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Search Results: 1 - 10 of 534 matches for " Yukiko Asada "
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Assessment of the health of Americans: the average health-related quality of life and its inequality across individuals and groups
Yukiko Asada
Population Health Metrics , 2005, DOI: 10.1186/1478-7954-3-7
Abstract: This study uses the 1990 and 1995 National Health Interview Survey from the United States. The measure of HRQL is the Health and Activity Limitation Index (HALex). The measure of health inequality across individuals is the Gini coefficient. This study provides confidence intervals (CI) for the Gini coefficient by a bootstrap method. To describe health inequality by group, this study decomposes the overall Gini coefficient into the between-group, within-group, and overlap Gini coefficient using race (White, Black, and other) as an example. This study looks at how much contribution the overlap Gini coefficient makes to the overall Gini coefficient, in addition to the absolute mean differences between groups.The average HALex was the same in 1990 (0.87, 95% CI: 0.87, 0.88) and 1995 (0.87, 95% CI: 0.86, 0.87). The Gini coefficient for the HALex distribution across individuals was greater in 1995 (0.097, 95% CI: 0.096, 0.099) than 1990 (0.092, 95% CI: 0.091, 0.094). Differences in the average HALex between all racial groups were the same in 1995 as 1990. The contribution of the overlap to the overall Gini coefficient was greater in 1995 than in 1990 by 2.4%. In both years, inequality between racial groups accounted only for 4–5% of overall inequality.The average HRQL of Americans was the same in 1990 and 1995, but inequality in HRQL across individuals was greater in 1995 than 1990. Inequality in HRQL by race was smaller in 1995 than 1990 because race had smaller effect on the way health was distributed in 1995 than 1990. Analysis of the average HRQL and its inequality provides information on the health of a population invisible in the traditional analysis of population health.To assess the health of a population, we have traditionally relied on the average or overall level of health in a population. For example, 77.2 years of life expectancy for Americans in 2001 [1] or an infant mortality rate of 6.8 per 1,000 in the United States in 2001 [2] provide some information ab
Need-based resource allocation: different need indicators, different results?
George Kephart, Yukiko Asada
BMC Health Services Research , 2009, DOI: 10.1186/1472-6963-9-122
Abstract: Using the 2000/2001 Canadian Community Health Survey, we estimated relative per capita need for general practitioner, specialist, and hospital services by province using two approaches that incorporated a different set of need indicators: (1) demographics (age and sex), and (2) demographics, socioeconomic status, and health status. For both approaches, we first fitted regression models to estimate standard utilization of each of three types of health services by indicators of need. We defined the standard as average levels of utilization by needs indicators in the national sample. Subsequently, we estimated expected per capita utilization of each type of health services in each province. We compared these estimates of per capita relative need with premature mortality in each province to check their face validity.Both approaches suggested that expected relative per capita need for three services vary across provinces. Different approaches, however, yielded different and inconsistent results. Moreover, provincial per capita relative need for the three health services did not always indicate the same direction of need suggested by premature mortality in each province. In particular, the two approaches suggested Newfoundland had less need than the Canadian average for all three services, but it had the highest premature mortality in Canada.Substantial differences in need for health care may exist across Canadian provinces, but the direction and magnitude of differences depend on the need indicators used. Allocations from models using survey data lacked face validity for some provinces. These results call for the need to better understand the biases that may result from the use of survey data for resource allocation.A key policy objective in most publicly financed health care systems is to allocate resources according to need. Many jurisdictions implement this policy objective through need-based allocation models. A number of countries (e.g., Australia, Norway, the Unite
Equity in health services use and intensity of use in Canada
Yukiko Asada, George Kephart
BMC Health Services Research , 2007, DOI: 10.1186/1472-6963-7-41
