Quantile causality and dependence between renewable energy consumption, WTI prices, and CO2 emissions: new evidence from the USA.

This study investigates the Granger causal interplays between renewable energy consumption, WTI crude oil prices, and CO2 emissions in the USA using monthly data between January 1986 and May 2022. The study applies quantile-based techniques, namely, the quantile unit root test developed by Galvao (2009), the quantile cointegration test proposed by Xiao (2009), and the novel Granger causality-in-quantiles test suggested by Troster (2018). The results suggest that the series display a unit root across different quantiles and that the cointegration relationships exhibit heterogeneous behavior across quantiles. Regarding the causal linkages, the findings show: (i) a unidirectional causality from renewable energy consumption to oil prices, mainly at the lowest or highest quantiles of the distribution, (ii) a bidirectional causality between oil prices and CO2 emissions mainly in the middle and extreme quantiles, but there is evidence of causality from oil prices to CO2 emissions across the quantiles than in the reverse direction, and (iii) a unidirectional causality from renewable energy consumption to CO2 emissions at the lowest to medium and the highest quantiles. These findings have important implications for policy-makers.

Economic impacts of overweight and obesity: current and future estimates for 161 countries.

INTRODUCTION: The scope of the challenge of overweight and obesity (OAO) has not been fully realised globally, in part because much of what is known about the economic impacts of OAO come from high-income countries (HICs) and are not readily comparable due to methodological differences. Our objective is to estimate the current and future national economic impacts of OAO globally. METHODS: We estimated economic impacts of OAO for 161 countries using a cost-of-illness approach. Direct and indirect costs of OAO between 2019 and 2060 were estimated from a societal perspective. We assessed the effect of two hypothetical scenarios of OAO prevalence projections. Country-specific data were sourced from published studies and global databases. RESULTS: The economic impact of OAO in 2019 is estimated at 2.19% of global gross domestic product (GDP) ranging on average from US$20 per capita in Africa to US$872 per capita in the Americas and from US$6 in low-income countries to US$1110 in HICs.If current trends continue, by 2060, the economic impacts from OAO are projected to rise to 3.29% of GDP globally. The biggest increase will be concentrated in lower resource countries with total economic costs increasing by fourfold between 2019 and 2060 in HICs, whereas they increase 12-25 times in low and middle-income countries. Reducing projected OAO prevalence by 5% annually from current trends or keeping it at 2019 levels will translate into average annual reductions of US$429 billion or US$2201 billion in costs, respectively, between 2020 and 2060 globally. CONCLUSION: This study provides novel evidence on the economic impact of OAO across different economic and geographic contexts. Our findings highlight the need for concerted and holistic action to address the global rise in OAO prevalence, to avert the significant risks of inaction and achieve the promise of whole-of-society gains in population well-being.

Estimated impact of the 2020 economic downturn on under-5 mortality for 129 countries.

In low- and middle-income countries (LMICs), economic downturns can lead to increased child mortality by affecting dietary, environmental, and care-seeking factors. This study estimates the potential loss of life in children under five years old attributable to economic downturns in 2020. We used a multi-level, mixed effects model to estimate the relationship between gross domestic product (GDP) per capita and under-5 mortality rates (U5MRs) specific to each of 129 LMICs. Public data were retrieved from the World Bank World Development Indicators database and the United Nations World Populations Prospects estimates for the years 1990-2020. Country-specific regression coefficients on the relationship between child mortality and GDP were used to estimate the impact on U5MR of reductions in GDP per capita of 5%, 10%, and 15%. A 5% reduction in GDP per capita in 2020 was estimated to cause an additional 282,996 deaths in children under 5 in 2020. At 10% and 15%, recessions led to higher losses of under-5 lives, increasing to 585,802 and 911,026 additional deaths, respectively. Nearly half of all the potential under-5 lives lost in LMICs were estimated to occur in Sub-Saharan Africa. Because most of these deaths will likely be due to nutrition and environmental factors amenable to intervention, countries should ensure continued investments in food supplementation, growth monitoring, and comprehensive primary health care to mitigate potential burdens.

Investigating the asymmetry effects of crude oil price on renewable energy consumption in the United States.

