Search

Purpose: The purpose of this paper is to explore how principals' leadership approaches to teacher professional development arise from school banding and may impact upon teacher professional capital and student achievement. Design/methodology/approach: The case study is situated within the context of school-based management, comprising reflective accounts of nine school principals selected by stratified sampling from a sample of 56 Hong Kong schools to represent Bands One, Two, and Three schools. The reflective accounts were triangulated with observations of teachers and analysis of school websites. Findings: First, under school-based management, principals remain obliged to recognize the power of state-defined examinations in determining the schools' future priorities. Second, the exercise of school autonomy in response to this obligation varies, depending upon the competitive advantage schools have in the school banding system. Ideally, effective school-based management is dependent upon the principal's capacity to facilitate good instructional practices. However, principals need to adjust their leadership practices to school contextual demands. Third, adaptations to contexts result in the varied developments of teacher capacities in schools, corresponding with the types of principal leadership adopted. Originality/value: While statistical studies have identified attributes of exemplary principal leadership, few studies have examined the qualitative reasons for the exemplification of these attributes, and the influence of the school context in shaping these attributes. Departing from assumptions that leadership attributes are intrinsic to individuals, this paper considers how principals contextualize leadership in teacher professional development to the schools' student academic achievement.

Purpose: This paper aims to study the relationship between high-performance work system (HPWS) and organizational performance and to examine the role of human resource development (HRD) Climate in mediating the relationship between HPWS and the organizational performance in the context of the power sector of India. Design/methodology/approach: The empirical research paper has been conceptualized on the basis of extensive literature survey and examined through a case-based approach. Data and information collected to examine strength of the proposed hypothesis in the context of a power-based company in India. Findings: Agreeing with most of the research, HPWS is found to be positively related with organizational performance. The result does not agree with the HPWS research conducted in Asian countries. Taking clues from "Black Box" approach, the role of HRD Climate as a mediating factor has been studied. The result proved that HPWS influences organizational performance through a supportive development environment (HRD climate) based on openness, confrontation, trust, authenticity, proaction, autonomy, collaboration and experimentation (OCTAPAC). Research limitations/implications: Designing and implementing HPWS requires the organization to nurture and develop a suitable HRD climate through development of organizational culture based on OCTAPAC. Practical implications: Implications for HRD-HPWS practices such as group-based pay, decentralized participative decisions, self-managed work teams, social and family events, and appraisal based on team goals along with OCTAPAC culture can significantly contribute to the transfer climate by influencing both peer and supervisor. It can significantly contribute to training motivation by influencing both career and job attitudes, and organizational commitment of trainees. Originality/value: The research is unique in its attempt to understand the role HRD climate as intermediating variables to enhance the effectiveness of HPWS. This may add a lot of value in encouraging organizations to establish HRD Climate.

Typically, an ESP course is designed to develop students' communication skills not solely for the office, but also for useful in a specific workplace. Unfortunately, ESP for Schools of Business at some South-East Asian universities is not being very effective in promoting students' performance in the workplace. Behind this backdrop, this paper explores learners' pragmatic workplace learning practices that impact on their profession and have immediate applicability to their professional responsibilities. This article, in other words, addresses the gaps between what students learn in ESP class and what they need in real workplace. The data were collected through questionnaires from 30 ESP teachers. The data were analysed both qualitatively and quantitatively. The research results revealed that the current ESP in use fails to capture the learners' needs and skills in workplace communication. It, therefore, suggests that ESP textbook has to adapt the practical workplace needs related materials as well as supplementing extra materials through teachers' constant "needs analysis".

Purpose: The global expansion of higher education has brought about more ambitious educational goals that require new approaches to curriculum, teaching, and learning. While higher education in East Asia is no exception to this trend, it has been observed that both teachers and learners in the region have adhered to a strong tradition of lecture-based instruction. An underlying research question concerned the responsiveness of East Asian students to learner-centered education. The purpose of this paper is to examine the extent to which learner-centered education can be implemented successfully in the East Asian higher education context. Design/methodology/approach: This study presents a quantitative study informed by a description of the context for implementation. It adopts a quasi-experimental, multiple time series design and examines the process and effects of change in teaching and learning at a graduate school of business (GSB) in Thailand. The GSB implemented a variety of active learning methods that were explicitly designed to increase student engagement. Descriptive statistics, as well as mixed effects models, were used to analyze student course evaluation data over a several year period. Findings: Active learning methods could be implemented in the context of an East Asian high education institution and they entailed positive change in student engagement over time. Originality/value: The paper's results support assertions that Asian students respond positively to well-designed instructional methods that seek to foster active learning. (Contains 3 tables, 1 figure, and 1 note.)

This study explores the nature of undergraduate students' errors and misconceptions in particle mechanics. This paper provides in-depth descriptions of the errors presented by students and accounts for them in terms of students' procedural or conceptual knowledge. Specifically, this study analyses students' written responses to questions on dynamics and the conservation of momentum. A total of 154 student scripts in 2005 and 142 scripts in 2006 were analysed for errors and misconceptions regarding these mechanics concepts. In addition, a questionnaire was administered to students on which they stated which type of knowledge (procedural or conceptual) was more useful in answering these questions. Overall, the findings of this study suggest that students make regular errors for which there are complex causes. It was also found that students' procedural and conceptual knowledge of a subject has a bearing on the errors and misconceptions that they make. The paper concludes with some suggestions for how errors and misconceptions can be diagnosed and analysed. It highlights the importance of error analysis as a teaching skill. (Contains 5 figures, 3 tables and 1 footnote.)