Abstract: We used a nationally representative cross-sectional survey, the 2000/01 Canadian Community Health Survey, which provides a large sample size (about 110,000) and permits more comprehensive adjustment for need indicators than previous studies. We separately examined general practitioner, specialist, and hospital services using two-part hurdle models: use versus non-use by logistic regression, and the intensity of use among users by zero-truncated negative binomial regression.We found that lower income was associated with less contact with general practitioners, but among those who had contact, lower income and education were associated with greater intensity of use of general practitioners. Both lower income and education were associated with less contact with specialists, but there was no statistically significant relationship between these socioeconomic variables and intensity of specialist use among the users. Neither income nor education was statistically significantly associated with use or intensity of use of hospitals.Our study unveiled possible socioeconomic inequities in the use of health care services in Canada.Universal health care systems aim to provide health services based on need. Among many forms of the provision of universal health care systems around the world, the Canadian system is one of the most ambitious with public financing for all physician and hospital services deemed medically necessary with no payment at the point of service. Since the establishment of the Canada Health Act in 1984, which set criteria of public administration, comprehensiveness, universality, portability, and accessibility, supporters of the Canadian health care system have been a strong advocate for equal access for equal need. They have striven to remove financial or other barriers to access to physician and hospital services.To what extent has the Canadian health care system met this goal of equitable access? In a comprehensive review of the Canadian literature on equit
A Problem with the Individual Approach in the WHO Health Inequality Measurement
Yukiko Asada, Thomas Hedemann
International Journal for Equity in Health , 2002, DOI: 10.1186/1475-9276-1-2
Abstract: We look at the three questions: (1) is the World Health Organization's health inequality measure value-free as it claims? (2) if it is not, what is the normative position implied by its approach when measuring health inequality? and (3) is the individual approach a logically consistent methodological choice for that normative position?We argue that the World Health Organization's health inequality measure is not value-free. If it was, the health inequality information that the measurement collected could not reasonably be included in its ranking of how well national health systems performed. The World Health Organization's normative position can be interpreted as a quite expansive view of justice, in which health distributions that have causes amenable to human intervention are considered to be matters of justice. Our conclusion is that if the World Health Organization's health inequality measure is to be interpreted meaningfully in a policy context, its conceptual underpinning must be re-evaluated.In the World Health Report 2000, the World Health Organization (WHO) proposed two principles by which the performance of national health system should be assessed: "goodness, the best attainable average level" and "fairness, the smallest feasible differences among individuals and groups" [1], p. xi]. These two principles are translated into five indicators in its index of national health system's performance, and one of them is the level of health inequality within nations. For this, the WHO made the controversial choice to measure inequality across individuals rather than across groups, the standard in the field [2,3]. Although the WHO's choice has already been widely discussed and criticized [4-13], we believe there are further important points to make.We look at the following three questions in this paper. First, is the WHO health inequality measure in fact value-free as it claims? Second, if, as we will argue, it is not, what is the normative position implied by the W
The ideal of equal health revisited: definitions and measures of inequity in health should be better integrated with theories of distributive justice
Ole Norheim, Yukiko Asada
International Journal for Equity in Health , 2009, DOI: 10.1186/1475-9276-8-40