The reduction in oil prices might make crude oil a cheaper alternative to renewable energy (RE). Given this, the present paper examines the effect of fluctuation of oil prices on the use of RE in the United States (US) during the period 1970 to 2018. We constructed two nonlinear autoregressive distributed lag (NARDL) models to examine the effect of the positive and negative oil price shocks on the use of RE in the US. The RE consumption is taken as the dependent variable and the gross domestic product (GDP), Brent crude prices, population density, trade openness, and price index as independent variables. The result revealed that the rise in crude oil price, GDP, and population density will increase RE use in the short run and in the long run as well. Moreover, the study finds that any decrease in oil prices will decrease RE use in the short run and its effect will eventually diminish in the long run. On the policy front, it is suggested that US should raise its energy security by reducing its dependency on imported crude oil and increase the role of RE through the imposition of taxes on oil and increase the base of production and consumption through a series of measures.

The number of nurses and midwives per 1000 inhabitants influences life expectancy: a retrospective analysis based on data from 46 countries.

OBJECTIVES: Increased life expectancy results in greater challenges posed to healthcare. Concurrently, a shortage of healthcare workforce, including nurses, has been observed. Thus, an urgent need exists to implement improvements in healthcare services based on sufficient evidence. The aim of the study was to evaluate the influence of the relative number of nurses/midwives on life expectancy, and the influence of selected economic variables: gross domestic product (GDP), health expenditure as a percentage of GDP, and health expenditure per capita, on this number. The aim of the study was to evaluate the influence of the relative number of nurses/midwives on life expectancy, and the influence of select economic variables: GDP, health expenditure as a percentage of GDP, and health expenditure per capita on this number. MATERIAL AND METHODS: A retrospective analysis based on data from 46 countries was performed. Correlations between the relative number of nurses/midwives and life expectancy as well as economic variables were evaluated. To trace the differences between the countries with different relative numbers of nurses/ midwives, the countries were divided into groups as follows - group 1: <5 nurses and midwives/1000 nurses inhabitants, group 2: 5-10 nurses and midwives/1000 inhabitants, and group 3: >10 nurses and midwives/1000 inhabitants. RESULTS: Correlations were found between the relative number of nurses/midwives and life expectancy (p < 0.001, r = 0.68), and economic variables (p < 0.001, r = 0.82; p < 0.001, r = 0.62, and p < 0.001, r = 0.8, respectively). Life expectancy was higher in group 3 vs. groups 1 and 2 (p < 0.001 and p = 0.036, respectively), and in group 2 vs. group 1 (p = 0.006). Economic variables were higher in group 3 vs. group 1 (p < 0.001 for all) and group 2 (p = 0.016, p = 0.025, p = 0.022, respectively), and in group 2 vs. group 1 (p = 002, p = 0.024, p = 0.002, respectively). CONCLUSIONS: The relative number of nurses/midwives correlates with life expectancy and relies on the country's income and level of healthcare system financing. Int J Occup Med Environ Health. 2021;34(4):505-12.

A global trend of caffeine consumption over time and related-environmental impacts.

Caffeine is one of the most consumed substances, and it has been largely detected in aquatic ecosystems. We investigated the trends in caffeine consumption over three decades and its relationships with gross domestic product (GDP) and human development index (HDI) to understand global patterns and to identify potential hotspots of contamination. The total caffeine consumption is increasing mainly due to population growth. Moreover, caffeine consumption per capita is also increasing in some countries, such as Brazil, Italy, and Ethiopia. A high positive correlation between caffeine consumption per capita with HDI and GDP was found for coffee-importing countries in Europe, while a high negative correlation was found for coffee-exporting countries in Africa. The literature review showed that the highest caffeine concentrations coincide with countries that present an increasing caffeine consumption per capita. Also, approximately 35% of the caffeine concentrations reported in the literature were above the predicted no-effect concentration in the environment and, again, overlaps with countries with increasing per capita consumption. Despite the high degradation rate, caffeine consumption tends to increase in a near future, which may also increase the overall amount of caffeine that comes into the environment, possibly exceeding the thresholds of several species described as tolerant to the current environmental concentrations. Therefore, it is essential to prevent caffeine from reaching aquatic ecosystems, implementing sewage treatment systems, and improving their efficiency.

The evolution of the field of legal medicine: A holistic investigation of global outputs with bibliometric analysis.

