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Aim: To explore the health beliefs of clinical and academic nurses from Japan, Australia and China regarding wearing paper masks to protect themselves and others, and to identify differences in participants' health beliefs regarding masks., Background: The correct use of face masks and consensus among health professionals across the globe is essential for containing pandemics, and nurses need to act according to policy to protect themselves, educate the public and preserve resources for frontline health workers. Paper masks are worn by health professionals and the general public to avoid the transmission of respiratory infections, such as COVID-19, but there appear to be differences in health beliefs of nurses within and between countries regarding these., Methods: This qualitative descriptive study used content analysis with a framework approach., Findings: There were major differences in nurse participants' beliefs between and within countries, including how nurses use paper masks and their understanding of their efficacy. In addition, there were cultural differences in the way that nurses use masks in their daily lives and nursing practice contexts., Conclusion: Nurses from different working environments, countries and areas of practice hold a variety of health beliefs about mask wearing at the personal and professional level., Implications for Nursing Policy and Health Policy: The COVID-19 pandemic has sparked much discussion about the critical importance of masks for the safety of health professionals, and there has been considerable discussion and disagreement about health policies regarding mask use by the general public. Improper use of masks may have a role in creating mask shortages or transmitting infections. An evidence-based global policy on mask use for respiratory illnesses for health professionals, including nurses, and the general public needs to be adopted and supported by a wide-reaching education campaign., (© 2020 International Council of Nurses.)

In this document, we propose a universal definition of heart failure (HF) as a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion. We also propose revised stages of HF as: At risk for HF (Stage A), Pre-HF (Stage B), Symptomatic HF (Stage C) and Advanced HF (Stage D). Finally, we propose a new and revised classification of HF according to left ventricular ejection fraction (LVEF). This includes HF with reduced ejection fraction (HFrEF): symptomatic HF with LVEF ≤40%; HF with mildly reduced ejection fraction (HFmrEF): symptomatic HF with LVEF 41-49%; HF with preserved ejection fraction (HFpEF): symptomatic HF with LVEF ≥50%; and HF with improved ejection fraction (HFimpEF): symptomatic HF with a baseline LVEF ≤40%, a ≥10 point increase from baseline LVEF, and a second measurement of LVEF > 40%., (© 2021 European Society of Cardiology and Elsevier, Inc.)

Aim: The aim of this study was to examine the relationship between welfare states and nursing professionalization indicators., Design: We used a time-series, cross-sectional design. The analysis covered 16 years and 22 countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, South Korea, Spain, Sweden, Switzerland, United Kingdom, and the United States, allocated to five welfare state regimes: Social Democratic, Christian Democratic, Liberal, Authoritarian Conservative, and Confucian., Methods: We used fixed-effects linear regression models and conducted Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction. We applied the Amelia II multiple imputation strategy to replace missing observations. Data were collected from March-December 2017 and subsequently updated from August-September 2018., Results: Our findings highlight positive connections between the regulated nurse and nurse graduate ratios and welfare state measures of education, health, and family policy. In addition, both outcome variables had averages that differed among welfare state regimes, the lowest being in Authoritarian Conservative regimes., Conclusion: Additional country-level and international comparative research is needed to further study the impact of a wide range of structural political and economic determinants of nursing professionalization., Impact: We examined the effects of welfare state characteristics on nursing professionalization indicators and found support for the claim that such features affect both the regulated nurse and nurse graduate ratios. These findings could be used to strengthen nursing and the nursing workforce through healthy public policies and increase the accuracy of health human resources forecasting tools., (© 2019 John Wiley & Sons Ltd.)

Objective: The aim of the current study is to explore country of origin and social race category differences in dental crowding prevalence through an anthropological approach., Design: Data were collected from individuals within five countries (Australia, China, Japan, South Africa, United States; n = 1008) and seven social race groups in two countries (American Black, American White, Latinx, and Indigenous in the United States, South African Black, South African White, and South African Coloured; n = 654). Statistical significance between groups was assessed with a Kruskal-Wallis test, while a Dunn's post-hoc test identified which groups significantly differed., Results: Results indicate South Africa is characterized by the lowest frequencies of dental crowding, with Coloured South Africans yielding the highest and Black South Africans displaying the lowest frequencies. Individuals in the United States exhibited relatively high levels of minor dental crowding. American Blacks had lower crowding levels, while the Indigenous group had high levels of severe crowding. Individuals within China and Japan exhibited higher relative prevalence of severe crowding., Conclusions: Overall, significant differences exist in dental crowding prevalence across countries and social race categories using an anthropological grading system to assess crowding. These differences are likely impacted by sociocultural (aesthetic preferences) and economic (access to dental care) factors., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Through literature search in regular database and official websites of relevant countries, this paper combs and summarizes the main characteristics of disease prevention and control systems in five countries, the United States, Germany, South Korea, Australia and Japan, and the European Union at key levels including legal construction, organizational structure, financing, personnel construction and international cooperation, in order to provide decision support for the construction of disease prevention and control system in China in the future.

Disputes around trade inequality have been growing over the last 2 decades, with different countries claiming inequality in different terms including monetary deficits, resource appropriation and degradation, and environmental emission transfer. Despite prior input-output-based studies analyzing multidimensional trade consequences at the sector level, there is a lack of bottom-up studies that uncover the complexity of trade imbalances at the product level. This paper quantifies four types of flows, monetary, resource, embodied energy use, and embodied greenhouse gas (GHG) emissions, resulting from aluminum trade for the four economies with the highest aluminum trade, that is, the United States, China, Japan, and Australia. Results show that the United States has a negative balance in monetary flows but a positive balance in resource flows, embodied energy use, and GHG emissions. China has a positive balance in monetary and resource flows but a negative balance in embodied energy use and GHG emissions. Japan has a positive balance in all flows, while Australia has a negative balance in all flows. These heterogeneous gains and losses along the global leaders of aluminum trade arise largely from their different trade structures and the heterogeneities of price, energy use, and GHG emission intensities of aluminum products; for example, Japan mainly imports unwrought aluminum, and its quantity is 3 times that of the exported semis and finished aluminum-containing products that have similar energy and GHG emission intensities but 20 times higher prices, while Australia mainly exports bauxite and alumina that have the lowest prices, the quantity of which is 25 times that of imported semis and finished products. This study suggests that resource-related trade inequalities are not uniform across economic and environmental impacts and that trade policies must be carefully considered from various dimensions.

