were performed to assess the association between breastfeeding and the risk of ovarian cancer., Results: Significant inverse dose-response relations were found for both duration of lactation and the number of children breastfed. The adjusted ORs were 0.09 (95% CI: 0.04, 0.19) for women with ≥31 mo of total lactation and those with ≤10 mo of lactation and 0.38 (95% CI: 0.27, 0.55) for women with ≥3 children breastfed compared with those with one child breastfed., Conclusion: Prolonged lactation is associated with a lower risk of ovarian cancer in parous Chinese women.

Objective: To ascertain the relationship between tea drinking and the risk of ovarian cancer among southern Chinese women, a case-control study was conducted in southern China during 2006-2008., Methods: Five hundred incident patients with histologically confirmed epithelial carcinoma of the ovary and 500 controls (mean age 59 years) were recruited from four public hospitals in Guangzhou. Information on frequency, quantity and duration of tea drinking, amount of dried tea leaves brewed, together with habitual diet and lifestyle characteristics, was obtained face-to-face from participants using a validated and reliable questionnaire. Logistic regression analyses were performed to assess the association between tea consumption variables and the ovarian cancer risk., Results: The control subjects reported higher tea consumption levels and prevalence (78.8%) than the ovarian cancer patients (51.4%). Regular drinking of green tea, black tea and/or oolong tea was associated with a lower risk of ovarian cancer, the adjusted odds ratio being 0.29 (95% confidence interval 0.22-0.39) after accounting for confounding factors. When compared with non-drinkers, apparent inverse dose-response relationships were observed for years of drinking, number of cups and quantity of tea consumed, as well as amount of dried tea leaves brewed (p < 0.01)., Conclusion: Regular tea consumption is associated with a reduced risk of ovarian cancer for southern Chinese women., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

This study describes Japanese mothers' knowledge and attitudes towards breastfeeding using the Iowa Infant Feeding Attitudes Scale (IIFAS). A cross-sectional survey of 1,612 mothers was conducted in Japan in 2007. The participants were recruited at the free health checks conducted for infants at 18 months of age. The survey was self-administered using the Japanese version of the IIFAS. Descriptive statistics were used to summarise sample characteristics and IIFAS score followed by multiple logistic regression to identify association between total IIFAS score and breastfeeding duration. While the IIFAS showed that the majority recognized some benefits of breastfeeding, their overall knowledge and attitudes towards breastfeeding were neutral and more positive towards the use of infant formula. It is important to provide accurate prenatal education that focuses on methods and long-term benefits of infant feeding to mothers, family and health professionals.

The natural history of cervical cancer suggests that prevention can be achieved by modification of the host's immune system through a nutrient-mediated program. This study reviews the preventive role of dietary intake on cervical intraepithelial neoplasia (CIN) induced by human papillomavirus (HPV). Electronic databases were searched using relevant keywords such as, but not limited to, human papillomavirus infection, cervical intraepithelial neoplasia, lifestyle factors, nutrients intake, and diet. High consumption of fruit and vegetables appears to be protective against CIN. The findings also highlight the possibility of consuming high levels of specific nutrients, vitamins, and minerals, and retaining sufficient level of these elements in the body, especially those with high antioxidants and antiviral properties, to prevent progression of transient and persistent HPV infections to high-grade CIN 2 and 3 (including in situ cervical cancer). The protective effect is not significant for high-risk HPV persistent infections and invasive cervical cancer. Although it appears that intake of specific nutrients, vitamins, and minerals may be good in CIN prevention, there is lack of evidence from controlled trial to confirm this. Health professionals shall focus on implementation of a balanced-diet prevention strategy at an early stage for cervical cancer prevention.