The purpose of this study is to make a holistic summary of the articles published in the field of Legal Medicine/Forensic Science through bibliometric methods, determine the top cited publications in the field, and to determine the most active journals and especially trend topics. The articles published in the field of Legal Medicine between the years 1975 and 2018 were downloaded from the Web of Science index and were analyzed using bibliometric methods. The correlations between the number of publications of the countries and the Gross Domestic Product (GDP), and the Gross Domestic Product per capita (GDP PPP) values was analyzed using the Spearman's correlation coefficient. The number of articles to be published in the field of Legal Medicine between the years 2019 and 2022 was estimated with linear regression analysis. The results showed that there were totally 38845 articles published in the field of Legal Medicine. Regression analysis results indicate that it will exceed 2500 publications after 2022. The most productive countries in the field of Legal Medicine were the USA (12.448, 32.045%). A high correlation was found between legal medicine publication productivity and GDP and GDP PPP (r = 0.726, p < 0.001; r = 0.703, p < 0.001). As for the collaboration between countries, analysis results showed that the network web indicated the most important factor as the geographical location. This study will provide important information to a forensic scientist (a doctor, academic, and practitioner).

Three decades of changes in water environment of a large freshwater Lake and its relationship with socio-economic indicators.

Tai Lake (Ch: Taihu) has attracted international attention forcyanobacteria blooms. However, the drivers of cultural eutrophication, especially long-term socio-economic indicators have been little researched. The results of research demonstrate how socio-economic development affected quality of water and how it has been improved by anthropogenic activities. This study described variability in indicators of water quality in Tai Lakeand investigated thedrivers. Significant relationships existed between concentrations of annual mean total nitrogen (TN), total phosphorous (TP), chemical oxygen demand (COD) and biological oxygen demand (BOD), and population, per capital gross domestic production (GDP) and sewage discharge (p < 0.05). However, mechanisms causing change varied among TN, TP, COD and BOD. Before 2000, the main contributors to increases in concentrations of TN were human population, GDP and volumes of domestic sewage discharges. After 2000, discharges of industrial sewage become the primary contributor. After 1998, the regressions of annual mean TN, TP and COD on per capital GDP, population and domestic sewage discharge were reversed compared to the former period. Since 1999, an apparent inverted U-shaped relationship between environmental pollution and economic development has developed, which indicated that actions taken by governments have markedly improved quality of water in Tai Lake. The statistical relationship between BOD and per capital GDP didn't conform to the Kuznet curve. The U-shaped Kuznet curve may offer hope for the future that with significant environmental investments a high GDP can be reached and maintained without degradation of the environment, especially through appropriate management of industrial sewage discharge.

The moderating role of oil price changes in the effects of service trade and tourism on growth: the case of Turkey.

The aim of this study is to examine the role of oil price changes in the effects of services trade and tourism on real income growth in Turkey. Time series analysis using the 1960-2017 annual period has been adapted with this respect. Results confirm the long-term impacts of tourism and services trade sectors on real income growth in Turkey. Tourism and trade (both services and manufacturing) exert positively significant effects on the long-term performance of macroeconomic activity as measured by gross domestic product. Oil prices negatively impact on real income growth of Turkey. It is also found that oil prices negatively moderate the effects of foreign trade, services trade, and tourism on real income growth in Turkey. This finding reveals that significant effects of foreign trade, services trade, and tourism on real income are negatively influenced from oil price changes.

Health Expenditure Growth under Single-Payer Systems: Comparing South Korea and Taiwan.

OBJECTIVE: Achieving universal health coverage has been an important goal for many countries worldwide. However, the rapid growth of health expenditures has challenged all nations, both those with and without such universal coverage. Single-payer systems are considered more efficient for administrative affairs and may be more effective for containing costs than multipayer systems. However, South Korea, which has a typical single-payer scheme, has almost the highest growth rate in health expenditures among industrialized countries. The aim of the present study is to explicate this situation by comparing South Korea with Taiwan. METHODS: This study analyzed statistical reports published by government departments in South Korea and Taiwan from 2001 to 2015, including population and economic statistics, health statistics, health expenditures, and social health insurance reports. RESULTS: Between 2001 and 2015, the per capita national health expenditure (NHE) in South Korea grew 292%, whereas the corresponding growth of per capita NHE in Taiwan was only 83%. We find that the national health insurance (NHI) global budget cap in Taiwan may have restricted the growth of health expenditures. Less comprehensive benefit coverage for essential diagnosis/treatment services under the South Korean NHI program may have contributed to the growth of out-of-pocket payments. The expansion of insurance coverage for vulnerable individuals may also contribute to higher growth in NHE in South Korea. Explicit regulation of health care resource distribution may also lead to more limited provisioning and utilization of health services in Taiwan. CONCLUSION: Under analogous single-payer systems, South Korea had a much higher growth in health spending than Taiwan. The annual budget cap for total reimbursement, more comprehensive coverage for essential diagnosis and treatment services, and the regulation of health care resource distribution are important factors associated with the growth of health expenditures.