This paper aims at advancing the conceptualization of leisure as a contributor to quality of life (QOL) in an international and multicultural context, based on an extensive and critical review of literature on leisure and QOL from a global, international perspective. Given the central role of culture in conceptualizing this notion, this paper gives attention to various cultural contexts world-wide. To illustrate the diversity of our societies, examples are introduced specifically from three culturally unique contexts in this paper--i.e., Asian, Middle-East, and Indigenous contexts. Also, some examples are drawn from other cultural groups in global and international contexts, particularly, in non-western contexts. Then, the final section of this paper aims at integrating and synthesizing the knowledge gained from this review to develop a tentative/working proposition about "how" leisure can contribute to QOL from international and cross-cultural perspectives. Specifically, based on such integration, this paper identifies and describes major pathways linking leisure to QOL. Overall, an overarching theme common to almost all cultural contexts examined appears to be the role of leisure-like activities as a context or space for creating meanings which then help to promote the quality of people's lives. Major pathways or mechanisms that can facilitate meaning-making and life-quality-enhancement highlighted in this review include: (a) positive emotions and well-being experienced from leisure, (b) positive identities and self-esteem gained from leisure, (c) social and cultural connections and a harmony developed through leisure, and (d) leisure's contribution to learning and human development across the life-span. Also, emphasized in this paper is the role of leisure as a context for realizing and utilizing human strengths and resilience. It is important, however, to stress that in people's quest for a meaningful life, the benefits of meaning-making through leisure involveboth "remedying the bad" and "enhancing the good," as shown throughout this paper. Despite these benefits, we should not ignore that leisure experiences are socially and culturally constructed and shaped by the inequalities of society. Thus, the reality of power imbalance and inequalities should be acknowledged and appropriately addressed socially, culturally, and politically. Particularly, providing culturally relevant and meaningful leisure opportunities for less privileged population groups world-wide is clearly a top priority.

This paper presents a study of 428 youths who participated in service-learning projects in developing countries in South-East Asia, China and India. Using mixed-method approach, this study examined the reasons for their participation in the YEP (youth expedition projects) and the impact of their service-learning experiences on their civic attitudes and competence skills. Positive outcomes in civic engagement, competence skills and development of sense of self for participants as a whole and in terms of age group are discussed. The author concludes that it is important to make service-learning an explicit training and educational goal in order for educators to facilitate the building of capacities in youths, so that they can appreciate the value that service-learning can bring in character development and shape early commitment to civic involvement. (Contains 5 tables.)

Partnership and the integration of language and content teaching in English-medium schools have long been active areas of research and inquiry in applied linguistics and TESOL. However, most researchers have tended to focus on methods and techniques to use in the classroom or on the analysis of the linguistic demands of the content areas. Much less attention has been paid to researching the process of co-planning and co-teaching and to supporting the evolution of the partnership between ESL and content teachers. This paper draws on questionnaire and interview data collected as part of a school-based professional development initiative in an English-medium school in Asia that focused on developing more collaborative relationships between ESL and content/classroom teachers in a large culturally and linguistically diverse elementary school. The paper begins with an analysis of some of the underlying assumptions in current conceptualisations of effective collaboration between ESL and mainstream/content-area teachers, then presents an emerging framework that draws on teacher talk and critical discourse analysis to describe and evaluate the stages of collaboration and the different levels of its effectiveness. The implications of this research for evaluating approaches to partnership and for setting realistic goals for professional development and institutional change will also be explored.

Based on a study of 1689 high school teachers across 132 high schools in 12 countries, this paper discusses their views on spirituality for high school adolescents. In general, they favoured spirituality for adolescents and its inclusion in the curriculum. Specifically teachers from European countries, US, Canada and Australia attested the relational consciousness aspect of spirituality, which enabled adolescents to form and preserve meaningful social relationships and build their altruistic potential. Log regression analysis showed that spiritual assessment of adolescents was perceived as comprehending their spiritual starting point, specifically by those from European countries, US, Canada and Australia. Further, they perceived spirituality as an integral part of the moral science and value education curriculum, with the main curricular objective as cultivating adolescents' spiritual sensibilities and mindfulness. The study provides the nuances of such as curriculum on spirituality in the high schools in terms of knowledge, skills and attitude components.

Because information and documentation units in libraries have responsibility for an ever-increasing number of projects, this paper aims at analyzing the discipline of project management in library and information science (LIS) from a professional perspective. To that end, the researchers employed quantitative and qualitative methodology based on a questionnaire of 17 items sent to academic librarians. The questions dealt with the geographic origin and institutional affiliation of the respondents, the education of the librarians, their professional experience, and the library projects in which they have been involved. The survey also asked about the presence of project management as courses in library and information science studies.

We know little about how internationalisation processes are understood, rationalised and prioritised in different parts of the world. A global survey of internationalisation in universities was undertaken at the University of Southampton to fill this gap. Its purpose was to discover how strategic leaders in universities in different parts of the world defined, rationalised and prioritised a range of familiar internationalisation approaches. Based on a self-completion questionnaire survey administered to 500 universities in six major world regions including South America, North America, Middle East nations, Asian nations, Australia and New Zealand and sub-Saharan Africa, findings were processed from just under 200 responding universities. The findings suggest that internationalisation strategies in universities across the world seem to be based on three emergent value driven models. In western universities, a commercial imperative appears to underpin the internationalisation processes and understanding. In Confucian and many Middle East nations, there is a deep-seated cultural imperative at the heart of the internationalisation agenda. In the poorer universities of the south, a curriculum-value driven process seems to characterise the internationalisation priorities of universities there. The paper concludes that despite the global rhetoric about an emerging isomorphism in HE, wide disparities continue to exist, which entrench the poverty differentials that have always existed between universities in the north and those in the south. Further research is needed that identifies ways to develop a more responsible commercial purpose that can be reconciled with the needs of universities in the poorer parts of the world. (Contains 8 tables.)

This paper aims to investigate the current XML-related courses available in 96 LIS schools in South East Asia and Taiwan's 9 LIS schools. Also, this study investigates the linkage of library school graduates in Taiwan who took different levels of XML-related education (that is XML arranged as an individual course or XML arranged as a section unit in courses) and their professional qualification. Research questions include what is the availability of XML-related courses in countries in Taiwan and South East Asia? What are Taiwan LIS graduates' views on degree of XML-related courses satisfaction, cognition of learning XML technology, and views of XML-related courses? What is the linkage of Taiwan LIS graduates who studied different levels of XML-related education and their professional qualifications? This study applies 3 research methodologies: information gathering from the internet; questionnaire surveys; in-depth interviews. Results of the analysis show that LIS schools should provide optional XML-related courses with practical sessions, and library associations should provide regular XML-related continuing education to enhance LIS students' professional qualifications. (Contains 1 figure and 1 table.)