Objectives: The aim of this study is to review the issues of publication of clinical trials with consideration of ethics and the incomplete evidence base., Methods: We review clinical trials and issues of communications and ethics. Several case studies of notable public health researchers will be discussed., Results: Many of the major breakthroughs of public health practice, including the works of John Snow would not have been published under modern guidelines for scientific communication. The research-publication system of modern health care poses many challenges for editors. Journal editors need to include a balance of different types of studies where insufficient randomised controlled trials are available., Conclusion: Clinical trials are a reliable source of evidence for health care practitioners. Journals need to uphold the integrity of the information provided by randomised controlled trials (RCTs) and synthesise and communicate health information. At the same time, editors must assess non-RCT evidence and be vigilant for many of the other potential problems in health and medical communication., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To ascertain the relationship between habitual physical activity and the risk of ovarian cancer among southern Chinese women., Method: A case-control study was conducted in Guangzhou, Guangdong Province, during 2006-2008. Information on physical activity exposure and lifestyle characteristics was obtained from 500 incident ovarian cancer patients and 500 hospital-based controls (mean age 59 years) using a validated and reliable questionnaire. Logistic regression analyses were performed to assess the association between physical activity levels and the ovarian cancer risk., Results: The control subjects reported significantly longer duration of strenuous sports and moderate activity in daily life than the ovarian cancer patients. Increased engagements in such leisure time activities were associated with reduced cancer risks after adjustment for confounding factors. A significant inverse dose-response relationship was also found for total physical activity exposure, with adjusted odds ratio 0.49 (95% confidence interval 0.35-0.68) for women engaged in 23 or more metabolic equivalent tasks (MET)-hours per week relative to those less than 12 MET-hours per week., Conclusion: The study provided evidence of an inverse association between habitual physical activity and the risk of ovarian cancer, which is important for the promotion and encouragement of leisure time exercise activities to prevent the disease., (Copyright © 2012 Elsevier Inc. All rights reserved.)

This study aimed to translate and validate a Chinese (simplified) version of the Iowa Infant Feeding Attitude Scale (IIFAS) and compare the infant feeding attitudes of Chinese mothers living in Perth Australia and in Chengdu P.R. China. A survey was undertaken on 200 Chinese mothers living in Perth and 1620 mothers living in Chengdu. The simplified Chinese version of IIFAS had a moderate level of internal consistency with a Cronbach's alpha of 0.69 for mothers in Australia and 0.55 for mothers in China. The mean IIFAS scores in both country groups lay in the range of 'neutral breastfeeding attitudes'. Higher IIFAS scores were significantly associated with the likelihood of both breastfeeding initiation (OR: 3.85; CI: 2.49-5.96; p<0.001) and longer (>=8 months) breastfeeding duration (OR: 2.52; CI: 1.87-3.40; p<0.001). Chinese mothers in Perth (mean IIFAS score=60.0±6.3) tended to have more positive attitudes towards breastfeeding than mothers in Chengdu (mean IIFAS score=57.7±5.1, p<0.001), and had a longer duration of 'any breastfeeding' (10.0±6.2 months in Perth compared to 7.4±4.3 months in Chengdu, p<0.001). In conclusion, higher scores on the IIFAS in simplified Chinese are associated with breastfeeding initiation and duration in Chinese populations.

This study aimed to investigate the rate of breastfeeding at discharge and associated influencing factors in rural China. A prospective cohort study of infant feeding practices was undertaken during 2010-2011 in Jiangyou city, Sichuan Province of China. Logistic regression analysis was performed to ascertain pertinent factors affecting the prevalence of any breastfeeding at discharge. The participants consisted of 695 mothers aged 18-44 years. The breastfeeding rate at discharge was 93.5% (95% CI: 91.7-95.3). Perceived paternal breastfeeding preference was positively associated with actual breastfeeding at discharge (OR=4.46, 95% CI: 2.15-9.28). Other significant determinants were 'receiving breastfeeding support' from staff during hospital stay (OR=3.41, 95% CI: 1.58-7.34) and making the decision on feeding method during pregnancy or after childbirth (OR=0.46, 95% CI: 0.22-0.93). In conclusion, provision of comprehensive breastfeeding support in hospital and education programs targeting expectant and future parents are recommended to further increase the rate of breastfeeding at discharge in rural areas of China.

Background: The north-western region of China has a high incidence of oesophageal cancer. This study aimed to investigate whether the intake of food and beverage at high temperature is associated with the risk of oesophageal cancer among adults residing in this remote part of China., Materials and Methods: A case-control study was undertaken in Urumqi and Shihezi, Xinjiang Uyghur Autonomous Region of China, between 2008 and 2009. Participants were 359 incident oesophageal cancer patients and 380 hospital-based controls. Information on temperature of food and beverage intake was obtained by face-to-face interview. Logistic regression analyses were performed to ascertain the association between intake temperature and the risk of oesophageal cancer., Results: The oesophageal cancer patients consumed foods and beverages at higher temperatures than controls, p<0.001. High temperature of tea, water and food intake appeared to increase the risk of oesophageal cancer by more than two-fold, with adjusted odds ratio (95% confidence intervals) of 2.86 (1.73-4.72), 2.82 (1.78-4.47) and 2.26 (1.49-3.45), respectively., Conclusions: Intake of food and beverage at high temperature was positively associated with the incidence of oesophageal cancer in north-western China.