The development and enhancement of occupational health services (OHS) at the national level is central to ensuring the sustainable health, well-being and work engagement of the working population. However, due to differences in national health, social security and occupational safety and health systems, the content, capacity, coverage and provisions of OHS vary considerably across national contexts. Obtaining a better understanding in terms of such similarities and variations internationally is essential as such comparative information can help inform evidenced-based decision-making on OHS at both policy and practice levels. This paper therefore reviews and analyses the key policies, standards and approaches in OH systems and services, using both academic and grey literature, across 12 industrialised countries (Australia, Canada, Finland, France, Germany, Ireland, Italy, Japan, The Netherlands, Poland, United Kingdom and the United States of America). It provides a detailed overview and categorization of OHS in these selected countries in terms of the legal and policy context, organisation and financing and coverage and staffing while specifically discussing variations aimed at psychosocial risk management and the promotion of mental health and well-being at work. It draws conclusions on key development needs of OHS internationally to ensure psychosocial risk management and mental health promotion are prioritised effectively in a preventive manner.

Background: Bacillus Calmette-Guérin (BCG) vaccine provides partial protection against Buruli ulcer caused by Mycobacterium ulcerans in epidemiological studies. This study aimed to quantify M. ulcerans-specific immune responses induced by BCG immunisation., Methods: Intracellular cytokine analysis of in-vitro experiments done 10 weeks after BCG immunisation in 130 Australian infants randomised to one of three BCG vaccine strains given either at birth (BCG-Denmark, BCG-Japan, or BCG-Russia) or at two months of age (BCG-Denmark)., Results: Proportions of polyfunctional CD4 + T-cells were higher in M. ulcerans-stimulated compared to unstimulated control samples. These proportions were not influenced by the vaccine strain or timing of the immunisation. The M. ulcerans-specific immune responses showed similar patterns to those observed in M. tuberculosis-stimulated samples, although they were of lower magnitude., Conclusions: Our data show that BCG immunisation induces M. ulcerans-specific immune responses in infants, likely explaining the cross-protective effect observed in epidemiological studies. (ACTRN12608000227392)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier Ltd.)

Aims: The use of mechanical restraint is a challenging area for psychiatry. Although mechanical restraint remains accepted as standard practice in some regions, there are ethical, legal and medical reasons to minimise or abolish its use. These concerns have intensified following the Convention on the Rights of Persons with Disabilities. Despite national policies to reduce use, the reporting of mechanical restraint has been poor, hampering a reasonable understanding of the epidemiology of restraint. This paper aims to develop a consistent measure of mechanical restraint and compare the measure within and across countries in the Pacific Rim., Methods: We used the publicly available data from four Pacific Rim countries (Australia, New Zealand, Japan and the United States) to compare and contrast the reported rates of mechanical restraint. Summary measures were computed so as to enable international comparisons. Variation within each jurisdiction was also analysed., Results: International rates of mechanical restraint in 2017 varied from 0.03 (New Zealand) to 98.9 (Japan) restraint events per million population per day, a variation greater than 3000-fold. Restraint in Australia (0.17 events per million) and the United States (0.37 events per million) fell between these two extremes. Variation as measured by restraint events per 1000 bed-days was less extreme but still substantial. Within all four countries there was also significant variation in restraint across districts. Variation across time did not show a steady reduction in restraint in any country during the period for which data were available (starting from 2003 at the earliest)., Conclusions: Policies to reduce or abolish mechanical restraint do not appear to be effecting change. It is improbable that the variation in restraint within the four examined Pacific Rim countries is accountable for by psychopathology. Greater efforts at reporting, monitoring and carrying out interventions to achieve the stated aim of reducing restraint are urgently needed.

It is important that scales that evaluate body image and related attitudes and behaviors are both reliable and valid to evaluate these constructs in different countries. This paper introduces a series of five papers that examine the measurement invariance of multiple scales for men and women across eight countries (Australia, Belgium, Canada, China, Italy, Japan, Spain, and the US). The papers examined measures of: sociocultural influences (i.e., appearance-related pressures) on strategies to lose weight/increase muscle; internalization of the thin/muscular ideal; body image; personality constructs; body change strategies to increase muscles and lose weight; and eating regulation. Measurement invariance was generally well-established across the eight countries. One or more items were removed in some scales for some countries to establish invariance. Factor loadings were equivalent across countries and refined scales demonstrated acceptable levels of reliability. The most frequent difference in the scales was in the item intercepts across groups, although most item intercepts were equivalent across groups. This series of papers makes an important contribution to the body image literature by demonstrating the validity of measures of body image, disordered eating, and sociocultural factors that can be used to better understand the relationship between these variables across different countries., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The Psychoneuroimmunology Research Society (PNIRS) created an official Chinese regional affiliate in 2012, designated PNIRS China . Now, just eight years later, the program has been so successful in advancing the science of psychoneuroimmunology that it has expanded to the whole of Asia-Oceania. In 2017, PNIRS China became PNIRS Asia-Pacific . Between 2012 and 2019, this outreach affiliate of PNIRS organized seven symposia at major scientific meetings in China as well as nine others in Taiwan, Japan, South Korea, Australia and New Zealand. This paper summarizes the remarkable growth of PNIRS Asia-Pacific . Here, regional experts who have been instrumental in organizing these PNIRS Asia-Pacific symposia briefly review and share their views about the past, present and future state of psychoneuroimmunology research in China, Taiwan, Australia and Japan. The newest initiative of PNIRS Asia-Pacific is connecting Asia-Pacific laboratories with those in Western countries through a simple web-based registration system. These efforts not only contribute to the efforts of PNIRS to serve a truly global scientific society but also to answer the imperative call of increasing diversity in our science., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Influenza C virus is a pathogen that causes acute respiratory illness in children and results in the hospitalization of infants. The antigenicity of the hemagglutinin esterase (HE) glycoprotein is highly stable, and it is not yet known whether antigenic changes contribute to the worldwide transmission and the occurrence of outbreaks of influenza C virus. Here, we performed antigenic analysis of 84 influenza C viruses isolated in Yamagata, Japan, during a 4-year period from 2015 to 2018 and analyzed sequence data for strains of the virus from Japan and many other parts of the world. Antigenic and phylogenetic analyses revealed that 83 strains belonged to the C/Sao Paulo lineage, and two sublineage strains, the Aichi99 sublineage and Victoria2012 sublineage, cocirculated between 2016 and 2018. Aichi99 sublineage strains exhibiting decreased reactivity with the monoclonal antibody YA3 became predominant after 2016, and these strains possessed the K190N mutation. Residue 190 is located in the 190-loop on the top side of the HE protein within a region that is known to show variation that does not impair the biological activity of the protein. The Aichi99 sublineage strains possessing the K190N mutation were detected after 2012 in Europe, Australia, the USA, and Asia as well as Japan. These observations suggest that antigenic variants with K190N mutations have circulated extensively around the world and caused outbreaks in Japan between 2016 and 2018. Our study indicated that the 190-loop is an important antigenic region, and the results suggested that changes in the 190-loop have contributed to the extensive transmission of the virus., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The following are the supplementary data related to this article. Supplementary data to this article can be found online at https://doi.org/10.1016/j.meegid.2020.104269., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: The purpose of this analysis was to compare the age-specific incidence rates (ASIRs) of breast cancer in Australia and Japan to determine the appropriateness of national screening target age groups., Methods: The paper is based on secondary sources of data. The ASIRs in 2006-2015 were collected from the Australian Institute of Health and Welfare (AIHW) and the National Cancer Center Japan. Descriptive analysis was performed for a comparison of ASIRs between Australia and Japan by age and over time. Percentage change, rolling average and risk ratio were calculated for further analysis., Results: In Australia, ASIRs rose sharply from age 40 years and peaked at 65-69 years. Japanese data demonstrated a considerable increase each year and two peaks were recorded, at ages 45-49 and 60-64. The ASIRs after age 65 decreased with age in Japan but increased with age in Australia. The ASIRs of women aged 40-49 was lowest among Australian women and the highest among Japanese women, while they had similar ASIRs in the direct comparative analysis., Conclusions: The screening age range of Australian and Japanese national breast cancer screening guidelines covers incidence peak ages in each country and therefore provides benefit for cancer screening. Our findings also indicated that further evidence is required to investigate the inclusion of Japanese migrant women in Australia aged 40-49 years into the screening target and the BCI rates of post-migrant women in Australia as different migrant groups have different ASIRs. This is to ensure that the groups of women with the highest cancer incidence are appropriately covered in screening programs., .