During the past 30 years academic leaders have advocated for the adoption of "pedagogies of engagement" in the hopes of increasing student involvement and retention, as well as learning outcomes in higher education. More recently, universities in Asia have joined this movement, despite barriers arising from cultural norms and teaching traditions that reify knowledge and reinforce status differentiation between teachers and students. This paper explores the implementation of problem-based learning (PBL), one pedagogy of engagement in higher education in Asia. The research presents a longitudinal, mixed-methods case study of PBL implementation at a graduate school of business in Thailand. The data, collected over a seven-year period, suggest that implementation of a PBL track in the college's management curriculum was successful when judged on a variety of academic staff and student indicators. Although the capacity to generalise case study findings are inherently limited, the statistical analyses suggest that PBL can exert a positive impact on instructional effectiveness in an East Asian context known for its reliance on traditional approaches to teaching and learning. (Contains 3 tables and 4 figures.)

This paper aims to find out two outcomes of feedback in the novice writers' graphic organizers, which are the novice writers' ability to align their ideas to their writing goal, and their perceived germane, metacognitive, extraneous and intrinsic cognitive loads when generating and revising ideas based on the feedback. Data was gathered from the students' graphic organizers, mental difficulty questionnaires and focus group discussion. The findings show that the students' relevance of ideas improved with feedback in their organizers, except for one sub-process. In addition, the students' metacognitive load seems to affect the amount of ideas generated. These findings have implications for media selection mix and social collaborative environments. (Contains 2 figures and 10 tables.)

In this paper we describe the development and evaluation of two activities for delivery in first year B.Sc. and M.Chem. degree courses, in which we introduced an international context representing either a linguistic or a cultural modification to the previously developed case studies. The case studies focus on an industrial and an environmental scenario. The industrial scenario was recast within a site based in India, whilst the environmental scenario introduced material in several European languages. Evaluation of student attitudes before and after the engagement with the activities suggest that their attitudes towards working in a non-UK environment and towards language learning had become more positive.

Purpose: The main purpose of this study is threefold: to analyze the current conditions of higher education services offered in the three target markets; to conduct market segmentation analysis of these markets; and to recommend the most appropriate market entry strategies for Hong Kong's education service providers. Design/methodology/approach: The data for this project were obtained primarily by questionnaire survey and interviews. The research team collected 1,370 questionnaires and conducted a total of 121 individual and focus group interviews in the four studied cities--Mumbai, New Delhi, Jakarta, and Kuala Lumpur. Findings: The study found that there was a high unmet demand for higher education overseas and that the visibility of Hong Kong's higher education was relatively weak in these Asian markets. In order to capture the continued rise of students in Asia, higher education institutions and the Hong Kong government need to work together to analyze the potential markets critically and employ marketing strategies sensibly. Several key recommendations have been provided based on the findings. Research limitations/implications: The study was undertaken in a few key cities in these three target markets. However, findings from the study may generate insights into other cities with similar characteristics in these countries and the Asian regions. Practical implications: The paper suggests that decision makers at the institutional level and government level seeking to enter these markets must pay attention to the importance of market segmentation and the 4P variables in formulating their marketing strategies. Originality/value: Few studies have examined the current condition of higher education services in these three emerging Asian markets. The study provides some useful marketing information to education decision makers in Hong Kong and elsewhere who may be interested in formulating marketing strategies in these markets. (Contains 1 table and 12 figures.)

This paper examines Australian students' knowledge of Asia, and reports on a national survey of Year 5 and 8 students. Knowledge was measured by using a combined set of subtests tailored to each state and territory curriculum and reported in terms of a standards referenced framework. The survey collected data from more than 7000 students in over 300 schools covering all states and territories. It showed that, at the primary level, student knowledge of Asia was related to school policy-related commitment and to the frequency of the teachers' use of resources. In secondary schools, the development of knowledge and understanding of Asia was related to the range of teaching resources drawn upon, as well as the frequency of their use. Commitment to studies of Asia was important and influential, but it seemed not to matter whether this commitment was at a teacher or school level. (Contains 1 table and 6 figures.)

Although nonsuicidal self-injury (NSSI) is prevalent among adolescents and is associated with an increased risk of adverse outcomes, many adolescents with NSSI do not seek help. However, there is a lack of research on the factors that may increase the likelihood of help-seeking, especially within Asia. To address this gap, the present study examined whether certain factors were associated with informal and formal help-seeking – specifically gender, severity of NSSI, functions of NSSI and authoritative parenting. 121 adolescents (M age = 16.2 years, 71.1% female) were recruited from specialist outpatient clinics and inpatient psychiatric wards from a public hospital in Singapore. One caregiver per adolescent was also recruited. Data from self-report questionnaires were analysed using logistics regression analyses. The results suggest that the severity of NSSI increases the likelihood of informal help-seeking, while adolescents who have parents with more authoritative parenting style are less likely to seek informal help. Gender and functions of NSSI were not found to be associated with help-seeking. The findings from this study can guide professionals in their efforts to encourage help-seeking within Asian populations, as well as inform prevention and treatment programs for Asian adolescents with NSSI. Plain language summary: Factors that encourage Asian youths who self-harm to get help from non-professionals and professionals: There are many youths who engage in self-harm for reasons other than suicide. Although self-harm could lead to various negative outcomes, many youths do not seek help. However, not much is known about what encourages these youths to seek help from non-professionals (e.g., family, friends) and professionals (e.g., psychologists), especially within Asia. This paper looked at certain factors that may be linked to whether youths seek help – including gender, severity of self-harm, reasons for self-harm, and parenting style. Youths and caregivers were recruited from a public hospital in Singapore. The study found that youths with more severe self-harm are more likely to seek help from non-professionals, whereas youths with parents who are highly responsive and provide consistent discipline are less likely to seek help from non-professionals. None of the factors studied were relevant in whether youths sought help from professionals. The findings from this study can guide professionals to prevent and treat self-harm in Asia, as well as improve efforts to encourage Asian youths to seek help. [ABSTRACT FROM AUTHOR]