The Japanese health system places great emphasis on healthy development. However, the prevalence of Exclusive Breastfeeding at one month postpartum between 1980 and 2005 has remained unchanged, fluctuating between 42% and 49%. At the same time, the Any Breastfeeding prevalence has gradually increased from about 80% to 95%. In 2010, the latest national breastfeeding report showed that 'exclusive' and 'any' breastfeeding rates have improved. However, as the World Health Organization (WHO) definition of breastfeeding practices was not used in this study or in other national surveys, it is difficult to interpret these latest results. While the Japanese government has launched several promotion projects, there have been few studies and reviews of risk factors that influence breastfeeding duration. The objectives of this review were to summarise the factors that have influenced the duration of breastfeeding in Japan to provide information relevant to breastfeeding promotion programs. A search of electronic databases in Japanese and English was undertaken up to 2011. The inclusion criteria for this review were studies that focused on infant feeding practices and targeted Japanese mothers, fathers, or health professionals, but excluded mothers' friends and peer groups. In total, 12 articles were selected for the final analysis. Smoking status, low birth weight of infants and maternal perceptions of insufficient breast milk supply were negative influences on breastfeeding duration, while support from husbands/partners is associated with continued breastfeeding. Some factors that have been found to be associated with breastfeeding in other countries, including maternal age, family income, maternal educational levels, and living with grandparents of infants have not been confirmed in Japan. While the national breastfeeding rates were higher than other countries of similar health status, inconsistent knowledge of breastfeeding benefits and inappropriate hospital practices remain in Japan may be associated with increased the use of infant formula and reduced breastfeeding duration. Most of the studies reviewed were cross-sectional in design, with only a limited number of cohort studies. Also many published studies used small sample sizes. Cohort studies of infant feeding practices with larger sample sizes are required to monitor trends in rates and risk factors for breastfeeding outcomes.

Background: Perinatal research on anxiety and depression has primarily focused on mothers. We have limited knowledge of fathers' anxiety during the perinatal period yet there is evidence that the parenting capacity of a person can be compromised by anxiety and depression. The purpose of this paper is to identify the impact of a father inclusive intervention on perinatal anxiety and depression. The prime focus of the intervention was to provide education and support to fathers of breastfeeding partners with the aim of increasing both initiation and duration of breastfeeding., Methods: A repeated measures cohort study was conducted during a RCT that was implemented across eight public maternity hospitals in Perth, Western Australia between May 2008 and June 2009. A baseline questionnaire which included the Hospital Anxiety and Depression Scale (HADS) was administered to all participants on the first night of their hospital based antenatal education program and was repeated at six weeks postnatal. SPSS version 17 was used for reporting descriptive results., Results: The mean anxiety levels at baseline for the fathers in the intervention group (n=289) and control group (n=244) were 4.58 and 4.22 respectively. At 6 weeks postnatal (only matched pairs), intervention and control group were 3.93 and 3.79. More intervention group fathers self-rated less anxiety compared to the fathers in the control group from baseline to post test (p=0.048). Depression scores for intervention fathers at baseline (mean=1.09) and at six weeks (mean=1.09) were very similar to fathers in the control group at baseline (mean=1.11) and at six weeks (mean=1.07) with no significant changes., Conclusions: Both intervention and control group fathers experienced some anxiety prior to the birth of their baby, but this was rapidly reduced at six weeks. Paternal anxiety is common to new fathers and providing them with information and strategies for problem-solving can increase their knowledge and potentially lower the risk of postnatal anxiety., Trial Registration: (Australian New Zealand Clinical Trials Registry ACTRN12609000667213).

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.

