Introduction  The purpose of this study was to identify risk factors related to the mental health of technical intern trainees from the Philippines in Japan, which focus on the relationship between their acculturation strategies and mental health.Method  Mental health, acculturation strategies, acculturative stress, job stress, social support and demographic factors including Japanese language proficiency were used for the variables in the English version of self-administered questionnaire. A total of 180 (115 men, 47 women and 16 gender unreported) Filipino technical intern trainees participated in this study. The data of 132 (95 men, 37 women) participants who completely answered the questionnaires were analyzed.Results  Results showed that gender, marital status, existence of children, Japanese language proficiency, acculturation strategies and acculturative stress were significantly related to the mental health of Filipino technical intern trainees. Results also showed that social support was significantly related to Japanese language proficiency and acculturation strategies for acquisition of Japanese culture. Conclusions  Findings suggest that factors contributing to the worsening of mental health of Filipino technical intern trainees are (a) being male, (b) existence of a child/children, (c) single marital status, (d) low Japanese language proficiency, (e) low acquisition of Japanese culture, and (f) high acculturative stress. Findings also suggest low levels of social support are risk factors related to low Japanese language proficiency and low acquisition of Japanese culture. Support programs for improvement in Japanese language skill and familiarizing with Japanese culture may be an effective way to maintain positive mental health in Filipino technical intern trainees. In addition, an establishment of environment to be able to easily and adequately receive psychological support from their family members living in the Philippines may be important to their mental well-being.

Objective  Donor countries either suspended or restricted development aid for Myanmar during the period of the military regime. However, the democratic movement, which began in 2011, gradually resolved this situation. The government of Myanmar organized a “Myanmar Development Cooperation Forum” in 2013, where the government demonstrated a path for the country’s future development to development partners, including donor countries, international organizations, and international funds. Furthermore, the government has increased the budget for the health sector and upheld universal health coverage (UHC), a target of Social Development Goals, as a goal for the future. To achieve that goal, the “National Health Plan 2017-2021” was recently formulated. This research attempts to identify issues that need to be considered by development partners in this changing environment.Methods  The research was conducted through field studies and literature reviews to investigate the movements of both the government of Myanmar and development partners. It identified issues that need to be considered to achieve UHC, as well as those that development partners should consider when providing aid.Results and conclusion  During the era of the Millennium Development Goals, development partners tended to focus their development aid on maternal and child health, control of specific diseases, and strengthening health services for those specific health problems. However, in order to extend health and medical services to all people, without financial risks on the part of patients under the goal of UHC, it is necessary for the government to formulate and execute comprehensive health policies based on an analysis of Myanmar’s health and medical problems. Aligning with this change, development partners need to concretize their support in response to Myanmar’s health policy issues.

Purpose  This study aimed to explore the health behaviors and identify its related factors in international university students in Japan.Methods  A self-administered questionnaire was used, targeting 274 international students enrolled at one Japanese university. It included demographic information on financial status, social support, behaviors toward health promotion and healthcare seeking, and health literacy (HLS-EU-Q16). Those who consulted a doctor or had such intentions for diseases or injury were defined as a group characterized by healthcare seeking action. Data were analyzed using descriptive statistics and bivariate analysis.Results  Of the 274 students, 70 (25.5%) responded to the questionnaires. Almost half of them were Chinese (44.3%), had been staying in Japan for more than a year but less than five years (54.3%) and had concerns about financial issues (50.0%). With reference to the number of Japanese friends they could consult, 44.3% had fewer than five. The latter was significantly associated with health promoting behaviors (p = 0.026). Further, duration of stay in Japan was significantly associated with health care seeking behaviors (p = 0.034). Financial status and health literacy were not significantly associated with either behavior.Conclusions  Numbers of Japanese friends and duration of their stay may contribute to improve the health behaviors of international students in Japan. However, regardless of language ability, the health literacy of international students may not be utilized well enough in the host country. Providing more opportunities to international students to socialize with Japanese peers and to learn about Japanese health care systems earlier on their arrival could be highly beneficial to improve their health behaviors.