Background: Understanding the resilience of healthcare is critically important. A resilient healthcare system might be expected to consistently deliver high quality care, withstand disruptive events and continually adapt, learn and improve. However, there are many different theories, models and definitions of resilience and most are contested and debated in the literature. Clear and unambiguous conceptual definitions are important for both theoretical and practical considerations of any phenomenon, and resilience is no exception. A large international research programme on Resilience in Healthcare (RiH) is seeking to address these issues in a 5-year study across Norway, England, the Netherlands, Australia, Japan, and Switzerland (2018-2023). The aims of this debate paper are: 1) to identify and select core operational concepts of resilience from the literature in order to consider their contributions, implications, and boundaries for researching resilience in healthcare; and 2) to propose a working definition of healthcare resilience that underpins the international RiH research programme., Main Text: To fulfil these aims, first an overview of three core perspectives or metaphors that underpin theories of resilience are introduced from ecology, engineering and psychology. Second, we present a brief overview of key definitions and approaches to resilience applicable in healthcare. We position our research program with collaborative learning and user involvement as vital prerequisite pillars in our conceptualisation and operationalisation of resilience for maintaining quality of healthcare services. Third, our analysis addresses four core questions that studies of resilience in healthcare need to consider when defining and operationalising resilience. These are: resilience 'for what', 'to what', 'of what', and 'through what'? Finally, we present our operational definition of resilience., Conclusion: The RiH research program is exploring resilience as a multi-level phenomenon and considers adaptive capacity to change as a foundation for high quality care. We, therefore, define healthcare resilience as: the capacity to adapt to challenges and changes at different system levels, to maintain high quality care. This working definition of resilience is intended to be comprehensible and applicable regardless of the level of analysis or type of system component under investigation.

While direct to consumer health-related genetic testing (DTCGT) has potential to provide accessible genetic information and empower individuals to make informed healthcare decisions, it attracts concern associated with regulatory gaps, clinical utility and potential for harm. Understanding public reactions to DTCGT is vital to facilitate considered regulatory, health care and consumer protection strategies. Yet little is known, particularly outside the dominant US market, about how the general public view and might engage with DTCGT outside traditional health care systems. This paper addresses this knowledge gap with the first empirical study to investigate general public views across four countries, each at different stages of market development. US (n = 1000), UK (n = 1014), Japanese (n = 1018) and Australian (n = 1000) respondents completed an online experimental survey assessing comprehension, risk perceptions, and potential psychological and behavioural outcomes by type of test (disease pre-disposition and drug sensitivity), severity, lifestyle factors, and family history. Results showed generally low awareness and intention to purchase across countries, highest in the US and lowest in Japan. Results also showed clear preference for within-country purchases (less in Japan), with reports returned via doctors far more important in Japan. All respondents were more likely to act on test results, where there was higher genetic or lifestyle risk of developing a disease. Statistical comparisons of demographic and health-related variables across countries point to the need for further analyses designed to explain much needed cross-cultural, cross-health care system and developed versus developing market differences.