Objectives: Our aim was to systematically review published evidence on the construct validity, test-retest reliability and responsiveness of generic preference-based measures (PBMs) used in East and South-East Asia.Methods: This systematic review was guided by the COSMIN guideline. A literature search on the MEDLINE, EMBASE, PsycINFO and PubMed databases up to August 2019 was conducted for measurement properties validation papers of the EuroQol-5 Dimensions (EQ-5D), Short Form-6 Dimensions (SF-6D), Health Utilities Index (HUI), Quality of Well-Being (QWB), 15-Dimensional (15D) and Assessment of Quality of Life (AQOL) in East and South-East Asian countries. Included papers were disaggregated into individual studies whose results and quality of design were rated separately. The population-specific measurement properties (construct validity, test-retest reliability and responsiveness) of each PBM were assessed separately using relevant studies. The overall methodological quality of the studies used in each of the assessments was also rated.Results: A total of 79 papers containing 1504 studies were included in this systematic review. The methodological quality was 'very good' or 'adequate' for the majority of the construct validity studies (99%) and responsiveness studies (61%), but for only a small portion of the test-retest reliability studies (23%). EQ-5D was most widely assessed and was found to have 'sufficient' construct validity and responsiveness in many populations, while the SF-6D and EuroQol-Visual Analog Scale (EQ-VAS) exhibited 'inconsistent' construct validity in some populations. Scarce evidence was available on HUI and QWB, but current evidence supported the use of HUI.Conclusions: This systematic review provides a summary of the quality of existing generic PBMs in Asian populations. The current evidence supports the use of EQ-5D as the preferred choice when a generic PBM is needed, and continuous testing of all PBMs in the region. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is a multifaceted global health problem disproportionately affecting low- and middle-income countries (LMICs). The Capturing data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project was tasked to expand the volume of AMR and antimicrobial use data in Asia. The CAPTURA project used 2 data-collection streams: facility data and project metadata. Project metadata constituted information collected to map out data sources and assess data quality, while facility data referred to the retrospective data collected from healthcare facilities. A down-selection process, labelled "the funnel approach" by the project, was adopted to use the project metadata in prioritizing and selecting laboratories for retrospective AMR data collection. Moreover, the metadata served as a guide for understanding the AMR data once they were collected. The findings from CAPTURA's metadata add to the current discourse on the limitation of AMR data in LMICs. There is generally a low volume of AMR data generated as there is a lack of microbiology laboratories with sufficient antimicrobial susceptibility testing capacity. Many laboratories in Asia are still capturing data on paper, resulting in scattered or unused data not readily accessible or shareable for analyses. There is also a lack of clinical and epidemiological data captured, impeding interpretation and in-depth understanding of the AMR data. CAPTURA's experience in Asia suggests that there is a wide spectrum of capacity and capability of microbiology laboratories within a country and region. As local AMR surveillance is a crucial instrument to inform context-specific measures to combat AMR, it is important to understand and assess current capacity-building needs while implementing activities to enhance surveillance systems. [ABSTRACT FROM AUTHOR]

This paper examines the link between reliance on Facebook for news, political knowledge, and political engagement in the Philippines. We tested five hypotheses using data gathered from an online survey of 978 Filipinos conducted from February 1 to March 31, 2016. Findings support the hypothesis that those who rely less on social media as a news source exhibit higher levels of perceived knowledge about politics than those who rely more on it for news. Controlling for traditional news use, following political officials or institutions on social media is associated with higher levels of political interest and engagement, those with more politically active friends on Facebook have higher levels of exposure to political content online, and there is a positive correlation between Facebook being a source of information about politics and discussing politics more often with others. However, the hypothesis that those with more friends on their network who are politically active, will have greater political knowledge and more political engagement than those who have few politically active friends on their Facebook network is not supported. [ABSTRACT FROM AUTHOR]

With increasing concerns about urban air quality and carbon emissions, electric vehicles (EVs) have gained popularity in megacities, especially in Europe and Asia. The energy consumption of EVs has subsequently caught researchers’ attention. However, the exploration of energy consumption of EVs has largely focused on people’s revealed driving behavior and rarely touched on their self-perception of driving styles. In this paper, we developed a more human-centric approach, aiming to investigate how the energy efficiency of EVs is shaped by the driving behavior and driving style in the urban scenario from field test data and driving style questionnaires (DSQs). Field tests were carried out on a designated route for a total of 13 drivers in the city of Beijing, where vehicle operation parameters were recorded under both congested and smooth traffic conditions. DSQs were collected from a larger pool of drivers including the field test drivers to be applied to driving style factor analysis. The results of a correlation analysis demonstrate the dynamic interaction between drivers’ revealed behavior and stated driving style under different traffic conditions. We also proposed an energy consumption prediction model with the fusion of collected driving parameters and DSQ data and the result is promising. We hope that this study would draw inspiration for future research on people’s transitioning driving behavior in an electric-mobility era. [ABSTRACT FROM AUTHOR]

Background and aims Prohibitions on producing, distributing and selling cannabis are loosening in various jurisdictions around the world. This paper describes the diversification of cannabis supply laws and discusses the challenges to and opportunities for learning from these changes. Methods We document changes in cannabis supply laws that de jure legalized cannabis production for medical and/or non-medical purposes (excluding industrial hemp) in Australasia, Europe, North America and South America. We also highlight challenges to evaluating these legal changes based on our experiences studying cannabis laws and policies in the United States. Findings As of August 2016, two countries have passed laws to legalize large-scale cannabis production for non-medical purposes at the national (Uruguay) or subnational level (four US states). At least nine other countries legally allow (or will soon allow) cannabis to be supplied for medicinal purposes. Most of the changes in cannabis supply laws have occurred since 2010. The data available in most countries are inadequate for rigorously evaluating the changes in cannabis supply laws. Conclusion The evidence base for assessing changes in cannabis supply laws remains weak. Efforts should focus upon collecting information about quantities consumed and market transactions as well as validating self-report surveys. [ABSTRACT FROM AUTHOR]