Health insurance or subsidy has universal advantage for management of hospital malnutrition unrelated to GDP.

BACKGROUND AND OBJECTIVES: Protein-energy and micronutrient malnutrition are global public health problems which, when not prevented and severe, require medical management by clinicians with nutrition expertise, preferably as a collectively skilled team, especially when disease-related. This study aimed to investigate barriers and facilitators of clinical nutrition services (CNS), especially the use of oral, enteral (EN) and parenteral (PN) nutrition in institutional and home settings. METHODS AND STUDY DESIGN: An international survey was performed between January and December 2014 in twenty-six countries from all continents. Electronic questionnaires were distributed to 28 representatives of clinical nutrition (PEN) societies, 27 of whom responded. The questionnaire comprised questions regarding a country's economy, reimbursement for CNS, education about and the use of EN and PN. RESULTS: The prevalence of malnutrition was not related to gross domestic product (GDP) at purchasing power parity (PPP) per capita (p=0.186). EN and PN were used in all countries surveyed (100%), but to different extents. Reimbursement of neither EN nor PN use depended on GDP, but was associated with increased use of EN and PN in hospitals (p=0.035), although not evident for home or chronic care facilities. The size of GDP did not affect the use of EN (p=0.256), but it mattered for PN (p=0.019). CONCLUSIONS: A worldwide survey by nutrition support societies did not find a link between national economic performance and the implementation of medical nutrition services. Reimbursement for CNS, available through health insurance systems, is a factor in effective nutrition management.

[Trends in Google searches on complementary and alternative medicine]. / Tendencias de las búsquedas en Google sobre terapias de medicina alternativa y complementaria.

BACKGROUND: The aim of this article is to evaluate the interest in complementary and alternative medicine (CAM) therapies using Google Trends in spanish-speaking countries. METHODS: An observational study was conducted using GoogleTrends. The search volume of 34 CAM therapies in spanish were evaluated globally and in 21 spanish-speaking countries. Also, the relationship between the median of the most popular searches and the gross domestic product (GDP) per capita in each of the countries was evaluated using Spearman's test. RESULTS: A decreased trend in search volume was observed in homeopathy, herbal medicine, acupunctureand sensory therapies; and an increasing trend in chiropraxy. A direct association was observed between the GDP per capita and the median between the most popular CAM therapies, this relationship was no significant (p = 0.432). CONCLUSIONS: The interest in CAM therapies shows temporal and geographic variations that must be studied in depth. These results can be used for the establishment of an international monitoring for the use of CAM therapies.

Introducción: el objetivo de este artículo es evaluar el interés de la población en terapias de medicina alternativa y complementaria (MAC), a través de la herramienta Google Trends y en países de habla hispana. Métodos: se realizó un estudio observacional mediante la herramienta Google Trends. Se evaluaron las tendencias de búsqueda de 34 terapias de MAC en español, de manera global y en 21 países de habla hispana. Se evaluó la asociación entre la mediana de búsquedas de las terapias más populares y el producto interno bruto (PIB) per cápita en cada país, mediante la prueba de Spearman. Resultados: se observa una tendencia descendente en el volumen de búsquedas de homeopatía, medicina herbaria, acupuntura y terapias sensoriales; así como una tendencia ascendente de la quiropraxia. Además, al analizar los países se observó una asociación directa entre el PIB per cápita y la mediana de la búsqueda de las terapias de MAC más populares, pero esta no fue significativa (p = 0.432). Conclusiones: el interés de terapias de MAC presenta variaciones temporales y geográficas que deben estudiarse a profundidad. Estos resultados pueden ser de utilidad para establecer una vigilancia internacional al respecto.

Organization and Finance of China's Health Sector: Historical Antecedents for Macroeconomic Structural Adjustment.