Data sources The following seven databases were searched: PubMed, EMBASE, DARE, NHSEED, HTA, Cost-Effectiveness Analysis Registry and Paediatric Economic Database Evaluation (PEDE).Study selection The review included trial and model-based economic evaluation studies and the participants included children aged from 0 to 12 years old who were healthy except for having dental caries. Studies of mixed populations of parents and children were included where the data for children were presented separately.The interventions included were:• Community-based oral-health education/training programs related to healthy oral habits.• Screening of children's teeth.• Supervised toothbrushing technique through the provision of toothbrushes, an appropriate amount of fluoride toothpaste, and topical fluoride.• Advice on dietary control, such as limitation of sugar or carbohydrates consumption, and enhanced fortified nutrition with an appropriate amount of calcium intake.• The comparators were situations where the populations were the same as the test group, but were receiving no intervention, or a dissimilar one .The interventions were oral-health promotion programs (OHPPs) implemented by oral-health professionals in the contexts of home visits, telephone calls, healthcare centres and primary schools.The outcome measures were reductions in the Decayed, Missing, Filled Teeth (DMFT) index for permanent teeth or (dmft) index for deciduous teeth among children and OHPP cost, incremental cost (difference between mean costs of intervention and mean costs of the comparator), and cost-effectiveness analysis (CEA).Data extraction and synthesis The title, abstract and full text of each study were screened. During the first phase screening of titles and abstracts, irrelevant records were removed. The exclusion criteria were: participant with health-related diseases or aged older than 12 years; interventions other than OHPP (such as implant dentistry or other invasive-dentistry programs); other economic-evaluation outcomes such as cost-benefit, cost-utility or cost-minimisation; authors' opinion (unoriginal records); reviews; and study language other than English. The second-phase screening assessed full texts of the articles using the same eligibility criteria. The risk of bias was assessed using the Drummond 10-item Checklist. Meta-analysis: The costs were converted to 2015 USA dollars. Data analysis was performed through dichotomous outcomes such as the number of children in the intervention and in the control group, the DMFT index in children, and the OHPP cost. Odds ratios (ORs), effect sizes with 95% confidence interval (CIs) and study weights were estimated from random effects analysis. Forest plots were constructed for each outcome, and chi-square tests used to assess homogeneity, where a p-value of less than 0.1 indicated statistically significant heterogeneity. An I2 test was used to quantify inconsistencies between studies as the percentage of variation across studies. Data synthesis was carried out using narrative demonstration, with a summary of the characteristics of each included study. For quantitative synthesis, a summary of the combined estimation related to the OHPP effect was measured. Three types of subgroup analysis were performed: by the age of the children (age under or equal to 6 years, and age 6-12 years), by publication year (studies published in the last five years, and earlier published studies) and by the country of the study. Egger's regression test and a funnel plot were used to assess and demonstrate publication bias. Publication bias was considered present if the p-value of the Egger test was more than 0.05.Results 19 full texts were included into qualitative synthesis and eight articles used in quantitative synthesis. Qualitative synthesis results: With regards to the country of origin, 32% of the studies were conducted in the United Kingdom (n = 6), 26% in Australia (n = 5), 16% in the United States (n = 3). There was also one study from each of the following countries Finland, Ireland, Japan, Nigeria and Singapore. Fifty-two percent (n = 10) were model-based economic evaluation studies and 47% (n = 9) were trial-based economic evaluations. The population of 14 studies were younger than six years of age, while in four studies the children were over the age of six years. In one paper the age of the children was not clearly stated. Just under a half of the papers (47%) were published in the last five years.The majority of the studies had a low risk of bias (n = 12, 63%) and seven (37%) had a moderate risk of bias. Various outcome measures were used in the included studies: DMFT, average number of dental visits, number of prevented caries teeth, average number of cavity-free months, probability of less cost, caries prevalence, number of specific OHPP visits, quality-adjusted life year, cost-effectiveness ratio, and percentages of not having debris.Quantitative synthesis results: The overall pooled impact of OHPPs showed that children with tooth decay had 81% lower odds of participating in OHPP (95% CI 61-90%, I2: 98.5%, p = 0) with considerable heterogeneity among studies. OHPPs were successful in reducing financial costs in 97 out of 100 OHPPs (95% CI 89-99%, I2: 99%, p = 0) with considerable heterogeneity among studies. The studies with participants under the age of six years old weighted 71% with an OR of 0.14 (95% CI, 0.05-0.39, I2: 99%). These children had the highest benefit of OHPPs to lower DMFT/S. The studies reporting children aged six years and over weighted 29% with an OR of 0.29 (95% CI, 0.08-1.01, I2: 99%), and these children had no benefit from OHPPs in lowering DMFT/S. Studies with under-six-year-old participants had an OR of 0.07 (95% CI, 0.02-0.32) revealing no cost-effectiveness effect to reduce OHPP incremental cost, whereas studies reporting children aged six years and older had an OR of 0.0 (95% CI, 0.00-48,704.6). The authors concluded that OHPPs involving the later (older) children were cost-effective in reducing the OHPPs' incremental cost.Conclusions A comprehensive analysis of the OHPPs confirmed that DMFT could be reduced, hence, lowering the financial burden of dental-care treatment. More effort is needed to manage the allocation of scarce resources, taking into account the economic impact of dental caries on healthcare systems. More studies on caries-prevention programmes among young children in high-, middle- and low-income countries are needed, in order to assess the clinical and financial effectiveness.

Vespa velutina nigrithorax is an invasive alien organism that has raised concerns in all beekeeping communities of invaded countries including the Republic of Korea, European countries and Japan. Known also as the yellow-legged hornet (or the 'Asian hornet'), it is native to northern India, eastern Nepal, Bhutan and the People's Republic of China. Given its climatic and biological characteristics and the effects of climate change, some coastal areas of North America, Argentina, South Africa, Australia and New Zealand are also susceptible to invasion. Vespa velutina nigrithorax notably affects managed honey-bee colonies by predation on foragers and causing a reduction in the collection of food resources. Being a generalist predator, the yellow-legged hornet also preys on other managed and wild pollinators, and therefore its impacts are not limited to the beekeeping sector but also represent a biodiversity concern. The purpose of this paper is to provide an assessment of V. v. nigrithorax against the four criteria established in Chapter 1.2. of the World Organisation for Animal Health (OIE) Terrestrial Animal Health Code for the inclusion of a disease, infection or infestation in the OIE list. The work was requested by the OIE Scientific Commission for Animal Diseases and presented to this Commission and to the OIE Terrestrial Animal Health Standards Commission in September 2017. Owing to the lack of effective measures to prevent its spread, the fact that its legal situation in some countries is under the mandate of environmental authorities rather than Veterinary Services, and because it is not considered a disease or parasite, V. v. nigrithorax is not currently being proposed for inclusion in the OIE list. At the end of the text, the statements from the two commissions are included and discussed.

Using the logarithmic mean divisia index decomposition methods within the multi-region input-output analytical framework, this paper investigates global energy-related sulfur oxides emissions transferring via trade, so as to reveal spatial characteristics of the pollutant emissions flows, and explores driving factors of the changes of sulfur dioxide emissions embodied in trade (SEET) for 39 major countries for the period 1995-2011. One important finding from this study is that the global SEET mainly flew from developing countries like China to highly developed economies like the U.S., the EU, and Japan. However, of particular concern is that for some countries like Canada and Australia with ample resources and wealthy regions, they had been gradually becoming the net sulfur dioxide emissions exporters in global trade since 1995. Another important finding is that economic development had played a significant role in promoting the global SEET growth, and the expanse of population scale had a slight and positive driving effect on increasing the sulfur oxides emissions embodied in trade for a large proportion of 39 countries, but some coping strategies like improving energy intensity, increasing the proportion of clean energy in the total energy consumption, and optimizing industrial structure could effectively lower the sulfur oxides emissions embodied in trade in a group of 39 countries., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Problem: Do conservative econometric models that comply with the Golden Rule of Forecasting provide more accurate forecasts?, Methods: To test the effects of forecast accuracy, we applied three evidence-based guidelines to 19 published regression models used for forecasting 154 elections in Australia, Canada, Italy, Japan, Netherlands, Portugal, Spain, Turkey, U.K., and the U.S. The guidelines direct forecasters using causal models to be conservative to account for uncertainty by (I) modifying effect estimates to reflect uncertainty either by damping coefficients towards no effect or equalizing coefficients, (II) combining forecasts from diverse models, and (III) incorporating more knowledge by including more variables with known important effects., Findings: Modifying the econometric models to make them more conservative reduced forecast errors compared to forecasts from the original models: (I) Damping coefficients by 10% reduced error by 2% on average, although further damping generally harmed accuracy; modifying coefficients by equalizing coefficients consistently reduced errors with average error reductions between 2% and 8% depending on the level of equalizing. Averaging the original regression model forecast with an equal-weights model forecast reduced error by 7%. (II) Combining forecasts from two Australian models and from eight U.S. models reduced error by 14% and 36%, respectively. (III) Using more knowledge by including all six unique variables from the Australian models and all 24 unique variables from the U.S. models in equal-weight "knowledge models" reduced error by 10% and 43%, respectively., Originality: This paper provides the first test of applying guidelines for conservative forecasting to established election forecasting models., Usefulness: Election forecasters can substantially improve the accuracy of forecasts from econometric models by following simple guidelines for conservative forecasting. Decision-makers can make better decisions when they are provided with models that are more realistic and forecasts that are more accurate., Competing Interests: The authors have declared that no competing interests exist.

