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Background: The adoption of Robotic Pancreaticoduodenectomy (RPD) is increasing globally. Meanwhile, reduced-port RPD (RPRPD) remains uncommon, requiring robot-specific techniques not possible with laparoscopy. We introduce a unique RPRPD technique optimizing surgical field exposure. Methods: Our RPRPD utilizes a single-site plus-two ports technique, facilitated by a single-port platform through a 5-cm incision. The configuration of robotic arms (arm1, arm2, arm3, and arm4) were strategically designed for optimal procedural efficiency, with the arms2 and arm3, alongside the assistant trocar, mounted on the single-port platform, while the arms1 and arm4 were positioned laterally across the abdomen. Drainage was established via channels created at the arm1 and arm4 insertion sites. A "gooseneck traction" was principally employed with the robotic instrument to prop up the specimen rather than grasp, improving the surgical field's visibility and access. Clinical outcomes of patients who underwent RPRPD performed between August 2020 and September 2023 by a single surgeon across two centers in Taiwan and Japan were reviewed. Results: Fifty patients underwent RPRPD using the single-site plus-two ports technique. The gooseneck traction technique enabled goodsurgical field deployment and allowed for unrestricted movement of robotic arms with no collisions with the assistant instruments. The median operative time was 351 min (250–488 min), including 271 min (219–422 min) of console time and three minutes (2–10 min) of docking time. The median estimated blood loss was 80 mL (1–872 mL). All RPRPD procedures were successfully performed without the need for conversion to open surgery. Postoperative major morbidity (i.e., Clavien-Dindo grade ≥ IIIa) was observed in 6 (12%) patients and median postoperative hospital stay was 13 days. Conclusions: The single-site plus-two ports RPRPD with the gooseneck traction proves to be a safe, feasible option, facilitating surgical field visibility and robotic arm maneuverability. [ABSTRACT FROM AUTHOR]

Background Symptom burdens tend to increase for patients with cancer and their families over the disease trajectory. There is still a lack of evidence on the associations between symptom changes and the quality of dying and death. In this context, this research investigated how symptom changes influence the quality of dying and death. Methods This international prospective cohort study (the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED), 2017-2019) included 22, 11, and 4 palliative care units across Japan, South Korea, and Taiwan. Eligible participants were adults (Japan and Korea, ≥18 years; Taiwan, ≥20 years) with locally advanced or metastatic cancer. Physical and psychological symptoms were assessed by physicians upon admission and within 3 days before death. Death quality was assessed using the Good Death Scale (GDS), developed in Taiwan. Univariate and multivariate regression analyses were used to identify correlations between symptom severity changes and GDS scores. Results Among 998 patients (542 [54.3%] men and 456 [45.7%] women; mean [SD] age = 70.1 [± 12.5] years), persistent dyspnea was associated with lower GDS scores when compared to stable dyspnea (β  = −0.427, 95% CI = −0.783 to −0.071). Worsened (−1.381, −1.932 to −0.831) and persistent (−1.680, −2.701 to −0.659) delirium were also significantly associated with lower GDS scores. Conclusions Better quality of dying and death was associated with improved symptom control, especially for dyspnea and delirium. Integrating an outcome measurement for the quality of dying and death is important in the management of symptoms across the disease trajectory in a goal-concordant manner. [ABSTRACT FROM AUTHOR]

The outbreak of COVID-19 in early 2020 created dangerous public health conditions which pressured governments and health systems to respond in a rapid and effective manner. However, this type of rapid response required many governments to bypass standing; bureaucratic structures of health sector administration and political governance to quickly take; essential measures against a rapidly evolving public health threat. Each government's particular; configuration of governmental and health system decision-making created specific structural and functional challenges to these necessary centrally developed and coordinated strategies. Most East Asian governments (except Japan) succeeded relatively quickly in centralizing essential disease control and treatment initiatives in a timely manner. In contrast, a number of European countries, especially those with predominantly tax-based financing and politically managed health delivery systems, had greater difficulty in escaping bureaucratic governance and management constraints. Drawing on data about these governments' early stage COVID-19 control experiences, this article suggests that structural changes will be necessary if low-performing governments are to better respond to a pandemic. This paper also summarizes other relatively successful strategies. By adopting such strategies, nations can help overcome structural bureaucratic and administrative obstacles in responding to further waves of COVID-19 or similar future pandemic events. [ABSTRACT FROM AUTHOR]

