La nouvelle définition de la politique étrangère du Japon

The New Definition of Japan's Foreign Policy, by Koji Kakizawa With the end of the Cold War, Japan needs to redefïne its international role, especially its relationship with the United States. It can no longer confine itself to the role of economie contributor. Japan is called upon to undertake a more active political role, notably in the context of Asia's économie and strategie transformation. Such a policy must be implemented in the framework of regional or international organizations. Hence, Tokyo's participation in APEC and ASEM as well as in UN peace-keeping forces allows it to combine its membership in the Asian and in the industrialized worlds, and to enter the global political scene. These new responsibilities should translate into a permanent seat on the UN Security Council.Avec la fin de la guerre froide, le Japon doit redéfinir son rôle international, et en particulier ses relations avec les Etats-Unis. Il ne doit plus se limiter à une situation de contributeur économique. Il est appelé à assumer un rôle politique plus actif, notamment au sein d'une Asie en pleine mutation tant sur le plan économique que stratégique. Cette politique doit se déployer dans le cadre d'organisations régionales et internationales. Ainsi, la participation de Tokyo à l'APEC et à l'ASEM, ou aux forces de maintien de la paix des Nations unies, lui permet de combiner son appartenance aux mondes asiatique et industriel et de prendre une place sur la scène politique mondiale. Ces nouvelles responsabilités devraient se traduire par l'acquisition d'un siège de membre permanent du Conseil de sécurité des Nations unies.Kakizawa. La nouvelle définition de la politique étrangère du Japon. In: Politique étrangère, n°2 - 1996 - 61ᵉannée. pp. 293-301

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era