Evidence supporting the practice of skin-to-skin contact and breastfeeding soon after birth points to physiologic, social, and psychological benefits for both mother and baby. The 2009 revision of Step 4 of the WHO/UNICEF "Ten Steps to Successful Breastfeeding" elaborated on the practice of skin-to-skin contact between the mother and her newly born baby indicating that the practice should be "immediate" and "without separation" unless documented medically justifiable reasons for delayed contact or interruption exist. While in immediate, continuous, uninterrupted skin-to-skin contact with mother in the first hour after birth, babies progress through 9 instinctive, complex, distinct, and observable stages including self-attachment and suckling. However, the most recent Cochrane review of early skin-to-skin contact cites inconsistencies in the practice; the authors found "inadequate evidence with respect to details … such as timing of initiation and dose." This paper introduces a novel algorithm to analyse the practice of skin to skin in the first hour using two data sets and suggests opportunities for practice improvement. The algorithm considers the mother's Robson criteria, skin-to-skin experience, and Widström's 9 Stages. Using data from vaginal births in Japan and caesarean births in Australia, the algorithm utilizes data in a new way to highlight challenges to best practice. The use of a tool to analyse the implementation of skin-to-skin care in the first hour after birth illuminates the successes, barriers, and opportunities for improvement to achieving the standard of care for babies. Future application should involve more diverse facilities and Robson's classifications., (© 2017 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.)

Background: Building or maintaining institutional trust is of central importance in democratic societies since negative experiences (potentially leading to mistrust) with government or other institutions may have a much more profound effect than positive experiences (potentially maintaining trust). Healthy democracy relies on more than simply trusting the national government of the time, and is mediated through other symbols of institutional power, such as the legal system, banks, the media and religious organisations. This paper focuses on institutional trust-the level and predictors of trust in some of the major institutions in society, namely politics, the media, banks, the legal system and religious organisations. We present analyses from a consolidated dataset containing data from six countries in the Asia Pacific region-Australia, Hong Kong, Japan, South Korea, Taiwan and Thailand., Methods: Cross-sectional surveys were undertaken in each country in 2009-10, with an overall sample of 6331. Analyses of differences in overall levels of institutional trust between countries were undertaken using Chi square analyses. Multivariate binomial logistic regression analysis was undertaken to identify socio-demographic predictors of trust in each country., Results: Religious institutions, banks and the judicial system had the highest overall trust across all countries (70%, 70% and 67% respectively), followed by newspapers and TV (59% and 58%) and then political leaders (43%). The range of levels of higher trust between countries differed from 43% for banks (range 49% in Australia to 92% in Thailand) to 59% for newspapers (28% in Australia to 87% in Japan). Across all countries, except for Australia, trust in political leaders had the lowest scores, particularly in Japan and South Korea (25% in both countries). In Thailand, people expressed the most trust in religious organisations (94%), banks (92%) and in their judicial/legal system (89%). In Hong Kong, people expressed the highest level of trust in their judicial/legal system (89%), followed by religious organisations (75%) and banks (77%). Australian respondents reported the least amount of trust in TV/media (24%) and press/newspapers (28%). South Korea put the least trust in their political leaders (25%), their legal system (43%) and religious organisations (45%). The key predictors of lower trust in institutions across all countries were males, people under 44 years and people unsatisfied with the health and standard of living., Conclusion: We interpreted our data using Fukuyama's theory of 'high/low trust' societies. The levels of institutional trust in each society did not conform to our hypothesis, with Thailand exhibiting the highest trust (predicted to be medium level), Hong Kong and Japan exhibiting medium trust (predicted to be low and high respectively) and Australia and South Korea exhibiting low trust (predicted to be high and medium respectively). Taiwan was the only country where the actual and predicted trust was the same, namely low trust. Given the fact that these predictors crossed national boundaries and institutional types, further research and policy should focus specifically on improving trust within these groups in order that they can be empowered to play a more central role in democratic vitality., Competing Interests: The authors have declared that no competing interests exist.

Background: The International Psychogeriatric Association (IPA) capacity taskforce was established to promote the autonomy, proper access to care, and dignity of persons with decision-making disabilities (DMDs) across nations. The Asia Consortium of the taskforce was established to pursue these goals in the Asia-Pacific region. This paper is part of the Asia Consortium's initiative to promote understanding and advocacy in regard to surrogate decision-making across the region., Method: The current guardianship laws are compared, and jurisdictional variations in the processes for proxy decision-making to support persons with DMDs and other health and social needs in China, Japan, Thailand, and Australia are explored., Results: The different Asia-Pacific countries have various proxy decision-making mechanisms in place for persons with DMDs, which are both formalized according to common law, civil law, and other legislation, and shaped by cultural practices. Various processes for guardianship and mechanisms for medical decision-making and asset management exist across the region. Processes that are still evolving across the region include those that facilitate advanced planning as a result of the paucity of legal structures for enduring powers of attorney (EPA) and guardianship in some regions, and the struggle to achieve consensual positions in regard to end-of-life decision-making. Formal processes for supporting decision-making are yet to be developed., Conclusions: The diverse legal approaches to guardianship and administration must be understood to meet the challenges of the rapidly ageing population in the Asia-Pacific region. Commonalities in the solutions and difficulties faced in encountering these challenges have global significance.

Background: Trust is regarded as a necessary component for the smooth running of society, although societal and political modernising processes have been linked to an increase in mistrust, potentially signalling social and economic problems. Fukuyama developed the notion of 'high trust' and 'low trust' societies, as a way of understanding trust within different societies. The purpose of this paper is to empirically test and extend Fukuyama's theory utilising data on interpersonal trust in Taiwan, Hong Kong, South Korea, Japan, Australia and Thailand. This paper focuses on trust in family, neighbours, strangers, foreigners and people with a different religion., Methods: Cross-sectional surveys were undertaken in 2009-10, with an overall sample of 6331. Analyses of differences in overall levels of trust between countries were undertaken using Chi square analyses. Multivariate binomial logistic regression analysis was undertaken to identify socio-demographic predictors of trust in each country., Results: Our data indicate a tripartite trust model: 'high trust' in Australia and Hong Kong; 'medium trust' in Japan and Taiwan; and 'low trust' in South Korea and Thailand. Trust in family and neighbours were very high across all countries, although trust in people with a different religion, trust in strangers and trust in foreigners varied considerably between countries. The regression models found a consistent group of subpopulations with low trust across the countries: people on low incomes, younger people and people with poor self-rated health. The results were conflicting for gender: females had lower trust in Thailand and Hong Kong, although in Australia, males had lower trust in strangers, whereas females had lower trust in foreigners., Conclusion: This paper identifies high, medium and low trust societies, in addition to high and low trusting population subgroups. Our analyses extend the seminal work of Fukuyama, providing both corroboration and refutation for his theory.