Injury is a major cause of morbidity and mortality in children. However, the epidemiology and prehospital care for pediatric unintentional injuries in Asia are still unclear. A total of 9,737 pediatric patients aged <18 years with unintentional injuries cared for at participating centers of the Pan-Asian Trauma Outcome Study (PATOS) from October 2015 to December 2020 were reviewed retrospectively. Patients were divided into two groups: those <8 and those ≥8 years of age. Variables such as patient demographics, injury epidemiology, Injury Severity Score (ISS), and prehospital care were collected. Injury severity and administered prehospital care stratified by gross national income were also analyzed. Pediatric unintentional injuries accounted for 9.4% of EMS-transported trauma cases in the participating Asian centers, and the mortality rate was 0.88%. The leading cause of injury was traffic injuries in older children aged ≥8 years (56.5%), while falls at home were common among young children aged <8 years (43.9%). Compared with younger children, older children with similar ISS tended to receive more prehospital interventions. Uneven disease severity was found in that older children in lower-middle and upper-middle-income countries had higher ISS compared with those in high-income countries. The performance of prehospital interventions also differed among countries with different gross national incomes. Immobilizations were the most performed prehospital intervention followed by oxygen administration, airway management, and pain control; only one patient received prehospital thoracentesis. Procedures were performed more frequently in high-income countries than in upper-middle-income and lower-middle-income countries. The major cause of injury was road traffic injuries in older children, while falls at home were common among young children. Prehospital care in pediatric unintentional injuries in Asian countries was not standardized and might be insufficient, and the economic status of countries may affect the implementation of prehospital care. [ABSTRACT FROM AUTHOR]

Background and purpose: Social engagement is an important active aging strategy to promote older adults' mental health. The purposes of this study were to compare social engagement in older populations around the world and explore associations with mental health outcomes. Materials and methods: An international cross‐sectional survey was conducted from 2017 to 2019. Data were retrieved from The International Social Survey Programme for a secondary data analysis across 30 countries. This study applied the Taxonomy of Social Activities and its six levels as operational definitions for a consistent concept of social engagement for international comparisons. Results: In total, 9403 older adults with a mean age of 72.85 ± 6.40 years responded. The highest levels of older adults' social engagement were found in Switzerland, Thailand, and New Zealand. Older adults of a higher age, with a lower educational level, who were permanently sick or disabled, who had no partner, who were widowed or whose civil partner had died, who lived alone, and who had lower self‐placement in society had significantly lower social engagement than did their counterparts. In the regression model, older adults' social engagement positively predicted general health, self‐accomplishment, and life satisfaction, but negatively predicted loneliness and depression. Conclusions: In aging societies worldwide, encouraging older adults' social engagement would be beneficial to promote mental health. Implications for nursing practice and health policies: Community professional nurses can develop strategies of social engagement based on the needs and sociodemographic factors of older adults to improve their mental health. Developing efficient strategies and local policies by learning from successful experiences in other countries is important to promote social engagement in aging societies. [ABSTRACT FROM AUTHOR]

Aim: The percentage of medicine graduates opting for residency in obstetrics and gynecology (OB/GYN) has been decreasing in developed countries, including in Taiwan, Japan, and Korea. This multicountry study surveyed the OB/GYN residents affiliated with the Taiwan Association of Obstetrics and Gynecology (TAOG), the Japanese Society of Obstetrics and Gynecology (JSOG), and the Korean Society of Obstetrics and Gynecology (KSOG) to evaluate the factors affecting the choice of pursing OB/GYN. Methods: A 17‐item questionnaire surveying the factors influencing the choice of pursuing a major medical specialty was translated into Japanese, Korean, and Chinese and administered to postgraduate OB/GYN residents between July 1, 2020, and August 31, 2020. Data on the participants' sex, age, and level of residency were collected. Responses were compared between countries and sexes. Results: Residents of all three countries chose OB/GYN based on personal interest, and a sense of accomplishment in saving people's life. Other positive factors include improved quality of life; higher salaries; and more opportunity for new techniques, research, and promotion. The negative factors included medical litigations, longer work hours, and unsafe working environments. Korean residents had lower ratings in several items, including "support from family," "safety of working environment," and "effectiveness of the alternative dispute resolution system," which, unlike Japan and Taiwan, is not a no‐fault compensation system for childbirth accidents. Conclusions: The study findings can guide strategy making, such as decreasing workload and yet maintain training quality, to increase the number of medical students pursuing OB/GYN residency. [ABSTRACT FROM AUTHOR]