Short-term randomised, controlled trials have found that dietary protein relative to carbohydrate can reduce blood pressure. Our objective was to investigate the effects on blood pressure of an increase in protein intake from whey over 2 years in women aged over 70 years. From the general population, 219 women aged between 70 and 80 years were recruited to a 2-year randomised, double-blind, placebo-controlled parallel-design trial: 181 women completed the trial to the end of year 2. Participants were randomly assigned to consume a daily whey protein-based beverage (protein) or an energy-matched low-protein high-carbohydrate beverage (control). Blood pressure measurements were performed at baseline, year 1 and year 2. For protein relative to control, the estimated mean net differences in protein and carbohydrate intakes were 18 (95 % CI 13, 23) and -22 (95 % CI -9, -35) g/d at year 1, and 22 (95 % CI 17, 28) and -18 (95 % CI -6, -31) g/d at year 2. Intention-to-treat analysis found no overall differences between groups in blood pressure (P>0·5). Net differences in systolic and diastolic blood pressure were -2·3 (95 % CI -5·3, 0·7) and -1·5 (95 % CI -3·6, 0·6) mmHg at year 1, and 1·6 (95 % CI -1·5, 4·7) and 0·3 (95 % CI -1·9, 2·4) mmHg at year 2. Similar differences in systolic and diastolic blood pressure at years 1 and 2 were observed with per-protocol analysis. Therefore, the present study did not provide evidence that a higher whey protein intake in older women can have prolonged effects on blood pressure.

The prevalence of childhood overweight and obesity in China has increased in recent decades. However, studies reported from China use several different definitions and growth references, making it difficult to compare the rates of obesity from different regions. It also makes it difficult to establish the extent of secular trends in obesity and to make international comparisons. This article reviews the definitions of childhood obesity used in Chinese studies published over the past 10 years. The majority (79%) of the Chinese studies used a definition of >120% of the mean value of the National Center for Health Statistics reference population to diagnose childhood obesity. Only 7 studies (9%) conducted in China measured childhood obesity using age-specific and sex-specific body mass index (BMI) cutoffs, including International Obesity Task Force cutoffs, Centers for Disease Control 2000 and World Health Organization 2006 BMI curves, and Chinese BMI curves. It is important that a consistent and applicable definition is used and all studies accurately define the obesity with growth reference, cutoff criteria, sample selection, and age distribution. The use of sex-specific and age-specific BMI cutoffs should be considered when undertaking future studies of obesity in Chinese children.

Guidelines for patients with severe traumatic brain injury (sTBI) published in 2007 recommend providing early nutrition after trauma. Early enteral nutrition (EN) started within 48 h post-injury reduces clinical malnutrition, prevents bacterial translocation from the gastrointestinal tract, and improves outcome in sTBI patients sustaining hypermetabolism and hypercatabolism. The aim of this study was to examine the effect of early EN support on survival rate, Glasgow Coma Scale (GCS) score, and clinical outcome of sTBI patients. Medical records of sTBI patients with GCS scores 4-8 were recruited from 18 hospitals in Taiwan, excluding patients with GCS scores ≤3. During 2002-2010, data from 145 EN patients receiving appropriate calories and nutrients within 48 h post-trauma were collected and compared with 152 non-EN controls matched for gender, age, body weight, initial GCS score, and operative status. The EN patients had a greater survival rate and GCS score on the 7th day in the intensive care unit (ICU), and a better outcome at 1 month post-injury. After adjusting for age, gender, initial GCS score, and recruitment period, the non-EN patients had a hazard ratio of 14.63 (95% CI 8.58-24.91) compared with EN patients. The GCS score during the first 7 ICU days was significantly improved among EN patients with GCS scores of 6-8 compared with EN patients with GCS scores of 4-5 and non-EN patients with GCS scores of 6-8. This finding demonstrates that EN within 48 h post-injury is associated with better survival, GCS recovery, and outcome among sTBI patients, particularly in those with a GCS score of 6-8.

The effects of dietary protein on bone structure and metabolism have been controversial, with evidence for and against beneficial effects. Because no long-term randomized, controlled studies have been performed, a two-year study of protein supplementation in 219 healthy ambulant women aged 70 to 80 years was undertaken. Participants were randomized to either a high-protein drink containing 30 g of whey protein (n = 109) or a placebo drink identical in energy content, appearance, and taste containing 2.1 g of protein (n = 110). Both drinks provided 600 mg of calcium. Dual-energy X-ray absorptiometric (DXA) hip areal bone mineral density (aBMD), 24-hour urinary calcium excretion, and serum insulin-like growth factor 1 (IGF-1) were measured at baseline and at 1 and 2 years. Quantitative computed tomographic (QCT) hip volumetric bone mineral density (vBMD) and a femoral neck engineering strength analysis were undertaken at baseline and at 2 years. Baseline average protein intake was 1.1 g/kg of body weight per day. There was a significant decrease in hip DXA aBMD and QCT vBMD over 2 years with no between-group differences. Femoral neck strength was unchanged in either group over time. The 24-hour urinary calcium excretion increased significantly from baseline in both groups at 1 year but returned to baseline in the placebo group at 2 years, at which time the protein group had a marginally higher value. Compared with the placebo group, the protein group had significantly higher serum IGF-1 level at 1 and 2 years (7.3% to 8.0%, p < .05). Our study showed that in protein-replete healthy ambulant women, 30 g of extra protein increased IGF-1 but did not have beneficial or deleterious effects on bone mass or strength. The effect of protein supplementation in populations with low dietary protein intake requires urgent attention., (Copyright © 2011 American Society for Bone and Mineral Research.)