This paper presents a comparison of Japanese and Australian consumer sensory responses to beef, based on Meat Standards Australia methodology. Japanese and Australian consumers evaluated paired beef samples according to four sensory traits, and the weighted results were combined to produce a Meat Quality score (MQ4). The consumers also categorized the beef samples to one of four grades (unsatisfactory, good everyday, better than everyday and premium). The proportion of samples assigned to each grade was similar for Japanese and Australian consumers for yakiniku and shabu shabu cooking methods; however, Japanese consumers assigned lower scores to the grill samples. In terms of the MQ4 boundary scores between grades, these were very similar for both Japanese and Australian consumers across all cooking methods. In terms of the weightings for the four sensory traits, juiciness was more important for Japanese consumers than Australian for grill and shabu shabu cooking methods. Flavor had the highest weighting for both consumer groups. This study showed that a beef description system based on the MQ4 score, with some adjustments to the weightings and cut-off values, could be useful in describing the eating quality of beef for the Japanese consumer., (© 2013 Japanese Society of Animal Science.)

In the meat industry, correct labeling of beef origins or breed is required to assure quality and safety. This paper describes the development of discrimination markers between Japanese domestic and imported beef from the United States (US) and Australia (AUS) based on a bovine 50K single nucleotide polymorphism (SNP) array using a total of 110 samples: Japanese Black (n = 50), Japanese Holstein (n = 50) and US cattle (n = 10). Genotyping information revealed 1081 SNPs as candidate markers that were polymorphic only in US cattle. The genotyping results by PCR-restriction length polymorphism in Japanese Black (n = 300) and Holstein cattle (n = 146) revealed that 11 SNPs had alleles specific to US cattle. Their allelic frequencies in US cattle (n = 108) ranged from 0.097 to 0.250 with an average of 0.178 and the combined identification probability of US cattle was 0.987. In addition, we also verified the applicability of these US-specific markers to AUS cattle. Their allelic frequencies in AUS cattle (n = 280) ranged from 0.063 to 0.224 with an average of 0.137 and the combined identification probability of AUS cattle was 0.963. In conclusion, a set of these markers could be useful for discriminating between Japanese domestic and imported beef and would contribute to identify origins and prevent falsified labeling of beef., (© 2010 The Authors. Journal compilation © 2010 Japanese Society of Animal Science.)

Objective: The aim of this paper was to review the literature written by doctor-prisoners of the Japanese working on the Burma-Thai Railway with particular emphasis on the psychological and psychiatric conditions they encountered., Conclusions: The enormous respect and gratitude expressed by survivors for their medical attendants is an indication that in addition to performing extraordinary surgical and medical care in appalling conditions and with very limited available resources, these doctors also very adequately attended the clinical problems of demoralization, depression and acute delirium.

The primary role of the extensive and complex modern food legislation is to protect the consumer. Providing a framework for industry and enabling free trade are secondary aims. In the EU the 2006 Regulation on nutrition and health claims made on foods was adopted in December 2006. This Regulation defines detailed lists of permitted claims with precise conditions, requires foods making claims to meet specific nutrient profiles and requires the submission of a dossier for approval of new health claims. Nutrient profiles and an initial list of existing health claims will not be agreed until January 2009 and January 2010 respectively. The uncertainty about profiles and the initial list of claims as well as the prescriptive nature of the Regulation will have a major impact, some negative but some positive, on food innovation. Worldwide legislation on nutrition and health claims continues to develop. The current paper also provides an outline of some other key pieces of European legislation that affect food innovation. However, currently, all this legislation remains in development and up-to-date information can be sought from the reference material provided.

Japan's demography has changed dramatically, and with it, Japanese society and the circumstances of older people. These changes include shifts in family roles and functions, employment and social relations. Traditionally, families provided financial, physical and psychological support to their parents in the same household. While the proportion of older Japanese who live with adult children is still high in comparison to the rate in Western developed countries, patterns of care in Japan are gradually shifting towards the Western model. Public pensions supply financial support and the Long-Term Care Insurance System (LCIS) provides substantial physical care for frail older people. This paper focuses on current issues for older people in Japan, and provides a brief comparison with the situation in Australia. Japan's LCIS provides a simpler and more consistent basis for funding long-term care than Australia's system. On the other hand, Australia's pension system is comparatively robust.

This paper presents new evidence on availability, use, and prices of biopharmaceuticals in five major European Union (EU) markets, Canada, Australia, Japan, and Mexico, relative to the United States. Our data set from IMS Health includes all product sales in 2005. Per capita spending on biopharmaceuticals was at least twice as high in the United States as in the other countries. This difference reflects primarily greater availability and use of new, relatively high-price molecules and formulations. Prices for identical formulations are not higher on average in the United States. The broader price indexes, which do not control formulation, are also not higher in the United States, after adjusting for income.

Purpose: This paper summarizes the role of external advisors in oncology drug development and regulation from a global perspective., Design: Recently, representatives from the United States Food and Drug Administration, European Medicines Agency, the Japanese Pharmaceuticals and Medical Devices Agency, the Australian Therapeutic Goods Administration and Health Canada held a meeting in conjunction with the American Society of Clinical Oncology meeting. The role of external advisors in oncology drug development and regulation in each of these jurisdictions was presented and discussed., Results: All regulatory bodies described have experience with two forms of outside expertise: advice from individual experts and advice from a group of experts assembled as an advisory group. Regulatory jurisdictions use individual experts variably. In some regions, individual experts provide advice based on knowledge and experience during the drug development phase or in the planning phase for the submission of a drug registration package. In other regions, these individuals serve as external evaluators with the primary responsibility for the review of a clinical trials package submitted for drug registration. Advisory boards have been formalized in all jurisdictions discussed. Advisory boards have a role in discussing specific applications as well as broad policy issues. A common theme is a composition of a core panel of experts with augmentation by additional expertise as needed for consideration of specific scientific questions. In all jurisdictions, advisory board recommendations are not binding on the regulatory body., Conclusions: Global oncology drug development and registration involves the use of experts by regulatory authorities. The types of experts needed, the expert's role and the transparency of the advisory process reflect the individual needs in different regions.