The Paralympic Games is the largest sporting competition for athletes with an impairment. This competition has, however, had limited news coverage in the past particularly compared to the Olympic Games. This study analyzes newspaper coverage of the 2016 Paralympic Games by two newspapers in 11 countries (China, Iran, Japan, Malaysia, Oman, Saudi Arabia, Singapore, South Africa, South Korea, Taiwan, and the United Kingdom). The coverage period spanned 7-19 September 2016. Text and pictures were coded according to page number, content, gender, sport, and nationality of person. Media content analysis was used to extract coverage of themes. Results are presented using descriptive statistics and frequency counts. Of the 623 articles and 541 photographs analysed, a small percentage (7.3%) were on the front pages of newspapers. Most articles and photographs (78.7%) were about athletes or teams. There was more coverage of male athletes (53.2%) and local athletes (71.6%). The Paralympic Games has historically received less newspaper coverage than the Olympic Games. This study examined newspaper coverage of the 2016 Paralympic Games from 11 countries. For the 2016 Rio Paralympic Games, newspaper coverage in most countries was good, lasting nearly the whole duration, and this also included a number of front page reports. The type of coverage and number of reports differ between countries. Generally, the highest medal winning countries gave more media attention to the Games. The news reports focused primarily on their local athletes and teams. Moreover, males had more news coverage than females overall. [ABSTRACT FROM AUTHOR]

• Household is an important physical activity resource in older adults' daily life. • Older adults' HPA and SWB had a positive association. • Engaging in HPA is a good approach for increasing old adults' self-rated health. • HPA is recommended for old couples to maintain marital satisfaction. • Older adults living in China and South Korea had higher HPA than others. Engaging in lifelong physical activity has multiple health benefits for older populations. Household physical activity occupies older adults' awake time, and they can be an important energy expenditure during the day. The purpose of this study was to investigate the association between older adults' household physical activity and subjective well-being in four East Asian societies. The study design was a secondary data analysis. Data were retrieved from the module of Families 2016 in the database of the East Asian Social Survey. Participants were community-dwelling older adults with a mean age of 70.30±7.50 years and who lived in China, Japan, Korea, and Taiwan. Data were collected by interviews via structured questionnaires between 2016 and 2018. Descriptive analyses, independent t -tests, and an analysis of covariance were performed for the statistical analyses. In total, there were 3,432 valid responses. Participants who lived in Taiwan had significantly lower levels of total household physical activity than those living in other societies. Older adults' household physical activity was found to significantly differ by age, educational degree, gender, religion, marital status, occupation, and whether living alone. Older adults with high levels of household physical activity had significantly higher self-rated health and marital satisfaction than those with low levels. Household physical activity has potential benefits for subjective well-being across international older adult populations. Increasing household physical activity is recommended for older married couples to maintain marital satisfaction. [ABSTRACT FROM AUTHOR]

The equivalent reduction in greenhouse gas emissions (GHGEs) by Mahayana Buddhists with vegetarian diets is quantitatively evaluated. The Buddhists in seven Mahayana-dominated countries or regions, i.e., China, Japan, Vietnam, South Korea, Taiwan, Hong Kong, and Singapore, are studied. Assessments of the vegetarian population among these Mahayana-dominated countries or regions are performed. Correlation formulas based on data from a national survey are developed to quantify the GHGEs of various dietary groups by using the meat consumption as the only required input. To demonstrate its reliability, the prediction from the formulas developed is first compared with the results of a food production-and-consumption study using a different approach. Then, the formulas are used to assess the GHGE reduction due to Mahayana Buddhists with vegetarian diets. The assessment indicates that Mahayana Buddhists with vegetarian diets account for the equivalent GHGE reduction of 48.83 million metric tons of carbon dioxide equivalent, which is a huge amount and is equal to 11.3 or 8.9% of the GHGEs from France or the UK in 2012, respectively. [ABSTRACT FROM AUTHOR]

Introduction: High‐quality research is the foundation of occupational therapy and physical therapy/physiotherapy. A bibliometric study on the research productivity of occupational therapy and physical therapy/physiotherapy scholars in different Western and Asian countries/regions could provide a snapshot of current research achievement in rehabilitation science. Method: On the basis of an understanding of the leading role of rehabilitation research in Western countries and a recognition of achievements made by Asian occupational therapy and physical therapy/physiotherapy scholars, the current bibliometric study examined the research productivity of occupational therapy and physical therapy/physiotherapy professors and associate professors from four Western countries (Australia, Canada, the United States and the United Kingdom) and five Asian countries/regions (Hong Kong, Japan, Taiwan, Singapore and South Korea). The h‐indices of these scholars were retrieved online and aggregated to quantify the research productivity of institutions and countries/regions. Results: Australia, Canada, Hong Kong and the United States were identified as countries/regions with higher research productivity in occupational therapy and physical therapy/physiotherapy. The institutions were ranked on the basis of the median h‐indices of their professors and associate professors; the top 20 productive institutions with occupational therapy programmes had a median h‐index of 17.5 or higher, whereas the benchmark of the top 20 institutions with physical therapy/physiotherapy programmes was 25. Conclusion: Professors and associate professors in Australia, Canada, Hong Kong and the United States are productive in occupational therapy and physical therapy/physiotherapy research. The number of faculty members and university connections are regarded as important for research achievement. Recommendations for various levels of collaboration are provided. [ABSTRACT FROM AUTHOR]