Hand grip strength (HGS) is an important diagnostic tool for sarcopenia and a reliable predictor for age-related chronic diseases and mortality. Interventions in nutrition have been shown as a low-cost strategy to maintain muscular strength and mass. However, there are limited data on the effect of diet on HGS in Southeast Asian populations. This study aims to investigate the association of diet quality with HGS weakness and asymmetry in a multi-ethnic population in Singapore. This cross-sectional study used data from the Singapore Multi-Ethnic Cohort (n = 1547). Dietary data were collected using a validated semi-quantitative FFQ and summarised as the Dietary Quality Index – International (DQI-I). HGS was calculated as the maximum value of six measurements from both hands. HGS weakness and asymmetry were defined using well-recognised criteria. Multivariable linear regression and logistic regression were utilised for continuous and binary outcomes, respectively, adjusting for age, sex, ethnicity, physical activity and smoking status. It was found that the highest quartile of DQI-I was significantly associated with higher HGS (β = 1·11; 95 % CI 0·41, 1·82; P for trend < 0·001) and lower odds of HGS asymmetry (OR = 0·71; 95 % CI 0·53, 0·94; P for trend = 0·035) and both HGS weakness and asymmetry (OR = 0·50; 95 % CI 0·32, 0·76; P for trend = 0·004). Among the different components of DQI-I, only dietary adequacy was significantly associated with higher HGS (P for trend < 0·001) and lower odds for both HGS weakness and asymmetry (P for trend = 0·006). Our findings support that DQI-I, an indicator of overall diet quality, can be used to provide dietary guidelines for prevention and management of muscle wasting, sarcopenia and frailty. [ABSTRACT FROM AUTHOR]

Background: Kangaroo mother care has been highlighted as an effective intervention package to address high neonatal mortality pertaining to preterm births and low birth weight. However, KMC uptake and service coverage have not progressed well in many countries. The aim of this case study was to understand the institutionalisation processes of facility-based KMC services in three Asian countries (India, Indonesia and the Philippines) and the reasons for the slow uptake of KMC in these countries. Methods: Three main data sources were available: background documents providing insight in the state of implementation of KMC in the three countries; visits to a selection of health facilities to gauge their progress with KMC implementation; and data from interviews and meetings with key stakeholders. Results: The establishment of KMC services at individual facilities began many years before official prioritisation for scale-up. Three major themes were identified: pioneers of facility-based KMC; patterns of KMC knowledge and skills dissemination; and uptake and expansion of KMC services in relation to global trends and national policies. Pioneers of facility-based KMC were introduced to the concept in the 1990s and established the practice in a few individual tertiary or teaching hospitals, without further spread. A training method beneficial to the initial establishment of KMC services in a country was to send institutional health-professional teams to learn abroad, notably in Colombia. Further in-country cascading took place afterwards and still later on KMC was integrated into newborn and obstetric care programs. The patchy uptake and expansion of KMC services took place in three phases aligned with global trends of the time: the pioneer phase with individual champions while the global focus was on child survival (1998-2006); the newborn-care phase (2007-2012); and lastly the current phase where small babies are also included in action plans. Conclusions: This paper illustrates the complexities of implementing a new healthcare intervention. Although preterm care is currently in the limelight, clear and concerted country-led KMC scale-up strategies with associated operational plans and budgets are essential for successful scale-up. [ABSTRACT FROM AUTHOR]

Background: Multiple masculinities have been explicated through latent class analysis (LCA) in South Africa, and a question arises as to whether men can be similarly grouped by their behaviour in very different cultural contexts, and whether an analysis would point to similar origins to men's use of violence against women. The UN Multi-country Study on Men and Violence in Asia and the Pacific's data set enabled this question to be explored.Methods: In nine sites in six countries, data were collected from one man (18-49 years) interviewed in each of a random sample of households. Using LCA, we categorised men based on their probability of having engaged in 10 acts of violence against women or other illegal or sexually risky behaviour. We present multinomial logistic regression models of factors associated with class membership and associated childhood and trauma experiences.Results: The LCA model with 5 classes fitted best: the largest class (59.5% of men) had the lowest probabilities of engagement in the class-defining acts; men in the second (21.2%) were otherwise law abiding and not sexually risky, but very violent towards partners; men in the third (7.9%) had the highest probability of engagement in all violent and illegal behaviour; men in the fourth (7.8%) demonstrated behaviour at the nexus of sex and power including rape and transacted sex; and men in the fifth (3.6%), engaged in anti-social behaviour, but were less violent towards women and sexually risky. Assignment to more violent classes was associated with poverty, substance abuse and depression, and more gender inequitable attitudes and practices. Child abuse, neglect and bullying were associated with being in the more violent classes. Neither men's domestic practices nor their fathers' presence in their childhood were associated with class.Conclusions: Closely paralleling the South African findings, we have highlighted the childhood origins of men's violent and anti-social behaviour, as well as the interrelationships with men's mental health, poverty and misogyny, showing that these (intersectional) developmental processes transcend culture and setting. We need to prevent children's exposure to violence, and in gender transformative work with men, recognise and address past and present psychological distress stemming from trauma experience. [ABSTRACT FROM AUTHOR]

Aim The dramatic rise in childhood obesity incidence in developing countries is related to nutrition and lifestyle transition. The aim of this review was to evaluate the quality and reporting of dietary assessment methods used in studies examining the relationship between dietary outcome and childhood obesity in developing Asian countries. Methods A three-step search strategy was conducted in databases between inception and 2011 with an English language restriction. Inclusion criteria were any cross-sectional or cohort studies in children ≤18 years who resided in developing countries in Asian region that included reporting on dietary intake. Papers were screened with standardised tools for quality and dietary methodology reporting. Results The search process identified 2080 studies and 15 studies (in 16 articles) met inclusion criteria. The most commonly used dietary assessment method was dietary questionnaires (n = 10), followed by 24-hour diet recall (n = 4), food frequency questionnaire (n = 3) and an unweighed food record (n = 1). For dietary methodology reporting, 12 out of 16 articles were rated as 'poor', 3 rated as 'acceptable' and 1 as 'excellent'. Conclusions The quality rating was influenced by the dietary assessment tool chosen, and a quality rating of 'poor' was mostly obtained by studies using non-standardised, non-validated study-specific dietary questionnaires. Significant gaps were identified in dietary intake methodological quality and hence, there is an urgent need for valid dietary measures and reporting of dietary intake among overweight children for studies conducted in Asian region. [ABSTRACT FROM AUTHOR]

