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This study examines generalized trust and trust in institutions in Confucian Asia, covering six countries namely, China, Japan, Singapore, South Korea, Taiwan and Vietnam, and one dependent region, Hong Kong. Using data from the 2006 AsiaBarometer Survey, our study affirms the reliability and validity of using a two-item scale to measure generalized trust. Our analysis suggests that due to demographic differences, there are variations in the level of generalized trust of countries in Confucian Asia, despite the fact that these societies share a similar background in Confucian philosophy. The relationships between generalized trust and political trust, and between generalized trust and trust in public institutions, are weak but positive. The positive relationship between generalized trust and trust in economic institutions is only significant for some of the economies, while trust in international institutions has the weakest relationship with generalized trust for all societies. We conclude the paper with research implications.

As healthcare systems around the world are facing increasing physician shortages, more physicians are migrating from low to high income countries. Differences in medical education and international interaction may have significant effect on physician flows. The Chinese Medical Graduates (CMGs) in the US present an interesting case to examine this effect. This paper evaluated the current number and historical trends of CMGs in the US from mainland China, Taiwan, and Hong Kong comparing their differences and similarities in terms of demographic and geographic characteristics. Since 2000, the number of CMGs in the US showed a consistent upward trend at a rate of approximately 206 additional graduates per year. In 2010, there were 8,797 CMGs in the US. Compared to CMGs from mainland China, CMGs from Taiwan and Hong Kong were much older. Much larger proportion of Taiwan and Hong Kong CMGs were male. However, they were more likely to practice in solo settings than mainland CMGs. The vast majority of CMGs are concentrated in urban areas and no significant differences were found for their distributions in underserved areas. However, a larger proportion of Taiwan and Hong Kong CMGs were in western coastal states; whereas a larger proportion of mainland CMGs were located in eastern coastal states. Fluctuations in CMG numbers in the US reflect the significant differences within the medical education systems among the three. The seemingly homogenous CMGs in the US do show significant differences. Given the magnitude and historical trends of migration of CMGs to the US, further exploration of its causes and impact is needed. [ABSTRACT FROM AUTHOR]

Background: China has witnessed a rapid increase of cesarean section (CS) rates in recent years. Several non-clinical factors have been cited as contributing to this trend including maternal request and perceived convenience. We aimed to assess preferences for mode of delivery and reasons for preferences for CS in China to inform the development of future interventions to mitigate unnecessary CSs, which are those performed in the absence of medical indications.Methods and Findings: We conducted a mixed-methods systematic review and included longitudinal, cross-sectional, and qualitative studies in mainland China, Hong Kong, and Taiwan that investigated preferences for mode of delivery among women and family members and health professionals, and the reasons underlying such preferences. We searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, and one Chinese database (CNKI) using a combination of the key terms 'caesarean section', 'preference', 'choice', 'knowledge', 'attitude', 'culture', 'non-clinical factors', and 'health professionals-patient relations' between 1990 and 2018 without language restriction. Meta-analysis of quantitative studies and meta-synthesis of qualitative studies were applied. We included 66 studies in this analysis: 47 quantitative and 19 qualitative. For the index pregnancy, the pooled proportions of preference for CS reported by women in longitudinal studies were 14% in early or middle pregnancy (95% CI 12%-17%) and 21% in late pregnancy (95% CI 15%-26%). In cross-sectional studies, the proportions were 17% in early or middle pregnancy (95% CI 14%-20%), 22% in late pregnancy (95% CI 18%-25%), and 30% postpartum (95% CI 19%-40%). Women's preferences for CS were found to rise as pregnancy progressed (preference change across longitudinal studies: mean difference 7%, 95% CI 1%-13%). One longitudinal study reported that the preference for CS among women's partners increased from 8% in late pregnancy to 17% in the immediate postpartum period. In addition, 18 quantitative studies revealed that some pregnant women, ranging from 4% to 34%, did not have a straightforward preference for a mode of delivery, even in late pregnancy. The qualitative meta-synthesis found that women's perceptions of CS as preferable were based on prioritising the baby's and woman's health and appeared to intensify through interactions with the health system. Women valued the convenience of bypassing labour because of fear of pain, antagonistic relations with providers, and beliefs of deteriorating quality of care during labour and vaginal birth, fostering the feeling that CS was the safest option. Health professionals' preference for CS was influenced by financial drivers and malpractice fears. This review has some limitations, including high heterogeneity (despite subgroup and sensitivity analysis) in the quantitative analysis, and the potential for over-reporting of women's preferences for CS in the qualitative synthesis (due to some included studies only including women who requested CS).Conclusions: Despite a minority of women expressing a preference for CS, individual, health system, and socio-cultural factors converge, contributing to a high CS rate in mainland China, Hong Kong, and Taiwan. In order to reduce unnecessary CSs, interventions need to address all these non-clinical factors and concerns.Systematic Review Registry: Prospero CRD42016036596. [ABSTRACT FROM AUTHOR]

Mairead Black and Sohinee Bhattacharya discuss research findings on preferences for cesarean delivery in Asian settings and share their Perspective on facilitating woman-centered birth choices in China following the end of the one-child policy. [ABSTRACT FROM AUTHOR]