• The escalating population of older adults and increasing life expectancy have brought attention to the critical issue of managing age-related chronic conditions and their associated polypharmacy and potentially inappropriate medications (PIMs). • Despite a slight decrease in the prevalence of polypharmacy and PIMs in Taiwan between 2014 and 2019, the rates remain significantly higher than those observed in Japan. • There is a call to improve the quality of pharmacotherapy and develop systematic approaches to ensure appropriate prescriptions for older populations. Polypharmacy and potentially inappropriate medications (PIM) are widely recognized as vital quality indicators of pharmacotherapy in older adults. As Taiwan and Japan grapple with the ongoing challenges of population aging, obtaining an accurate understanding of the prevalence of these indicators is crucial for developing effective strategies to optimize pharmacotherapy in older populations. The present study aims to comprehensively evaluate the prevalence of polypharmacy and PIMs in Taiwan and two Japanese cohorts, shedding light on the similarities and differences in prescribing practices across these populations. This study employed a cross-sectional design to investigate individuals aged ≥65 years in Taiwan, as well as two Japanese cohorts: Japan Cohort 1 (dispensing data from chain pharmacies; year 2014 and 2019) and Japan Cohort 2 (claims data; year 2017 and 2019). The prescription records of these participants were collected from the national claims database in Taiwan for the years 2014, 2017, and 2019. To identify polypharmacy and hyper-polypharmacy, the study defined the use of 5–9 and 10+ drugs, respectively. Furthermore, the study identified PIMs based on the STOPP-J criteria. Notably, the study further explored the most frequently used PIMs (by categories) in Taiwan. In the year 2019, the prevalence of polypharmacy exhibited similar rates in Taiwan (35.4%) and Japan Cohort 2 (33.1%), while surpassing that of Japan Cohort 1 (25.6%). Nonetheless, the incidence of PIMs in Taiwan was the highest (66.5%), exceeding those of the two Japanese cohorts (Cohort 1: 43.7% and Cohort 2: 40.2%) in the same year. Notably, the top three categories of commonly used PIMs in Taiwan comprised non-steroidal anti-inflammatory drugs (NSAIDs), antithrombotic drugs, and benzodiazepines. This study highlights the varying prevalence of polypharmacy and PIMs between Taiwan and Japan, but emphasizes the need for collaborative efforts towards optimizing pharmacotherapy in older adults. [ABSTRACT FROM AUTHOR]