The "International Co-operation on Harmonisation of Technical Requirements for Registration of Veterinary Medicinal Products (VICH)" is an international programme of co-operation between regulatory authorities and the animal health industries of the European Union, Japan and the United States of America which aims to harmonise the technical requirements for the registration of veterinary medicinal products. Australia and New Zealand participate as active observers. The objective of this second paper is to present additional guidelines established by the Working Group on anthelmintic guidelines: (1) efficacy of anthelmintics: specific recommendations for equine (VICH GL15), (2) efficacy of anthelmintics: specific recommendations for porcine (VICH GL16), (3) efficacy of anthelmintics: specific recommendations for canine (VICH GL19), (4) efficacy of anthelmintics: specific recommendations for feline (VICH GL20) and (5) efficacy of anthelmintics: specific recommendations for poultry (VICH GL21). These guidelines do not consist of rigid stipulations, but make clear recommendations on the minimal standards needed. To the veterinary profession, livestock producers and animal owners, harmonisation should mean quicker access to safer and more effective veterinary anthelmintics. In general, products should be relatively more affordable because of the reduction in registration costs and efficient use of resources by the regulatory authorities.

The "International Co-operation on Harmonisation of Technical Requirements for Registration of Veterinary Medicinal Products (VICH)" is an international programme of co-operation between regulatory authorities and the animal health industries of the European Union, Japan, and the United States of America which aims to harmonise the technical requirements for the registration of veterinary medicinal products. Australia and New Zealand participate as active observers. The objective of the present paper is to present the guidelines established by the working group on Anthelmintic Efficacy Guidelines: (1) efficacy of anthelmintics: general requirements (VICH GL7); (2) efficacy of anthelmintics: specific recommendations for bovines (VICH GL12); (3) efficacy of anthelmintics: specific recommendations for ovines (VICH GL13); (4) efficacy of anthelmintics: specific recommendations for caprines (VICH GL14). These guidelines do not consist of rigid stipulations, but make clear recommendations on the minimal standards needed. To the veterinary profession, livestock producers and animal owners, harmonisation should mean quicker access to safer and more effective veterinary anthelmintics. In general, products should be relatively more affordable because of the reduction in registration costs and efficient use of resources by the regulatory authorities.

A position paper on the subject of certified surgical specialists was published in 1966 under the direction of Professor Charles Wells of Liverpool, England. President John Terblanche of the International Federation of Surgical Colleges brought together leaders in surgical education from four nations (Australia, Japan, South Africa, United States) to update current "state-of-the art" views. Presentations were made at the 38th Congress of the International Society of Surgery, August 18, 1999 in Vienna, Austria. After careful review of the four presentations, it was clear that surgeons all over the world have made great improvements in the many facets of surgical education. Yet the advances remain spotty, with gaps noted when viewed from an international perspective.

In this paper, the determinants of growth of aggregate health expenditures are investigated. The study departs from previous literature in that it looks at differences across countries in growth (and not levels) of health care expenditures. Estimation is made for 24 OECD countries. Health system characteristics usually believed to influence health expenditures growth, like population ageing, the type of health system (public reimbursement, public contract or integrate) and existence of gatekeepers, are found to be non-significant. Nevertheless, there is evidence that health expenditures experienced a clear slower growth in the last decade. The explanation for this slowdown could not be found in the proposed model and should stimulate further research.

This paper reports on two studies exploring similarities and contrasts in knowledge, attitudes and opinions on fluorides and fluoridation of two culturally different population groups. The first study compares the attitudes and opinions of parents of primary (elementary) schoolchildren in Melbourne, Australia, and Yokohama, Japan, and the second study compares the attitudes and opinions of dentists drawn from the same geographic areas. A self-administered questionnaire collected data on 517 parents and 629 dentists. The questionnaires were of similar design and content for both parents and dentists. They included a series of knowledge and attitudinal statements on preventive dentistry and use of fluorides. Attitudinal responses were measured on a 5-point agree-disagree Likert scale. Data were analyzed using both bivariate and multivariate techniques. Australian parents appeared better informed on the benefits of water fluoridation and held more favorable opinions on fluorides and fluoridation than their Japanese counterparts. Similarly, Australian dentists held more positive attitudes toward the use of fluorides and fluoridation than their Japanese peers. Cultural norms and experiences appear to shape parental attitudes, whereas the focus of dental education and dental practice on restorative treatments in Japan appears to be a substantial influence on the attitudes and opinions held by Japanese dentists.

This paper presents an analysis of the main policy and organisational issues confronting dental health systems in Japan and Australia. Using the changes in the epidemiology of dental disease (the oral disease which still affects much of public dental health planning) as evidence of fundamental differences in the dental health systems of the two countries, the analysis seeks to illuminate, first, the structures and processes in both nations to review and implement changes to educational practices and workforce planning and, second, the constraints on each nation's capability to respond quickly and appropriately to the changing dental health needs. It is argued that Japan's ability to rapidly change its oral health outcomes, its dental educational system and its traditional workforce structure and service-mix, is more constrained than appears to be the case in the Australian dental system. The major barriers to Japan's ability to change appear to lie in both its traditional cultural decision-making processes and in a series of specific health and educational structures which place high reliance on a private educational system for health providers, a national insurance system which rewards treatment under a fee-for-service reimbursement scheme and the lack of a formal, transparent, infra-structure for planning health priorities. Barriers to Australia achieving culturally appropriate oral health outcomes for the next century appear more related to whether national unity in goal setting and implementation strategies can be achieved. The constraints in Australia are related to its federal system and to the low priority given to financing public dental services.

A vigorous effort has been undertaken to develop a robust and high speed network in the Asia-Pacific region which satisfies the needs of the scientific community. Consortium for Asia-Pacific Advanced Network (APAN) are established in some countries in this region. Our group, along with collaborators in Singapore and Australia, is moving towards the establishment of Asia-Pacific Bioinformatics Network (APBioNet) based on APAN. In this paper, we describe the concept of APBioNet and introduce the activities of DNA Data Bank of Japan (DDBJ) which will play an important role in APBioNet. Some salient features of APBioNet are also discussed.

Morphological variations of the deciduous dentition are as useful as those of the permanent dentition for determining the biological affinities of human populations. This paper provides material on morphological variations of deciduous teeth of the prehistoric Japanese population from the Late and the Latest Jomon Period (ca. 2000-ca. 300 B.C.). The expression of nonmetric traits of the deciduous teeth in the Jomon sample shows a closer affinity with modern Japanese and Native American samples than with American White, Asiatic Indian, and African samples. However, the frequency of shoveling in deciduous upper incisors in the Jomon sample is lower than those in modern Japanese and Native American samples. The Jomon sample also expresses a much higher frequency of cusp 6 in deciduous lower second molars than seen in modern Japanese, Ainu, and Native American samples. The frequency in the Jomon sample is equal to that in the Australian Aboriginal sample, which shows cusp 6 most frequently among the samples compared. A somewhat low incidence of incisor shoveling in the Jomon sample was also reported in the permanent dentition (Turner [1976] Science 193:911-913, [1979] Am. J. Phys. Anthropol. 51:619-635, [1987] Am. J. Phys. Anthropol. 73:305-321, [1990] Am. J. Phys. Anthropol. 82:295-317; T. Hanihara [1992] Am. J. Phys. Anthropol. 88:163-182, 88:183-196). However, the frequency of cusp 6 in the Jomon sample shows no significant difference from those of Northeast Asian or Native American samples in the permanent dentition (Turner [1987] Am. J. Phys. Anthropol. 73:305-321; T. Hanihara [1992] Am. J. Phys. Anthropol. 88:163-182, 88:183-196). Evidently, some nonmetric traits express an inter-group difference only in the deciduous dentition.