Summary: The quality of life during the first 4 months after fracture was estimated in 2,808 fractured patients from 11 countries. Analysis showed that there were significant differences in the quality of life (QoL) loss between countries. Other factors such as QoL prior fracture and hospitalisation also had a significant impact on the QoL loss. Introduction: The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) was initiated in 2007 with the objective of estimating costs and quality of life related to fractures in several countries worldwide. The ICUROS is ongoing and enrols patients in 11 countries (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, UK and the USA). The objective of this paper is to outline the study design of ICUROS and present results regarding the QoL (measured using the EQ-5D) during the first 4 months after fracture based on the patients that have been thus far enrolled ICUROS. Methods: ICUROS uses a prospective study design where data (costs and quality of life) are collected in four phases over 18 months after fracture. All countries use the same core case report forms. Quality of life was collected using the EQ-5D instrument and a time trade-off questionnaire. Results: The total sample for the analysis was 2,808 patients (1,273 hip, 987 distal forearm and 548 vertebral fracture). For all fracture types and countries, the QoL was reduced significantly after fracture compared to pre-fracture QoL. A regression analysis showed that there were significant differences in the QoL loss between countries. Also, a higher level of QoL prior to the fracture significantly increased the QoL loss and patients who were hospitalised for their fracture also had a significantly higher loss compared to those who were not. Conclusions: The findings in this study indicate that there appear to be important variations in the QoL decrements related to fracture between countries. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine information seeking pattern of science and art research scholars and for this the data was gathered using questionnaire survey of 139 randomly selected Ph.D scholars of Science and Arts departments of Asia's largest residential university Banaras Hindu University, India. It has been found that both the groups of researchers have some similarities and some dissimilarity in information seeking. Even in this electronic era some research scholars of art discipline depend on print form of publications for their information needs. [ABSTRACT FROM AUTHOR]

In this study, we aimed to investigate the prevalence of poor mental health and its association with loneliness and social support among 3531 undergraduate students in nine Asian countries. Mental health was assessed using the Self-Reporting Questionnaire, which was developed by the World Health Organization. Across the entire sample, we detected that nearly half of the students reported poor mental health according to the Self-Reporting Questionnaire and nearly one out of seven students felt lonely. While feeling lonely increased the odds of experiencing poor mental health (odds ratio [OR]), moderate (OR: 0.35) and strong social support (OR: 0.18) decreases the odds of experiencing poor mental health. The high prevalence of poor mental health calls for further in-depth investigations and implementation of mental health support interventions. [ABSTRACT FROM AUTHOR]

Internet usage among adolescents has increased substantially over the last years, concurrently with emerging concerns that an abusive use is associated with detrimental health outcomes. Our objective was to examine the association between age of first exposure and heavy Internet usage in different domains. Data from the 2018 wave of the Programme for International Student Assessment (PISA) were retrieved. This included a total of 317,443 participants (49.2% boys) aged 15 and 16 years from 52 countries. Data from both Internet use and age of first exposure were retrieved and used to conduct metanalyses with random effects. Adolescents reporting an age of first exposure of Internet usage at ≥ 13 years old had the lowest odds for heavy Internet use (> 2 h/day) (reference group: ≤ 9 years) during weekends (odds ratio, 0.41 [95% CI, 0.35–0.48]), weekdays (odds ratio, 0.45 [95% CI, 0.37–0.56]), and during school time (odds ratio (odds ratio, 0.86 [95% CI, 0.77–0.96]) even when adjusted for sex, socioeconomic status, and country. A stronger association was observed in adolescents from South and Central America and Eastern Mediterranean regions in the domain of weekends and weekdays. The results indicate that early internet exposure is associated with heavy Internet use, particularly during weekends and weekdays, regardless the geographical region, in a linear fashion. Further research should aim to examine if better education and parental control in specific areas may avoid excessive Internet use that possibly have a negative influence on both mental and physical health. [ABSTRACT FROM AUTHOR]

Background: Parental support is crucial for children's healthy lifestyle formation. The present study examined the relations between parental support (i.e., encouragement and praise), children's perceived autonomy support and behaviors in the domains of physical activity (PA) and diet, and health-related quality of life (HRQoL) simultaneously in Asia. Method: Children aged 9 to 12 years and their parents (2065 dyads) in three Asian cities completed the respective questionnaires. Children reported perceived PA and dietary autonomy support, PA frequency, dietary behaviors, and HRQoL. Parents reported their PA and dietary support. The relations between parental support, children's perceived autonomy support an behaviors in the PA, and dietary domains as well as HRQoL were examined using multigroup path analyses. Results: Among three cities, the indirect effects of parental support on children's self-report PA or HRQoL via children's perceived PA autonomy support were significant. A hypothetical sequential indirect effect from parental PA support to children's HRQoL via children's perceived PA autonomy support and self-report PA was observed in Hong Kong. In Hong Kong and Taipei samples, the indirect effect of parental PA support on children's HRQoL via children's self-report PA and the indirect effect of children's perceived PA autonomy support on HRQoL via children's self-report PA were significant. In Hong Kong and Shanghai samples, children's perceived dietary autonomy support showed positive effect on HRQoL via healthy food consumption. Conclusions: Congruent findings across three cities suggest that parents should provide support via encouragement and praise to facilitate children's perceived autonomy support and further increase PA and HRQoL. Our study adds to the literature by examining relations of parental support and children's healthy lifestyle in Asia and provides insights to parents and researchers. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to examine and compare decision‐making preferences on end‐of‐life care for older people in Japan, the Hong Kong SAR and South Korea. Background: Cultural values and beliefs influence decision‐making on end‐of‐life care. Design: A cross‐sectional design was adopted. Methods: Community‐dwelling people aged ≥65 with additional requirements were recruited in 2016–2017 in the three regions. Their decision‐making preferences on end‐of‐life care were assessed using Pang et al.'s questionnaire. These preferences and their sociodemographic and personal experience variables were compared and analysed using univariate and multiple logistic regressions. The STROBE checklist was followed. Results: This study involved 415 participants. In all three regions, the most preferred decision maker and person with whom to discuss end‐of‐life care issues was a family member. Participants in the Hong Kong SAR were less likely to select a family member as their preferred decision maker than those in Japan (adjusted odds ratio = 0.129). Koreans were less likely to discuss end‐of‐life care issues with medical professionals than people in Japan (adjusted odds ratio = 0.278). More than 70% of the participants in each region indicated that they would not prefer to leave an advance directive to decide their end‐of‐life care. Conclusion: Older Asians prefer to make their own decisions after consulting others. Family members play an important role in helping older people plan their preferred end‐of‐life care arrangements, even acting as decision makers when older people become incapable of deciding for themselves. Relevance to clinical practice: Sufficient information should be provided to older people and their families for the older people to determine their preferred care. Helping families to understand and support the planned care and advance directives is a strategy for maximising family compliance with the care. Continuous efforts should be made to promote advance care planning and advance directives. [ABSTRACT FROM AUTHOR]