Using the Global Trust Inventory, an integrated measure of trust toward 21 relationships and institutions, the structure of trust was explored in four East Asian societies (Mainland China, Japan, South Korea, and Taiwan). The Western model, in which trust is distributed among seven factors representing different branches of society, did not generalize to these East Asian societies, perhaps due to differences in culture and institutional power structures. Instead, two unique structures of trust were identified. Mainland China had a top ‐ down structure of trust (the China model), in which trust is hierarchically separated between the central government and subordinate implementing bodies. The other three democratic East Asian societies shared a hybrid structure of trust (the Democratic East Asian model) that has a degree of similarity to both the China model and the Western model. Having established two similar, but still distinct models, a cross ‐ cultural comparison was made on the proportions of trust profiles generated by latent profile analysis. Mainland China had the largest proportion of people with a high propensity to trust, followed by Japan and South Korea, and Taiwan was the least trusting. Implications of the structure of trust and this alternative approach to conducting cross ‐ cultural comparisons are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is growing evidence suggesting an association between air pollution and suicide. However, previous findings varied depending on the type of air pollutant and study location. OBJECTIVES: We examined the association between air pollutants and suicide in 10 large cities in South Korea, Japan, and Taiwan. METHODS: We used a two-stage meta-analysis. First, we conducted a time-stratified case-crossover analysis to estimate the short-term association between nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter [aerodynamic diameter =10 lm (PM10), aerodynamic diameter =2:5 lm (PM2:5), and PM10-2:5] and suicide, adjusted for weather factors, day-of-week, long-term time trends, and season. Then, we conducted a meta-analysis to combine the city-specific effect estimates for NO2, SO2, and PM10 across 10 cities and for PM2:5 and PM10-2:5 across 3 cities. We first fitted single-pollutant models, followed by two-pollutant models to examine the robustness of the associations. RESULTS: Higher risk of suicide was associated with higher levels of NO2, SO2, PM10, and PM10-2:5 over multiple days. The combined relative risks (RRs) were 1.019 for NO2 (95% confidence interval [CI]: 0.999, 1.039), 1.020 for SO2 (95% CI: 1.005, 1.036), 1.016 for PM10 (95% CI: 1.004, 1.029), and 1.019 for PM10-2:5 (95% CI: 1.005, 1.033) per interquartile range (IQR) increase in the 0-1 d average level of each pollutant. We found no evidence of an association for PM2:5. Some of the associations, particularly for SO2 and NO2, were attenuated after adjusting for a second pollutant. CONCLUSIONS: Our findings suggest that higher levels of air pollution may be associated with suicide, and further research is merited to understand the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Aim The aim of the study was to improve the measurement of ageing taking into account characteristics of populations and in particular changes in life expectancy. Method Using projected life tables, we calculated prospective old age dependency ratios ( POADRs) to 2060, placing the boundary to old age at a moving point with a fixed remaining life expectancy ( RLE) for all countries of East Asia. Results POADRs grow less rapidly than old age dependency ratios ( OADRs). For example, in the Republic of Korea, the OADR is forecast to increase from around 0.1 in 1980 to around 0.8 in 2060, while the POADR is forecast to increase from around 0.1 to 0.4 over the same period. Conclusion Policy makers may wish to take into account the fact that the increases in measures of ageing will be slower when those measures are adjusted for changes in life expectancy. [ABSTRACT FROM AUTHOR]

BACKGROUND: A limited number of studies suggest that ambient temperature contributes to suicide; these studies typically focus on a single nation and use temporally and spatially aggregated data. OBJECTIVE: We evaluated the association between ambient temperature and suicide in multiple cities in three East Asian countries. METHODS: A time-stratified case-crossover method was used to explore the relationship between temperature and suicide, adjusting for potential time-varying confounders and time-invariant individual characteristics. Sex- and age-specific associations of temperature with suicide were estimated, as were interactions between temperature and these variables. A random-effects meta-analysis was used to estimate country-specific pooled associations of temperature with suicide. RESULTS: An increase in temperature corresponding to half of the city-specific standard deviation was positively associated with suicide in most cities, although average suicide rates varied substantially. Pooled country-level effect estimates were 7.8% (95% CI: 5.0, 10.8%) for a 2.3°C increase in ambient temperature in Taiwan, 6.8% (95% CI: 5.4, 8.2%) for a 4.7°C increase in Korea, and 4.5% (95% CI: 3.3, 5.7%) for a 4.2°C increase in Japan. The association between temperature and suicide was significant even after adjusting for sunshine duration; the association between sunshine and suicide was not significant. The associations were greater among men than women in 12 of the 15 cities although not significantly so. There was little evidence of a consistent pattern of associations with age. In general, associations were strongest with temperature on the same day or the previous day, with little evidence of associations with temperature over longer lags (up to 5 days). CONCLUSIONS: We estimated consistent positive associations between suicide and elevated ambient temperature in three East Asian countries, regardless of country, sex, and age. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to investigate whether there were gender-specific depressive symptom profiles or gender-specific patterns of psychotropic agent usage in Asian patients with depression. Method: Clinical data from the Research on Asian Psychotropic Prescription Patterns for Antidepressant study (1171 depressed patients) were used to determine gender differences by analysis of covariates for continuous variables and by logistic regression analysis for discrete variables. In addition, a binary logistic regression model was fitted to identify independent clinical correlates of the gender-specific pattern on psychotropic drug usage. Results: Men were more likely than women to have loss of interest (adjusted odds ratio = 1.379, p = 0.009), fatigue (adjusted odds ratio = 1.298, p = 0.033) and concurrent substance abuse (adjusted odds ratio = 3.793, p = 0.008), but gender differences in other symptom profiles and clinical features were not significant. Men were also more likely than women to be prescribed adjunctive therapy with a second-generation antipsychotic (adjusted odds ratio = 1.320, p = 0.044). However, men were less likely than women to have suicidal thoughts/acts (adjusted odds ratio = 0.724, p = 0.028). Binary logistic regression models revealed that lower age (odds ratio = 0.986, p = 0.027) and current hospitalization (odds ratio = 3.348, p < 0.0001) were independent clinical correlates of use of second-generation antipsychotics as adjunctive therapy for treating depressed Asian men. Conclusion: Unique gender-specific symptom profiles and gender-specific patterns of psychotropic drug usage can be identified in Asian patients with depression. Hence, ethnic and cultural influences on the gender preponderance of depression should be considered in the clinical psychiatry of Asian patients. [ABSTRACT FROM AUTHOR]