The number and scope of telemedicine projects and applications world-wide are growing rapidly along with exponential expansions in national and international information infrastructures and computer capabilities to support them. To track these rapid changes, the Center for Public Service Communications (CPSC) of Arlington, VA, developed the Telemedicine and Information Technologies in Health Care: Project Tracking Document for the National Aeronautics and Space Administration (NASA). This document is maintained by CPSC and frequently updated. It tracks the following areas in telemedicine and health care informatics: (1) major existing Federal grant and other assistance programs and activities; (2) legislation effecting policy in these areas; (3) projects using various technologies throughout the US; and (4) telemedicine projects/interests in other nations. This paper is a survey of international (global) telemedicine activities that are outlined in that document.

This paper is an empirical examination of the determinants of aggregate health care expenditure. The paper presents a systematic analysis of relationships across 19 OECD countries, showing the effects of aggregate income, institutional and socio-demographic factors on health care expenditure. The results indicate that institutional factors of the health systems, in addition to per capita Gross Domestic Product (GDP), contribute significantly to the explanation of the health care expenditure variation between countries; for example the way physicians in outpatient care are paid, and the mixture of public/private funding and inpatient/outpatient care.

In this paper, factors which have contributed to the high levels of workplace productivity in Japan are examined. On any number of productivity indicators, Japan outperforms Australia. A summary of the debate about whether Australia can learn from Japanese workplace productivity practices is presented. An analysis of what health care managers can learn from Japanese workplace productivity is conducted. Six Japanese-influenced measures are identified as having utility, or potential utility, for Australian health care. It is concluded that the adoption of some or all of these measures should be given careful consideration by health care managers.

Results of analysis of statistical data gathered and studied over a period from 1968-1989 have led to findings indicating that all cancers have a common cause. A relationship has been studied between the number of deaths due to all types of cancer and road accident deaths in time, by age, sex, and country. Road accident deaths in this paper are considered to be a measure of miles travelled for both males and females.

Transcultural research into psychopathology has often failed to produce a systematic body of findings concerning the relationship between culture and psychopathology. In this paper an attempt is made to overcome this problem by examining the relationship between culture and depression in terms of a theoretical task. Japanese and Australian depressed patients were given measures of depression and decision making. The relationship between specific variables associated with depression and those associated with decision making was investigated. Results showed that those depression variables which influenced decision making for Japanese patients were different to those for Australian patients. These findings are discussed in terms of their implications for psychiatric diagnosis and understanding the relationship between culture and depression.

This paper analyses health care expenditure in Sweden and compares this with the corresponding expenditure in OECD countries. The definition and measurement problems of health care expenditure are discussed, new figures for the development of health care expenditure are presented and different measures of health care expenditure are provided. We found that health care expenditure has increased by about 20% in constant prices for Sweden between 1980 and 1988, but that health care expenditure as a share of the GDP has dropped during the same period in current prices. Health care expenditure disaggregated on different age groups show for Sweden that in the age group 15-64 years, health care expenditure has not increased in constant prices between 1976 and 1985, but in the oldest age group, health care expenditure has increased considerable during this period. Health care expenditure in Sweden is as high as would be expected, taking into account the degree of economic development and the growth of expenditure during the 80s, and has followed that in comparable OECD countries. However, the relative price is lower, which means that the input of real resources are greater than in other countries.

Recently there has emerged a growing interest in transcultural aspects of depressive disorders. Unlike earlier studies, recent research has concentrated on using standardized assessment and evaluation procedures in an effort to reduce "differences" associated with research techniques. The following paper reports a study which, using the WHO developed Standardized Assessment of Depressive Disorders (WHO/SADD) schedule, examines the nature of depressive symptomatology in Australian and Japanese clinically depressed patients. While results supported the presence of a "symptom core" common to both cultures, some unexpected findings in relation to "feelings of guilt" and "severity of depression" were noted.

This paper describes a comparison between Japanese (N = 20) and Westerners (N = 20) in their respective frontal EMG levels and their ability to relax during one 5-minute biofeedback training session. The data indicated a significantly lower baseline muscle tension level in Japanese than in Westerners. After EMG biofeedback, however, no significant difference was found between the two groups. Japanese females showed significantly higher tension levels both during baseline and biofeedback phases than did japanese males.

This paper describes the dental provides in six study areas. The data were collected through interviews with samples of dentists who participated in the World Health Organization/US Public Health Service International Collaborative Study. Comparisons between dental providers in the different areas focus upon their personal characteristics, characteristics of their practices, their work patterns, the way they used their time, their professional activities and their satisfaction with dentistry. These descriptive data are related to consumer survey data obtained in another section of the International Collaborative Study.

This paper sets out to draw together the findings from the five individual studies and to draw tentative conclusions from them. It is pointed out that the comparisons made are between system factors and not between whole systems of oral health care. An attempt is made to evaluate the effectiveness of individual system features in the hope of being able to suggest ways in which those shown to be most beneficial might be incorporated into complete systems. In relation to caries experience, measured as DMF teeth, there is a wide variation, not only by each of the separate components to that total. In those studies where extensive school dental services exist, the F component accounts for almost all the score while in the other study groups it forms only about half the total, the proportion tending to be greater in the non-metropolitan than in metropolitan populations. In the same way treatment/need ratios and amounts of retreatment required show the benefits of the existence of the school dental service. The treatment/need ratio is then examined in relation to selected variables such as method of payment, utilization of auxiliaries, the existence of specified target groups etc. When the method of stepwise regression analysis is applied to the pooled samples utilization of services remains the most important predictor of treatment/need ratio. Others in order of importance are whether dental personnel decide on frequency of visits, whether the last visit was made for symptomatic reasons alone and whether lack of severity of symptoms had been a reason for avoiding oral health care. In relation to periodontal conditions no clear picture has emerged and this may demonstrate how systems of all types have failed to deal with this problem. Although much remains to be elaborated three main findings have already emerged from this study: (i) The need for reinforcement of preventive behaviour and services. (ii) The effectiveness of regulated contact between consumer and provider in meeting treatment needs. (iii) The need to concentrate on quality as well as volume of care in providing adequately for the needs of child and adolescent populations.