Background: Non‐pharmacologic interventions might be effective to reduce the incidence of delirium in pediatric intensive care units (PICU). Aim: To explore expert opinions and generate informed consensus decisions regarding the content of a non‐pharmacologic delirium bundle to manage delirium in PICU patients. Study design: A two‐round online Delphi study was conducted from February to April 2021. PICU experts (nurses, physicians, researchers, physical therapists, play specialists, and occupational therapists) located in Europe, North America, South America, Asia, and Australia participated. Results: We developed a questionnaire based on the outcomes of a comprehensive literature search in the domains: 1) cognition support; 2) sleep support; and 3) physical activity support. Under these domains, we listed 11 strategies to promote support with 61 interventions. Participants rated the feasibility of each intervention on a 9‐point Likert scale (ranging from 1 strongly disagree to 9 strongly agree). A disagreement index and panel median were calculated to determine the level of agreement among experts. In the second round, participants reassessed the revised statements and ranked the interventions in each domain in order of importance for age groups: 0–2, 3–5, and 6–18 years of age. During the first Delphi round, 53 of 74 (72%) questionnaires were completed, and in the second round 45 of 74 (61%) were completed. Five of the highest ranked interventions across the age groups were: 1) developing a daily routine, 2) adjusting light exposure according to the time of day, 3) scheduling time for sleep, 4) providing eyeglasses and hearing aids if appropriate, 5) encouraging parental presence. Conclusions: Based on expert consensus, we developed an age‐specific non‐pharmacologic delirium bundle of interventions to manage delirium in PICU patients. Relevance to Clinical Practice: An age‐specific Non‐Pharmacological Delirium bundle is now ready to be tested in the PICU and will hopefully reduce pediatric delirium. [ABSTRACT FROM AUTHOR]

Background: The potential effects of dietary oxalate (Ox) intake on cardio-renal function have remained unestablished. We evaluated the effect of usual Ox intake and its interaction with dietary calcium (Ca) on incident hypertension (HTN) and chronic kidney disease (CKD). Methods: Adult men and women, free of HTN and CKD at baseline (2006–2008), were recruited. Dietary intakes were assessed using a validated food frequency questionnaire, and the outcomes were documented up to 2014–2017. Multivariate Cox proportional hazard regression models were used to estimate the development of HTN and CKD in relation to Ox intakes. Repeated-measures generalized estimating equation (GEE) linear regression models were used to assess possible effect of Ox-intake on the estimated glomerular filtration rate (eGFR) and blood pressure levels over eight years. Results: Dietary Ox intakes were positively associated with incident CKD (HR = 2.59, 95% CI = 1.46–4.64) and HTN (HR = 1.79, 95% CI = 1.05–3.04). Compared to high-Ca consumers, subjects who had lower Ca intakes (< 990 vs. 1580 mg/d) had a higher incidence of CKD and HTN (HR = 2.43, 95% CI = 1.06–5.55, and HR = 1.72, 95% CI = 0.76–3.78). Participants with higher intakes of Ox (> 220 vs. < 150 mg/d) had lower eGFR values (75.3, 95% CI = 75.0–76.5 vs. 77.3, 95% CI = 76.6–78.1 mL/min/1.73m2, Ptime×group = 0.004) and higher SBP levels (112, 95% CI = 111–113 vs. 109, 95% CI = 108–110 mmHg, Ptime×group = 0.007) overtime. Conclusion: Higher dietary Ox intake may increase the risk of HTN and CKD. The relation between dietary Ox and risk of HTN and CKD seems to be varied by Ca intake, and subjects with lower Ca intakes may be more burdened by excessive amounts of dietary Ox. [ABSTRACT FROM AUTHOR]

Objective: Pharmacotherapy of depression in children and adolescents is complex. In the absence of research into the efficacy and safety of antidepressants in this group of patients, their off-label prescription is common. This paper aimed to illustrate the prescription pattern of antidepressants in children and adolescents from major psychiatric centres in Asia. Methods: The Research on Asia Psychotropic Prescription Pattern on Antidepressants worked collaborati vely in 2013 to study the prescription pattern of antidepressants in Asia using a unified research protocol and questionnaire. Forty psychiatric centres from 10 Asian countries / regions participated and 2321 antidepressant prescriptions were analysed. Results: A total of 4.7% antidepressant prescriptions were for children and adolescents. Fluoxetine, sertraline, and escitalopram were the most common antidepressants prescribed for children and adolescents. Almost one-third (30.3%) of prescriptions were for diagnoses other than depressive and anxiety disorders. There was less antidepressant polypharmacy and concomitant use of benzodiazepine, but more concomitant use of antipsychotics in children and adolescents compared with adults. Conclusion: Off-label use of antidepressants in children and adolescents was reported by 40 Asian psychiatric institutions that participated in the study. In-service education and regulatory mechanisms should be reinforced to ensure efficacy and safety of antidepressants in children and adolescents. [ABSTRACT FROM AUTHOR]