Purpose: The objective of these studies was to evaluate the pharmacokinetic profile, safety, and tolerability of mirabegron, a β3-adrenoceptor agonist for the treatment of overactive bladder, including food effects (low- or high-fat meals) and sex, in healthy East Asian subjects. Methods: In total, 5 pharmacokinetic studies of mirabegron were conducted in healthy East Asian subjects. Food effects were assessed in 3 randomized, single-dose studies in young Japanese male subjects (study 1), male and female subjects (study 2), and young Taiwanese male and female subjects (study 3). In the other 2 single- and multiple-dose studies in young Chinese male and female subjects (study 4 and study 5), mirabegron was administered as a single dose under fasted conditions. After the washout period, mirabegron was administered once daily under fed conditions for 8 days. Pharmacokinetic parameters were determined using noncompartmental methods. Safety and tolerability assessments included physical examinations, vital signs, 12-lead ECG, clinical laboratory tests (biochemistry, hematology, and urinaly-sis), and adverse event monitoring. Findings: After administration of single oral doses of mirabegron, exposure under fed conditions was lower than under fasted conditions in Japanese and Taiwanese subjects. In Japanese subjects, a greater reduction in mirabegron Cmax and AUC0-∞ was observed after a low-fat meal compared with a high-fat meal. In Chinese subjects, Cmax was reached at approximately 4.0 hours after single oral doses. Mirabegron accumulated 2- to 3-fold on once-daily dosing of multiple-dose relative to single-dose data. Steady state was reached within 7 days. After administration of mirabegron, mean values for Cmax and AUC in female subjects were higher than those in male subjects. Mirabegron was well tolerated in Japanese, Taiwanese, and Chinese subjects. Implications: Our studies confirm the higher exposure levels of mirabegron in female compared with male East Asian subjects as found earlier in Western subjects. Furthermore, the effects of food on the pharmacokinetic profiles appeared to be similar among the 3 populations tested in our studies. The findings suggest that there are no significant pharmacokinetic differences among the Japanese, Taiwanese, and Chinese populations. [ABSTRACT FROM AUTHOR]

Objective.The aims of this study were to (1) assess physical activity and weight status differences and (2) explore the direction and shape of subjective social status (SSS) association with physical activity and weight status within four Asian countries. Methods. Cross section data of adult respondents fromthe nationally representative East Asian Social Survey were used for analyses. Logistic regression stratified by gender was conducted for the first aim, and simple and quadratic logistic regression models were used for the second. Results. SSS was significantly associated with odds of weekly or daily physical activity across all countries and genders, except for South Korean and Japanese females. Quadratic models provided significantly better fit for Chinese males (LR (d.f. = 1) = 6.51, P value < .05) and females (LR (d.f. = 1) = 7.36, P value < .01), South Korean males (LR (d.f. = 1) = 4.40, P value < .05), and Taiwanese females (LR (d.f. = 1) = 4.87, P value < .05). Conclusions.This study provides a comparable cross Asian country measure of moderate-to-vigorous physical activity and new findings that a connection exists between SSS and physical activity. Differences of class distinction help explain the different shaped SSS relationships. [ABSTRACT FROM AUTHOR]

Background: Total or red meat intake has been shown to be associated with a higher risk of mortality in Western populations, but little is known of the risks in Asian populations. Objective: We examined temporal trends in meat consumption and associations between meat intake and all-cause and cause-specific mortality in Asia. Design: We used ecological data from the United Nations to compare country-specific meat consumption. Separately, 8 Asian prospective cohort studies in Bangladesh, China, Japan, Korea, and Taiwan consisting of 112,310 men and 184,411 women were followed for 6.6 to 15.6 y with 24,283 all-cause, 9558 cancer, and 6373 cardiovascular disease (CVD) deaths. We estimated the study-specific HRs and 95% CIs by using a Cox regression model and pooled them by using a random-effects model. Results: Red meat consumption was substantially lower in the Asian countries than in the United States. Fish and seafood consumption was higher in Japan and Korea than in the United States. Our pooled analysis found no association between intake of total meat (red meat, poultry, and fish/seafood) and risks of all-cause, CVD, or cancer mortality among men and women; HRs (95% CIs) for all-cause mortality from a comparison of the highest with the lowest quartile were 1.02 (0.91, 1.15) in men and 0.93 (0.86, 1.01) in women. Conclusions: Ecological data indicate an increase in meat intake in Asian countries; however, our pooled analysis did not provide evidence of a higher risk of mortality for total meat intake and provided evidence of an inverse association with red meat, poultry, and fish/seafood. Red meat intake was inversely associated with CVD mortality in men and with cancer mortality in women in Asian countries. [ABSTRACT FROM AUTHOR]