Background  The number of foreign tourists visiting Japan has increased to about 30 million people per year. 1.5% of them were injured or became sick during their travelin Japan and had to undergo medical treatment. Among the foreign tourists, 27% were not covered by travel health insurance.Case  A 40-year-old man from Southeast Asia who was visiting his relative in Japan experienced sudden hemiparesis and was diagnosed with cerebral infarction. During the initial treatment, it was found that the patient did not have health insurance and the relatives could not afford to pay the treatment costs. No other source of financial support was available to him During our consultations with the patient and his relatives about the medical treatment including medical expenses, he continued to be treated as an outpatient and it was aimed at an early return to his home country.Discussion  Foreigners, who are not covered under travel health insurance, could fall ill or sustain an injury during their stay in Japan. Appropriate medical care should be provided regardless of their ability to pay. However, a situation that could lead them to incur huge medical expenses from availing medical care should be avoided. For medical consultations of non-insured foreigners, it is better to consult the available systems and pay attention about feasible medical expenses. There is a need for a long-term vision of medical care to make a smooth transition from medical treatment in Japan to treatment in their home country.Conclusion  Although medical institutions can offer only a limited response, it is necessary to accumulate case examples from across the nation and prepare specific countermeasures and counselors.

Objective  Preterm birth is the major cause for neonatal deaths in low and middle income countries. The aim of this report is to evaluate the proportions of deaths of moderate to late preterm infants born at 32 to 36 weeks of gestations as well as the neonates with low birth weights weighing from 1500g to 2499g among the total neonatal deaths and analyze their causes of deaths in Lempira province, the Republic of Honduras. Study design  A secondary analysis based on the data sets from the regional office of Ministry of Health.Methods  We obtained data sets on infant mortality from January 2015 to June 2017 compiled by a regional office of Ministry of Health in Lempira province. We then calculated proportions of each cause of death in the groups of newborn infants stratified by gestational weeks and birth weights.Results  During the study period, a total of 253 neonatal deaths were recorded, comprising 66.9% of the total infant deaths (n=378). The number of the newborn infants who died during early neonatal period was 201 (79.4%). The number of preterm newborn infants who died during neonatal period was 146 (57.7%) and 70 (27.6%) were born at moderate to late preterm periods. 103 (40.7%) were born with their birth-weights below 2500g, and the number of those weighing from 1500g to 2499g were 61 (24.1%). The leading cause of deaths of moderate to late preterm infants was hyaline membrane disease (n=25/48: 52.1%), as was the case with low birth weight infants weighing from 1500g to 2499g. Conclusion  It was shown that approximately one fourths of neonatal deaths occurred in moderate to late preterm infants in Lempira province during the study period. Approximately half of these preterm infants died of hyaline membrane disease, who could have been saved with simple and low-cost equipment such as bubble continuous positive airway pressure.

  The way of Public Private Partnerships in development including Global Health has been changing dramatically. Japan is also making efforts to promote Public-Private Partnership to promote the Japanese medical technology and services globally. Since the program schemes are varied, we collect the information mainly through WEB at July 2017 to compare the features of each program and policy. We made a list of programs conducted by Ministries and responsible organizations. The programs are categorized in two directions, inbound which means inviting foreign patients to Japan for treatment, and outbound which means exporting Japanese medical devices, medicines, system, and services. Those are also categorized in two groups by objective and content, support for establishing foundation/core facilities, and support for the system and human-resource development. We created the correlation diagram based on these categorizations to show the relationship between each scheme/program. Programs undertaken by different agencies such as the Cabinet Secretariat, Ministry of Economy, Trade and Industry, Ministry of Health, Labor and Welfare, Ministry of Foreign Affairs, Japan International Cooperation Agency seems comprehensive and exhaustive. Therefore, we can expect a bigger impact if the appropriate support through those programs were provided in right time, especially for the outbound support. There is a need for developing overarching strategy among each program to the target country based on the needs assessment, local adaptability of the technology and services. From the fact that it has become clear that issues related to developing private funds for development by public funds as priming water such as the motivation for investment behavior and the different results are different in the public and private sectors, it is necessary to clarify the guidelines in Japan in order to strengthen such Public-Private Partnership.