Background: A glaucoma-specific health-related quality of life (HRQoL) item bank (IB) and computerized adaptive testing (CAT) system relevant to Asian populations is not currently available. We aimed to develop content for an IB focusing on HRQoL domains important to Asian people with glaucoma; and to compare the content coverage of our new instrument with established glaucoma-specific instruments. Methods: In this qualitative study of glaucoma patients recruited from the Singapore National Eye Centre (November 2018-November 2019), items/domains were generated from: (1) glaucoma-specific questionnaires; (2) published articles; (3) focus groups/semi-structured interviews with glaucoma patients (n = 27); and (4) feedback from glaucoma experts. Data were analyzed using the constant comparative method. Items were systematically refined to a concise set, and pre-tested using cognitive interviews with 27 additional glaucoma patients. Results: Of the 54 patients (mean ± standard deviation [SD] age 66.9 ± 9.8; 53.7% male), 67 (62.0%), 30 (27.8%), and 11 (10.2%) eyes had primary open angle glaucoma, angle closure glaucoma, and no glaucoma respectively. Eighteen (33.3%), 11 (20.4%), 8 (14.8%), 12 (22.2%), and 5 (9.3%) patients had no, mild, moderate, severe, or advanced/end-stage glaucoma (better eye), respectively. Initially, 311 items within nine HRQoL domains were identified: Visual Symptoms, Ocular Comfort Symptoms, Activity Limitation, Driving, Lighting, Mobility, Psychosocial, Glaucoma management, and Work; however, Driving and Visual Symptoms were subsequently removed during the refinement process. During cognitive interviews, 12, 23 and 10 items were added, dropped and modified, respectively. Conclusion: Following a rigorous process, we developed a 221-item, 7-domain Asian glaucoma-specific IB. Once operationalised using CAT, this new instrument will enable precise, rapid, and comprehensive assessment of the HRQoL impact of glaucoma and associated treatment efficacy. [ABSTRACT FROM AUTHOR]

Physical activity (PA) can help individuals maintain physical function and independence. The association between PA and functional limitations (FL) has not been explored in the Native Hawaiian and Pacific Islander (NHPI) population. The purpose of this study was to examine relationships between PA and FL among NHPI adults (age ≥ 45 years) living in the United States. Cross-sectional data from the 2014 NHPI-National Health Interview Survey (N = 628) was used to create three constructs of FL based on responses from the Functioning and Disability Survey Module: needing equipment/assistance, having difficulty walking, and having difficulty with performing self-care and other fine motor activities. We used 2-stage least squares regression to examine the relationship between PA and FL of NHPI adults while accounting for the potential endogeneity of PA to FL. Compared to NHPI adults who met the guideline for recommended levels of aerobic and strengthening PA, those who met only the strengthening guideline experienced less difficulty in two FL constructs (use of medical equipment/assistance and difficulty walking). Those who met the aerobic guideline reported even less difficulties in all three FL constructs. NHPI adults who met both the aerobic and strengthening guidelines experienced the least difficulties in all three FL constructs compared to those who met neither PA guidelines. PA is associated with function in this adult NHPI population. Aerobic guidelines alone may be more beneficial than meeting the strengthening guideline alone; however, meeting both the aerobic and strengthening guidelines is most protective against FL. [ABSTRACT FROM AUTHOR]

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13–15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22–1.29; boys, OR 1.29, 95% CI 1.25–1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place. [ABSTRACT FROM AUTHOR]

This study explores the effects of the perspective-taking of non-player characters (NPCs) on enhancing game immersion in prosocial virtual reality (VR) games. Prosocial games are games focusing on helping others. Game researchers have been keen to investigate factors that influence the immersive experience in digital games. Previous studies show that VR allows people to take the perspective of others, inducing empathy and prosocial behaviour in the real world. In this lab-based study, we explore whether and how taking the perspective of other game characters – NPCs in a prosocial VR game – influences players' in-game empathy towards NPCs and game immersion. Participants first experienced either a robot's perspective of being destroyed by fire in VR or read a text description about the same event. Then, they participated a prosocial VR game in which they saved robots. The findings show that perspective-taking experiences indirectly enhance participants' game immersion via the effects of closeness with the destroyed robot and empathy towards the four robots protected by the player. This indirect effect is moderated by players' weekly exposure to video games. These results suggest that VR-based perspective-taking of NPCs can indirectly enhance gameplay experiences in prosocial VR games. Theoretical and game design implications are discussed. [ABSTRACT FROM AUTHOR]

This study explored how managers' fairness perceptions of performance evaluation systems differ across countries and relate to their job satisfaction. Lack-of-group bias and transparency were the constructs used to assess fairness perceptions. The data sample consisted of 903 Asian managers from the subsidiaries of a leading multinational corporation ( MNC) strategically expanding its retail markets in Japan, China, Hong Kong, Malaysia, and Thailand. Results showed that the fairness perceptions of lack-of-group bias and transparency concerning the common performance evaluation system varied within these Asian countries. Furthermore, those fairness perceptions were significantly related to job satisfaction among Asian managers overall, as well as in each of the five geographical subgroups with the exception of Hong Kong, where the perception of a lack-of-group bias was only marginally related to job satisfaction. These findings offer theoretical implications regarding organizational justice, cross-national management, and performance evaluation, as well as practical implications for leveraging organizational justice perceptions of performance evaluation systems for the effectiveness of MNCs. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: In resource-constrained health systems medical travel is a common alternative to seeking unavailable health services. This paper was motivated by the need to understand better the impact of such travel on households and health systems. Methods: We used primary data from 344 subsidized and 471 non-subsidized inbound medical travellers during June to December 2013 drawn from the North, Centre and South regions of the Maldives where three international airports are located. Using a researcher-administered questionnaire to acquire data, we calculated annual out-of-pocket (OOP) spending on health, food and non-food items among households where at least one member had travelled to another country for medical care within the last year and estimated the poverty head count using household income as a living standard measure. Results: Most of the socio demographic indicators, and costs of treatment abroad among Maldivian medical travellers were similar across different household income levels with no statistical difference between subsidized and non-subsidized travellers (p value: 0.499). The government subsidy across income quintiles was also similar indicating that the Maldivian health financing structure supports equality rather than being equity-sensitive. There was no statistical difference in OOP expenditure on medical care abroad and annual OOP expenditure on healthcare was similar across income quintiles. Diseases of the circulatory system, eye and musculoskeletal system had the most impoverishing effect – diseases for which half of the patients, or less, did not receive the public subsidy. Annually, 6 and 14% of the medical travellers in the Maldives fell into poverty ($2 per day) before and after making OOP payments to health care. Conclusion: Evidence of a strong association between predominant public financing of medical travel and equality was found. With universal eligibility to the government subsidy for medical travel, utilization of treatment abroad, medical expenditures abroad and OOP expenditures on health among Maldivian medical travellers were similar between the poor and the rich. However, we conclude mixed evidence on the linkages between public financing of medical travel and impoverishment which needs to be further explored with comparison of impoverishment levels between households with and without medical travel. [ABSTRACT FROM AUTHOR]