Knowledge about aging and the attitudes toward older people were surveyed in undergraduate students (total number of subjects sampled is 1402) in four countries (Japan, China, Taiwan, and Vietnam) in eastern cultures and in two countries (United States and United Kingdom) in western cultures. All participants completed two questionnaires, FAQ1 (for knowledge) and ASD (for attitudes) in their own languages. It was found that within the undergraduate students sampled: (a) the level of knowledge about aging in the western countries is significantly higher than that in the eastern countries, and (b) attitudes toward aging are more positive in the western countries compared to the eastern countries. The data suggest that, within the limits of the sampling: (a) the tradition of respecting older adults in eastern cultures may have weakened gradually, and (b) the modernization theory that assumes industrialization devalues aging populations appears to be supported in eastern countries but not in western countries. An alternative non-linear theory is discussed for the relationship between modernization and the societal views on aging. Educational promotion of knowledge about aging is emphasized for the formation of positive attitudes toward older adults. [ABSTRACT FROM AUTHOR]

Abstract: The connection between divorce and suicide risk in Asia is unclear. To understand the contribution of cultural transitions to suicide among the divorced, we compare age- and sex-specific suicide rates among divorced men and women from five Pacific Rim populations: Hong Kong, Taiwan, Japan, South Korea and the state of Victoria in Australia. On a cultural spectrum, we consider Hong Kong and Taiwan to lie between the more individualistic Australian culture and the more collectivistic Japanese and Korean cultures. Coefficients of aggravation (COA) are also compared. Suicide rates were found to be higher among the divorced than among other marital status groups in all five populations, but this difference was small in Victoria. The effect of divorce was significantly greater for men than for women only in Japan and South Korea. In the other populations, divorced men and women were at equal risk. Age trends in suicide rates for the divorced groups differed across populations. The COAs for the divorced group aged 40 or younger in the East Asian populations were higher than the COAs for older divorced groups, though this was not the case in the Victorian population. Suicide patterns among the divorced in the East Asian populations can be understood in terms of the legacy of Confucian traditions. Gender differences in Japan and South Korea may reflect either gender inequality (male dominance in formal interactions and emotional dependence in domestic life within a deteriorating Confucian family support system) or unique socio-cultural factors among married women. Divorced East Asian groups aged 40 or younger may be at a higher risk of suicide due to individual-level cultural ambivalence combined with a desire for systemic-level emotional interdependence. Social welfare regimes in the four East Asian populations need to fill the vacancy left by retreating traditional family systems. Research implications are discussed. [Copyright &y& Elsevier]

• Older adults generally do not report ADL limitation until 77 years old, and mobility limitation occurs at a various age in Taiwan and Japan. • Older adults generally do not face serious disability until 85 or 86 years old in Taiwan or Japan, respectively. • The speed of disability with age for older adults Taiwan was faster than Japan in ADL and IADL limitation, but not in mobility. Disability development using age as the axis was void in the literature. Identification of the age trajectory of disability development across populations enables preparation for aging-related policies when conducting cross-national comparisons. This study compared three indicators of the development of physical disability in populations of Taiwan and Japan. Data comprised two nationally representative panel surveys (1) the Taiwan Longitudinal Study on Aging (N = 3,037) in 1996–2011 and (2) the National Survey of the Japanese Elderly in 1996–2012 (N = 1,974). Older adults (65+) were examined longitudinally. Activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility disability development during aging were analyzed using multilevel models. After age standardization, Japan reported higher prevalence rate of ADL disability (14.95% vs. 9.65%) but lower IADL (19.30% vs. 30.36%) and mobility disability (36.07% vs. 49.82%) as compared with Taiwan. ADL limitation occur (ADL limitation>=1) at the age of 77.9 and 77.2 for populations in Japan and Taiwan, respectively. Populations reached three ADL limitations at the age of 86.7 and 85.0 in Japan and in Taiwan, respectively. IADL limitation occur (IADL limitation>=1) at the age of 79.1 and 74.5 for populations in Japan and Taiwan, respectively. Mobility limitation occur (Mobility limitation>=1) at the age of 70.7 and 65.3 for populations in Japan and Taiwan, respectively. Older adults generally do not report ADL limitation until 77 and do not face serious disability until 85 or 86 in Taiwan or Japan, respectively. Mobility limitation occurs at a various age in different countries. [ABSTRACT FROM AUTHOR]