Objective  In Japan, the low pass rate of Economic Partnership Agreements (EPA) foreign nurse candidates in the National Nursing Examination is a serious issue because it suggests differences in nursing practice between the countries. This study aimed to reveal the discrepancy in nursing practice between Indonesian and Japanese nurses.Methods   Questionnaires were sent to 9 hospitals to collect data from Indonesian and Japanese nurses working together. It included the “Self-evaluation Scale on Oriented Problem Solving Behavior in Nursing Practice” to measure the quality of problem-solving behaviors.Results  Participants were 17 Indonesian (8 males, 9 females; average age: 30.6 years) and 50 Japanese nurses. Of them, 9 Indonesian nurses had not passed the National Nursing Exam. No remarkable difference was observed between the Indonesian and Japanese nurses on any of the sub-scales of the problem-solving scale. However, after matching the groups with nursing experience years (by selecting Japanese nurses with an experience of less than 10 years, n＝22), a notable difference was observed in “Securing consent from the patient for providing nursing care,” with Indonesian nurses who had not yet passed the National Nursing Exam scoring significantly lower than Japanese nurses (p＝0.01 for the Wilcoxon test with Bonferroni correction). While Japanese nurses assist patients with activities of daily living, the patient’s family is mainly responsible for such care in Indonesia. Therefore, Indonesian nurses do not fully acknowledge their need to secure consent in providing daily life assistance to patients.Conclusion   Indonesian nurses who had not passed the National Nursing Exam scored significantly lower on “Securing consent from the patient for providing nursing care.” Therefore, it is recommended to provide them education to enable them to recognize the importance of practicing nursing based on nursing plans that consider patients’ needs.

  Health service provision is one of the components in Universal Health Coverage (UHC). Medicines are vital for health services, and they should be affordable and accessible for safe and appropriate usage for everyone.  This article is a report on the symposium “Medicines for UHC,” held in the academic meeting of the Japanese Association of International Health in December 2017.  In Lao PDR, a study was conducted in urban and rural hospitals examining lists of available medicines, as well as their usage, distribution, and prices. The study showed that neurological medicines including anesthetics made up 29% of all medicines used in the urban central hospital, as it was one of the few hospitals that provided complex surgeries in Laos, resulting in a high concentration of patients. Anti-tuberculosis, ARV, and anti-Malaria medicines, as well as vaccines, were provided by Global Fund, GAVI, and other organizations, so that their costs were not included in the hospital’s procurement lists. While anti-microbial medicines only accounted for 13% of the medicines used at the urban central hospital, they accounted for 43% of those in rural hospitals, where most patients presented with upper respiratory and digestive infections. While the Ministry of Health sets the standards for evaluating and regulating the quality and cost of medicine, individuals can purchase medicines from private pharmacies without prescriptions, making it difficult to evaluate appropriate usage.  Regarding the quality of medicines, distribution companies, health workers, and patients cannot distinguish between authentic and falsified or substandard medicines. As an example, after a study in Cambodia revealed the existence of inappropriate medicines, the Cambodian government required companies to provide results of dissolution tests.  As the limitations on pharmaceutical regulatory authorities and their staff in developing countries impact their capabilities, we recommend supporting them in establishing effective pharmaceutical regulations internationally.

This report presents a series of health intervention activities in the humanitarian assistance in Northern Iraq implemented during the Iraq war between March and May 2003 by Peace Winds Japan, with the fund from Japan Platform. Preparedness before the war included organization of mobile clinic teams, stocking of medical supplies and coordination between local health authorities and aid agencies. The initial rapid assessment effectively identified needs of massive number of displaced people with considerable health problems and those of disrupted local health service system. Maximum twelve mobile clinics covered a variety of sites in four areas in Northern Iraq including Kurdistan area and Mosul. Disease patterns in these areas are similar, showing acute respiratory infections are the most common. Neither large outbreak nor high incident severe malnutrition did occur though diarrhea was prevalent in some unsanitary areas. Disruption of local health service system prevented patients with chronic diseases and severe diseases such as cancer, and vulnerable groups such as disabled persons from receiving continuous or timely care and treatment. Co-ordination was successful in demarcation of NGO's activities and information sharing along with joint assessment.
Equitable and quality health care is a challenge of the future reconstruction phase.