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The increasing burden of noncommunicable diseases (NCDs) is a major public health concern in Palau. This study aims to identify social and psychological factors related to NCDs among Palauan people using a qualitative approach. We conducted eight key informant interviews and eight focus group discussions, which were audio-recorded, transcribed and translated into English. Ideas of the respondents were extracted and labeled, and the labels were analyzed using an inductive multistage approach referred to as qualitative content analysis. Three themes emerged: (1) home education, (2) traditional local community, and (3) modernization and westernization of lifestyle. Respondents believed that the influence of the family on lifestyle was significant, but that disciplining children at home had become difficult. They considered that the traditional lifestyle was mostly healthy, and were reluctant to abandon certain unhealthy customs, such as serving abundant food to guests as a sign of fraternity. They also thought that they overate because of their stressful modernized lifestyle. This is the first qualitative study to analyze perception and behavior of the Palauan people in relation to NCDs. We found that the increase in NCDs was related to two concurrent trends: preserving certain traditional customs unfavorable to good health, and abandoning time-consuming healthy traditional lifestyle to adopt a modernized one. We also found that Palauan people were not confident in their ability to prevent NCDs. Therefore, health promotion activities should be designed to empower people to make positive changes., This is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (http://creativecommons.org/licenses/by-nc-nd/4.0/).

本稿では、大阪大学における大学院教育の中でも、文部科学省による「博士課程教育リーディングプログラム」のオールラウンド型に2011年度に採択された「超域イノベーション博士課程プログラム」において提供されてきた科目「海外フィールドスタディ」を通じた学習成果と高度汎用力の教育効果について考察した。その結果、本科目を通じて「高い国際性」、「専門以外の分野の幅広い知識」、「他者と協働する力」の3つの能力が他の能力と比較して育成されること、また、「物事を俯瞰し本質を見抜く力」、「自ら課題を発見する力」も一定程度能力の向上がみられることがわかった。一方で、「課題の解決策を立案する力」、「課題解決の実現に挑む力」、「独創的な能力」、「高度な専門的知識・研究能力」といった能力の育成までは至っていないこともわかった。超域イノベーション博士課程プログラムの海外フィールドスタディは2018年度以降も継続して実施されることから、今後は海外フィールドスタディの各コンポーネントと教育効果の関連性や、そこに発現するプロセスをより明確に認識し、本科目の質的な充実を目指していくことが必要である。, In this paper, authors examined learning outcomes and impacts on students' transferable skills through Overseas Field Study provided by the Cross-Boundary Innovation Program at the Osaka University, supported under the Programs for Leading Graduate Schools of the Japanese government's Ministry of Education, Culture, Sports, Science and Technology. Degree of internationality, extensive knowledge outside one's field, co-operative skill was significantly developed through the subject. Ability to identify essential issue, skill to identify challenges was modestly developed. On the other hand, impact of the subject was not significant to skill to develop solution, ability of solution implementation and advanced technical knowledge and research capacity. Given Cross-Boundary Innovation Program will be continued for FY2018 and beyond, it is essential to improve quality of the subject by continuously exploring associations between Overseas Field Study components and their educational impacts.

Non-communicable diseases have been recognized as a serious threat to public health in Palau. To tackle the problem, different strategies might be necessary for populations with different ethnic backgrounds. This study aims to find the differences in the prevalence of metabolic risk factors of non-communicable diseases between Palauans and Filipinos living in Palau, and examine possible determinants of the differences. We selected data of 2,032 participants, including native Palauans and Filipinos, from the Palau STEPS Survey 2011–2013 for this study. Logistic regression models were used to inspect the association of each metabolic risk factor with ethnicity by calculating odds ratios adjusted for potential confounding factors. Palauans had higher age-standardized prevalence of overweight or obesity (84% vs. 45%), hypertension (50% vs. 38%) and diabetes (19% vs. 13%) than Filipinos. However, after adjusting for BMI and various lifestyle related factors, there are no statistical significant differences in the prevalence of hypertension and diabetes between these two ethnic groups. Palauan men were less likely to have elevated total cholesterol, especially after adjusting for BMI (odds ratio=0.55, 95% confidence interval: 0.33–0.91), while Palauan women were more likely to have elevated triglycerides than their Filipino counterparts (odds ratio=1.45, 95% confidence interval: 1.02–2.06). Our findings suggested that Palauans’ higher BMI distribution might be able to explain their higher prevalence of hypertension and partially explain their higher diabetes prevalence. Palauans were not consistently more likely to have all metabolic risk factors, namely dyslipidemia were less likely to be observed in Palauan men.

We aimed to investigate the prevalence and predictors of diabetes and prediabetes among adults in Palau. We used data of 1915 adults, aged 25 to 64 years, who participated in the World Health Organization’s (WHO) STEPwise Approach to Risk Factor Surveillance (STEPS) study in Palau. Information on behavioral risk factors of NCDs and physical and biochemical measurements were obtained using standard methods of the WHO. The diagnosis of diabetes and prediabetes was based on the recent American Diabetes Association criteria. Predictors of the prevalence of diabetes and prediabetes were identified using multinomial logistic regression analysis. The overall age-standardized prevalence of prediabetes and diabetes were 40.4% (43.6% for men, 37.4% for women) and 17.7% (18.6% for men, 17% for women), respectively. Old age, overall obesity (high BMI), central obesity (large waist circumference or waist-hip ratio), hypertension and hypertriglyceridemia were significant predictors of prediabetes and/or diabetes. Diabetes occurred at a younger age in “obese” individuals than that of their “non-obese” counterparts. We confirmed that prediabetes and diabetes are highly prevalent in Palau affecting 40% and 18% adults, respectively. Introducing public health interventions to reduce and prevent obesity as early as possible could prove useful to curb the problem.

Palau, similar to other Pacific island countries, is currently highly burdened with non-communicable diseases (NCDs). The WHO STEPS was launched in 2011 to comprehensively survey indicators for NCDs in the country. This paper aims to describe the prevalence of key NCD risk factors assessed by the survey. The WHO instrument, including behavioral, physical and biochemical measurements, was adopted to the nationwide survey for all residents aged 25 to 64 years. A cluster-based sampling method was performed to obtain a national representative data. Valid data from 2,184 individuals were selected for the analyses, of which 75% were Palauans and 19% were Filipinos. Prevalence of current cigarette smoking was 25% in men and 10% in women. Betel nut chewing with tobacco was prevalent particularly among Palauans (58% in men, 69% in women) compared to the other ethnic groups. In terms of all types of tobacco use, 60% of men and 58% of women were current users. Overweight or obesity was very common among Palauans (84% in men, 86% in women) as well as Filipinos (52% in men, 40% in women). Hypertension was found in 55% of men and 49% of women, with the stage 2 hypertension being 21% and 19%, respectively. The prevalence of diabetic level hyperglycemia was more than 20%. Raised total cholesterol was detected in 16% of men and 20% of women. This survey revealed an alarmingly high prevalence of NCD risk factors, especially tobacco use, obesity, hypertension and raised blood glucose. The data would be useful baseline information to develop effective NCD strategies in Palau.