• Nested pattern of latent bullying victimization profiles emerges across six regions. • Latent profile analysis identifies similarities in victimization experiences by region. • The more severe victimization experience, the lower sense of school belonging. • Buffering effect of parental interest acts only in the Taiwanese subsample. Bullying victimization has a negative relationship with adolescents' sense of school belonging, which is an important contributor to their adaptive development. Based on the ecological systems perspective—which suggests that multiple systems in adolescence including the family and school are interconnected—experiences at home are linked with experiences at school. Thus the current study examined the relationship among bullying victimization, sense of school belonging, and parental support. Self-reported data of students from five Northeast Asian regions (Beijing-Shanghai-Jiangsu-Guangdong China, Hong Kong, Japan, South Korea, Taiwan) and the United States from the 2015 Programme for International Student Assessment, an international cross-sectional survey, was used. First, latent profile analysis was conducted to identify subgroups of adolescents who differ in their experiences of bullying victimization. Second, multivariate regression analysis was used to examine the association between victimization profiles and sense of school belonging, and to investigate the moderating role of parental support in this relationship. There were more similarities in subgroups of victimization than differences across the six regions. The association between latent risk profiles and sense of school belonging varied across the different regions. The buffering effect of parental support on the relationship between victimization profiles and sense of school belonging was supported only by the data from Taiwanese adolescents. Despite regional similarities and differences, a common finding emerged: membership to any subgroup of victimization lowered adolescents' sense of school belonging, when compared to membership to the very low group. Implications for intervention design for victimized adolescents are discussed. [ABSTRACT FROM AUTHOR]

Question In patients with intracerebral hemorrhage and systolic blood pressure (SBP) ≥ 180 mm Hg, does intensive lowering of SBP to < 140 mm Hg, beginning within 4.5 hours of symptom onset, reduce death or disability more than standard SBP lowering? Methods Design Randomized controlled trial (Antihypertensive Treatment of Acute Cerebral Hemorrhage II [ATACH-2] trial). ClinicalTrials.gov NCT01176565. Allocation Concealed.* Blinding Blinded* (adjudicators of safety outcomes). Follow-up period 3 months. Setting 110 clinical centers in the USA, Japan, China, Taiwan, South Korea, and Germany. Patients 1000 adults ≥ 18 years of age (mean age 62 y, 62% men) who had spontaneous supratentorial intracerebral hemorrhage (ICH), ≥ 1 SBP reading ≥ 180 mm Hg (mean 200.6 mm Hg), and Glasgow Coma Scale scores ≥ 5 on emergency department arrival. Exclusion criteria included inability to initiate treatment with 4.5 hours of symptom onset, intraparenchymal hematoma ≥ 60 cm3 on initial computed tomograpy, or reduction of SBP to < 140 mm Hg before randomization. Intervention Lowering and maintenance of hourly minimum SBP to 110 to 139 mm Hg (intensive) (n = 500) or to 140 to 179 mm Hg (standard) (n = 500) for 24 hours after randomization. To achieve SBP targets, IV nicardipine was initially used, followed by other treatments as needed. Outcomes Death or moderately severe or severe disability (modified Rankin Scale [mRS] score 4 to 6) at 3 months. Secondary outcomes included serious adverse events at 3 months, hematoma expansion ≥ 33% at 24 hours, and neurologic deterioration at 24 hours. 1042 patients were needed to detect a 10% absolute reduction in the primary outcome, assuming a 60% event rate in the standard group (90% power, 2-sided α = 0.05). Patient follow-up 96% for primary outcome (intention-to-treat analysis). Main results Enrollment was stopped for futility. 88% of the intensive-lowering group and 99% of the standard-lowering group achieved the target SBP within 2 hours of randomization (P < 0.001). The main results are in the Table. Conclusion In patients with intracerebral hemorrhage and systolic blood pressure (SBP) ≥ 180 mm Hg, intensive lowering of SBP levels to < 140 mm Hg did not reduce death or disability more than standard lowering. [ABSTRACT FROM AUTHOR]