China has exploded onto the world economy over the past few decades and is undergoing rapid transformation toward relatively more services. The health sector is an important part of this transition. This article provides a historical account of the development of health care in China since 1949. It also focuses on health insurance and macroeconomic structural adjustment to less saving and more consumption. In particular, the question of how health insurance impacts precautionary savings is considered. Multivariate analysis using data from 1990 to 2012 is employed. The household savings rate is the dependent variable in 3 models segmented for rural and urban populations. Independent variables include out-of-pocket health expenditures, health insurance payouts, housing expenditure, education expenditure, and consumption as a share of gross domestic product (GDP). Out-of-pocket health expenditures were positively correlated with household savings rates. But health insurance remains weak, and increased payouts by health insurers have not been associated with lower levels of household savings so far. Housing was positively correlated, whereas education had a negative association with savings rates. This latter finding was unexpected. Perhaps education is perceived as investment and a substitute for savings. China's shift toward a more service-oriented economy includes growing dependence on the health sector. Better health insurance is an important part of this evolution. The organization and finance of health care is integrally linked with macroeconomic policy in an environment constrained by prevailing institutional convention. Problems of agency relationships, professional hegemony, and special interest politics feature prominently, as they do elsewhere. China also has a dual approach to medicine relying heavily on providers of traditional Chinese medicine. Both of these segments will take part in China's evolution, adding another layer of complexity to policy.

Cost-effectiveness of Pharmaceutical Interventions to Prevent Osteoporotic Fractures in Postmenopausal Women with Osteopenia

BACKGROUND: To assess the cost-effectiveness of drug therapy to prevent osteoporotic fractures in postmenopausal women with osteopenia in Korea. METHODS: A Markov cohort simulation was conducted for lifetime with a hypothetical cohort of postmenopausal women with osteopenia and without prior fractures. They were assumed to receive calcium/vitamin D supplements only or drug therapy (i.e., raloxifene or risedronate) along with calcium/vitamin D for 5 years. The Markov model includes fracture-specific and non-fracture specific health states (i.e. breast cancer and venous thromboembolism), and all-cause death. Published literature was used to determine the model parameters. Local data were used to estimate the baseline incidence rates of fracture in those with osteopenia and the costs associated with each health state. RESULTS: From a societal perspective, the estimated incremental cost-effectiveness ratios (ICERs) for the base cases that had T-scores between -2.0 and -2.4 and began drug therapy at the age of 55, 60, or 65 years were $16,472, $6,741, and -$13,982 per quality-adjusted life year (QALY) gained, respectively. Sensitivity analyses for medication compliance, risk of death following vertebral fracture, and relaxing definition of osteopenia resulted in ICERs reached to $24,227 per QALY gained. CONCLUSIONS: ICERs for the base case and sensitivity analyses remained within the World Health Organization's willingness-to-pay threshold, which is less than per-capita gross domestic product in Korea (about $25,700). Thus, we conclude that drug therapy for osteopenia would be a cost-effective intervention, and we recommend that the Korean National Health Insurance expand its coverage to include drug therapy for osteopenia.

Health Care Expenditure and GDP in Oil Exporting Countries: Evidence From OPEC Data, 1995-2012.

BACKGROUND: There is a large body of literature examining income in relation to health expenditures. The share of expenditures in health sector from GDP in developed countries is often larger than in non-developed countries, suggesting that as the level of economic growth increases, health spending increase, too. OBJECTIVES: This paper estimates long-run relationships between health expenditures and GDP based on panel data of a sample of 12 countries of the Organization of the Petroleum Exporting Countries (OPEC), using data for the period 1995-2012. PATIENTS & METHODS: We use panel data unit root tests, cointegration analysis and ECM model to find long-run and short-run relation. This study examines whether health is a luxury or a necessity for OPEC countries within a unit root and cointegration framework. RESULTS: Panel data analysis indicates that health expenditures and GDP are co-integrated and have Engle and Granger causality. In addition, in oil countries that have oil export income, the share of government expenditures in the health sector is often greater than in private health expenditures similar developed countries. CONCLUSIONS: The findings verify that health care is not a luxury good and income has a robust relationship to health expenditures in OPEC countries.

Japan as the front-runner of super-aged societies: Perspectives from medicine and medical care in Japan.

