It is well known that extreme repetitive stress on the apophysis without considering the physical characteristics of children induces a growth disorder of the growing skeleton. However, only a few studies have evaluated the indexes of the muscle-tendon complex as a risk factor of apophysitis. The purpose of this study was to investigate the relationship between the elastic properties of the Achilles tendon, physical characteristics, muscle tightness (MT) and general joint laxity score (GLP), and tenderness from typical apophysitis (calcaneal tubercle, tibial tuberosity and iliac spine) in kindergarten and elementary school students. Body and lower leg size, and MT of the calf muscle increased ; while GLP decreased significantly with age. The Elastic index of the Achilles tendon and its standard deviations were greater among 5^th and 6^th graders than among 3^rd and 4^th graders. Point tenderness was more frequent in older age groups (4^th-6^th graders) than in younger age groups (kindergartren-3^rd graders) and was greatest in 4^th graders. When subjects were categorized into groups with and without point tenderness, no significant differences were found between GLP, muscle tightness of gastrocnemius, quadriceps and iliopsoas. However subjects who showed point tenderness had a higher Elastic index (p=0.07). Considering the pathomechanics of apophysitis, repetitive traction of the apophysis by a stiffer muscle-tendon unit lead to injury of the apophysis and growth plate. Tendon properties appear to be more sensitive to the pathomechanics of apophysitis.

Every year, an estimated 180 000 babies in the Western Pacific Region are infected by hepatitis B, 13 000 by syphilis and 1400 by HIV through mother-to-child transmission.1 These infections can be largely prevented by antenatal screening, treatment and timely vaccination for newborns. Despite challenges in controlling each disease, major achievements have been made. National immunization programmes have reduced the regional hepatitis B prevalence from over 8% in 1990 to 0.93% among children born in 2012. In addition, HIV testing and treatment have helped keep the regional prevalence of HIV infections at 0.1%. In contrast, the number of maternal syphilis cases is still high in the Western Pacific Region, with an estimated 45 million cases in 2012. Elimination of mother-to-child transmission of these infections cannot be achieved through vertically applied programming and require using and augmenting to the shared Maternal, Newborn and Child Health platform to coordinate, integrate and enable cost efficiencies for these elimination efforts. The Regional Framework for Triple Elimination of Mother-to-Child Transmission of HIV, Hepatitis B and Syphilis in Asia and the Pacific 2018–2030 offers such a coordinated approach towards achieving the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis and provides guidance for decision-makers, managers and health professionals working in programmes addressing maternal, newborn and child health, HIV, hepatitis, sexually transmitted infections and immunization.