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.

Background:   Alcoholic liver disease (ALD) is an important contributor to the total burden of alcohol-related harm; however, the morbidity of different types of ALD in Australia has not been described. The aim of this study was to investigate recent trends in hospital admission rates among alcoholic liver cirrhosis, alcoholic hepatic failure and alcoholic hepatitis in Australia, as well as the mortality of ALD., Method:   This is a population-based cohort study including the total 15+ years Australian population. Data were obtained from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare., Main Outcome Measures: (i) trend of standardized mortality rates and trend of standardized hospital admission rates for males and females for 1993/1994-2004/2005 (fiscal year), (ii) relative risk of alcoholic liver cirrhosis, alcoholic hepatic failure and alcoholic hepatitis hospital admissions for 1999/2000-2004/2005., Results:   The mortality rate of ALD decreased significantly. Significant increases in hospital admissions for alcoholic hepatic failure among older adults and alcoholic hepatitis among younger age groups were observed. There is a significant 10-fold increase in the risk of hospital admissions of alcoholic cirrhosis in 2002/2003 for the 20-29 years population., Conclusion:   Reductions in overall ALD mortality observed are likely the result of advances in disease management. Significant increase in hospital admissions suggests an increase in the prevalence of ALD among the Australian population. Dramatic increases in hospital admissions for alcoholic cirrhosis in 2002/2003 for the 20-29 years population may have been due to an increase in screening of alcohol-related harms in primary care settings., (© 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.)

White rice-based foods, which are high in refined carbohydrates, are widely consumed in China. A case-control study was conducted to investigate the association between white rice-based food consumption and the risk of ischemic stroke in the southern Chinese population. Information on diet and lifestyle was obtained from 374 incident ischemic stroke patients and 464 hospital-based controls. Logistic regression analyses were performed to assess the effects of rice-based foods on stroke risk. The mean weekly intake of rice foods appeared to be significantly higher in cases than in controls. Increased consumptions of cooked rice, congee, and rice noodle were associated with a higher risk for ischemic stroke after controlling for confounding factors. The corresponding adjusted odds ratios (with 95% confidence intervals) for the highest versus lowest intake level were 2.73 (1.31-5.69), 2.93 (1.68-5.13), and 2.03 (1.40-2.94), with significant dose-response relationships observed. The results provide evidence of a positive association between habitual rice food consumption and the risk of ischemic stroke in Chinese adults., (Copyright © 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

The role of calcium in the prevention of bone loss in later life has been well established but little data exist on the adequacy of calcium intakes in elderly Australian women. The aim of this study was to compare the dietary intake including calcium of elderly Australian women with the Australian dietary recommendation, and to investigate the prevalence of calcium supplement use in this population. Community-dwelling women aged 70-80 years were randomly recruited using the Electoral Roll for a 2-year protein intervention study in Western Australia. Dietary intake was assessed at baseline by a 3-day weighed food record and analysed for energy, calcium and other nutrients. A total of 218 women were included in the analysis. Mean energy intake was 7,140 ± 1,518 kJ/day and protein provided 19 ± 4% of energy. Mean dietary calcium intake was 852 ± 298 mg/day, which is below Australian recommendations. Less than one quarter of women reported taking calcium supplements and only 3% reported taking vitamin D supplements. Calcium supplements by average provided calcium 122 ± 427 mg/day and when this was taken into account, total calcium intake increased to 955 ± 504 mg/day, which remained 13% lower than the Estimated Average Requirement (EAR, 1,100 mg/day) for women of this age group. The women taking calcium supplements had a higher calcium intake (1501 ± 573 mg) compared with the women on diet alone (813 ± 347 mg). The results of this study indicate that the majority of elderly women were not meeting their calcium requirements from diet alone. In order to achieve the recommended dietary calcium intake, better strategies for promoting increased calcium, from both diet and calcium supplements appears to be needed.