BACKGROUND: The demographic structure of a country changes dramatically with increasing trends toward general population aging and declining birth rates. In Japan, the percentage of the elderly population (aged ≥65 years) reached 25% in 2013; it is expected to exceed 30% in 2025 and reach 39.9% in 2060. The national total population has been decreasing steadily since its peak reached in 2008, and it is expected to fall to the order of 80 million in 2060. Of the total population, those aged ≥75 years accounted for 12.3% as of 2013, and this is expected to reach 26.9% in 2060. As the demographic structure changes, the disease structure changes, and therefore the medical care demand changes. To accommodate the medical care demand changes, it is necessary to secure a system for providing medical care. Japan has thus far attained remarkable achievements in medical care, seeking a better prognosis for survival; however, its medical care demand is anticipated to change both qualitatively and quantitatively. As diseases in the elderly, particularly in the old-old population, are often intractable, conventional medical care must be upgraded to one suitable for an aged society. What is required to this end is a shift from "cure-seeking medical care" focusing on disease treatment on an organ-specific basis to "cure and support-seeking medical care" with treatments reprioritized to maximize the quality of life (QOL) for the patient, or a change from "hospital-centered medical care" to "community-oriented medical care" in correlation with nursing care and welfare. CURRENT SITUATION AND PROBLEMS: (1) Necessity for a paradigm shift to "cure-and-support seeking medical care" In addition to the process of aging with functional deterioration of multiple organs, the elderly often suffer from systemically disordering diseases, such as lifestyle-related diseases, as well as geriatric syndrome and daily activity dysfunction; therefore, integrated and comprehensive medical care is required. In addition, with regard to diseases in the elderly, not only their acute stage, but also their chronic and intermediate stages must be emphasized in their treatment. Aiming to achieve a complete cure of disease by exploring the cause and implementing radical treatment, the conventional medical care model is difficult to apply to the medical care of the elderly; medical care suitable for the elderly is required. (2) Spread of home-based care and the necessity for human resources development Many elderly people want to continue to live in their house and their community where they have been living for a long time, even with disease. There are increasing needs for QOL-emphasizing home-based care for patients in the intermediate stage after completion of acute stage treatment, or for end-of-life care. Hence, there is a demand for a shift to "community-oriented medical care" for providing comprehensive care supported with medical and nursing resources available in the community. As the percentage of the elderly population (aged ≥65 years) and the availability of medical care resources vary considerably among different regions, it is important that specialists in the fields of public health, medical care, nursing care, and welfare work on establishing a collaborative system suitable for the local characteristics of each region by making the best use of their own specialties. (3) Necessity for establishing a department of gerontology or geriatric medicine at each medical school In line with the increasing number of elderly people, it is necessary to upgrade the systems for educating and nurturing physicians engaged in healthcare and nursing care for the elderly. It is also necessary to develop the organic cooperation with other medical and nursing care professionals, such as registered nurses and care workers. At present, just approximately 30% of medical schools in Japan have a department specializing in medical care for the elderly and relevant medical education; there is an urgent need to improve the situation, as the majority of universities do not provide any such education. (4) Necessity for establishing a medical center for promoting medical care provider collaboration, multidisciplinary training and a means to increase public awareness In the medical care for the elderly, comprehensive care must be provided from the viewpoints of both healthcare and nursing care; to improve the quality of such care services, multidisciplinary collaboration and team-based medicine are indispensable. Therefore, physicians, nurses, therapists, pharmacists, dieticians, care managers, and other health care professionals who have thorough knowledge about medical care for the elderly are of utmost necessity. In reality, however, the collaboration of these health care professionals is unsatisfactory, and the degree of understanding of team-based medicine by each medical professional is low. Therefore, as in the case of the establishment of cancer centers within individual regions to promote medical care for cancer, there is a demand to nurture professionals engaged in medical care for the elderly, and to establish a core facility for the promotion of multidisciplinary collaboration and team-based medicine for each region. (5) Do the people understand the paradigm shift? Currently, not only healthcare professionals, but also many citizens seek "cure-seeking medical care" aiming at a restoration of organ function; however, surveys of the elderly often show that they want to restore independent daily activity, rather than to achieve a "cure." In contrast, in the actual medical care setting, contradictory situations prevail in which the public awareness of the shift to "cure-and-support seeking medical care" is unsatisfactory, including the fact that the majority of recipients of tertiary emergency care are elderly patients. CONTENTS OF THE PROPOSAL: The Science Council of Japan has the task to propose future visions for the Japanese aging society not only from the viewpoint of the health of each individual, but also from a broader perspective, taking into account the relationship between humans and society. Various issues related to general population aging are posing serious problems, which require prompt resolution. Although we made a number of proposals at the 21st Subcommittee for Aging, the situation has not changed satisfactorily. Accordingly, the present proposals on specific solutions were designed. (1) In a super-aged society, a paradigm shift to "cure-and-support seeking medical care" should be implemented A super-aged society will consist of an unprecedented demographic structure in which the percentage of only those people aged ≥75 years will increase in the entire population. Therefore, there is an urgent need to prepare for increasing populations of persons in need of long-term care and those who are likely to become in need of long-term care. Given the consideration that "patients are not merely sick persons, but rather living persons," a paradigm shift from conventional "cure-seeking medical care" to "cure and support-seeking medical care" must be implemented. (2) Facilitate a paradigm shift to community-oriented medical care, and promote the activity of female physicians in the medical care for the elderly A paradigm shift should be promptly facilitated by reorganizing hospital functions and establishing a community comprehensive care system for home-based care to promote the participation of the elderly by themselves in care-supporting society. To further promote the collaboration of medical care and welfare, not only persons in charge of actual regional settings, but also university schools of medicine and regional core medical institutions experienced in medical care for the elderly should take the initiative to promote home-based care and facilitate a paradigm shift to community-oriented medical care. In addition, programs should also be developed to re-educate female physicians who became housewives in order to nurture them to become facilitators of geriatric medicine. (3) Physicians who are required at local medical facilities must be nurtured through the establishment of a department of gerontology or geriatric medicine at each medical school To facilitate efficient medical care services, medical education and research, and human resources development in support of expected paradigm shifts, it is considered that a department of gerontology or geriatric medicine should be established at each medical school. Furthermore, it is necessary to allocate dedicated teachers of medical care for the elderly to all medical schools, as well as to upgrade practice-participatory drills and to collaborate with a broad range of entities, including local medical institutions, and welfare and nursing care facilities. Efforts must be made to nurture locally wanted physicians through specific efforts concerning team-based medicine. (4) Promote the establishment of centers for geriatrics and gerontology (provisional name) for medical care collaboration, multidisciplinary training, and a means to increase public awareness To promote the uniform accessibility of expertise on efficient medical care that is best suited for a super-aged society, it is necessary to build a post-graduation educational system under the initiatives of the Japan Geriatrics Society and the National Center for Geriatrics and Gerontology across the nation in cooperation with regional medical schools and the Japan Medical Association. Furthermore, at least one hospital serving as a center for geriatrics and gerontology should be established in each regional block (Hokkaido, Tohoku, Koshinetsu, Hokuriku/Tokai, Kinki, Chushikoku and Kyushu/Okinawa) by making the best use of existing hospitals. By establishing these centers, uniform accessibility for the quality of medical care for the elderly in each region is expected. (ABSTRACT TRUNCATED).

Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association.

AIMS: There has been large variations in the use of invasive electrophysiological therapies in the member countries of the European Society of Cardiology (ESC). The aim of this analysis was to provide comprehensive information on cardiac implantable electronic device (CIED) and catheter ablation therapy trends in the ESC countries over the last five years. METHODS: The European Heart Rhythm Association (EHRA) has collected data on CIED and catheter ablation therapy since 2008. Last year 49 of the 56 ESC member countries provided data for the EHRA White Book. This analysis is based on the current and previous editions of the EHRA White Book. Data on procedure rates together with information on economic aspects, local reimbursement systems and training activities are presented for each ESC country and the five geographical ESC regions. RESULTS: In 2013, the electrophysiological procedure rates per million population were highest in Western Europe followed by the Southern and Northern European countries. The CIED implantation and catheter ablation rate was lowest in the Eastern European and in the non-European ESC countries, respectively. However, in some Eastern European countries with relative low gross domestic product procedure rates exceeded those of some wealthier Western countries, suggesting that economic resources are not the only driver for utilization of arrhythmia therapies. CONCLUSION: These statistics indicate that despite significant improvements, there still is considerable heterogeneity in the availability of arrhythmia therapies across the ESC area. Hopefully, these data will help identify areas for improvement and guide future activities in cardiac arrhythmia management.