Abstract: The past decade witnessed great progress in research on health inequities. The standard use of terms is now firmly established among health researchers and policy makers. In the words of Kawachi, Subramanian, and Almeida-Filho, "health inequality is the generic term used to designate differences, variations, and disparities in the health achievements of individuals and groups," "while health inequity refers to those inequalities in health that are deemed to be unfair or stemming from some form of injustice" [1]. Researchers and policy makers can now choose their definition of health inequity from a wide menu of views proposed by many scholars in the past decade [2-7]. Although desired results have not always been achieved, many countries and international organizations have for some time embraced a goal of redressing health inequities by improving the health of populations [8]. The attempt to describe existing health inequities continues, and guidance on how to measure health inequities is now available[9,10] along with novel measures of health inequities [11,12].Given the explosive growth of interest in health inequities in the past decade, it is interesting that the most widely cited definition of health inequity still is, arguably, the one proposed by Whitehead and Dahlgren in 1991: "Health inequalities that are avoidable, unnecessary and unfair are unjust." [13]. The simplicity and all-encompassing nature of this definition are certainly attractive, but it is rudimentary in the light of recent developments in health inequity research. The Whitehead/Dahlgren definition is useful, but not linked to broader theories of justice [3]. For example, health inequalities that are "avoidable or unnecessary" are, presumably, those we as a society could do something about. But are all avoidable health inequalities arising from, say, small differences in income or educational level unjust? Should all non-health inequalities be eliminated if they are associated with inequaliti
Usefulness of Fractional Exhaled Nitric Oxide-Guided Treatment in Patients with Asthma-Chronic Obstructive Pulmonary Disease Overlap  [PDF]
Taisuke Akamatsu, Toshihiro Shirai, Yuko Tanaka, Hirofumi Watanabe, Yoshinari Endo, Yukiko Shimoda, Takahito Suzuki, Rie Noguchi, Mika Saigusa, Akito Yamamoto, Yuichiro Shishido, Takefumi Akita, Satoru Morita, Kazuhiro Asada
Open Journal of Respiratory Diseases (OJRD) , 2018, DOI: 10.4236/ojrd.2018.81001
Background: Some patients present clinical features of both asthma and chronic obstructive pulmonary disease (COPD), which has led to the recent proposal of asthma-COPD overlap (ACO) as a diagnosis. Fractional exhaled nitric oxide (FeNO) is a candidate biomarker to diagnose ACO. We assessed the effect of an add-on treatment with budesonide/formoterol (BUD/FM) combination in patients with ACO, which was diagnosed by FeNO. Methods: This was a prospective, single-arm, open-label, before and after comparison study. Subjects included 83 patients with COPD who attended outpatient clinics for routine checkups at Shizuoka General Hospital between June and November 2016. All patients fulfilled the GOLD definition of COPD and were receiving long-acting muscarinic antagonist (LAMA) or LAMA/long-acting β2 agonist (LABA) combinations. After an 8-week run-in period, BUD/FM was added to the patients with FeNO levels of ≥35 ppb, defined as having ACO. For patients receiving LAMA/LABA, BUD/FM was added after the discontinuation of LABA. The modified British Medical Research Council (mMRC) score, COPD assessment test (CAT) score, spirometric indices, forced oscillation parameters, and FeNO were assessed before and after 8 weeks of BUD/ FM add-on treatment. Results: Twenty-four patients (28.9%) had FeNO levels ≥ 35 ppb, and 17 patients completed the study (mean age: 73 years and GOLD I/II/III/IV, 5/10/1/1). The mean CAT scores significantly improved (9.2 to 5.4, p = 0.015) and 10 patients (58.8%) showed ≥2 points improvement, a minimal clinically important difference. The mean FeNO levels significantly decreased from 63.0 to 34.3 ppb (p < 0.006). However, there were no changes in mMRC scores, spirometric indices, or forced oscillation parameters. Conclusions: FeNO-guided treatment with BUD/FM improves symptoms in patients with ACO.
A team approach to improving colorectal cancer services using administrative health data
Geoffrey Porter, Robin Urquhart, Jingyu Bu, Cynthia Kendell, Maureen MacIntyre, Ron Dewar, George Kephart, Yukiko Asada, Eva Grunfeld
Health Research Policy and Systems , 2012, DOI: 10.1186/1478-4505-10-4
Abstract: The objectives of this paper are to: 1) provide a detailed description of the methodologies employed across the various studies being conducted by Team ACCESS; 2) demonstrate how administrative health data can be used to evaluate access and quality in CRC services; and 3) provide an example of an interdisciplinary team approach to addressing health service delivery issues.All patients diagnosed with CRC in NS between 2001 and 2005 were identified through the Nova Scotia Cancer Registry (NSCR) and staged using the Collaborative Stage Data Collection System. Using administrative databases that were linked at the patient level, Team ACCESS created a retrospective longitudinal cohort with comprehensive demographic, clinical, and healthcare utilization data. These data were used to examine access to and quality of CRC services in NS, as well as factors affecting access to and quality of care, at various transition points along the continuum of care. Team ACCESS has also implemented integrated knowledge translation strategies targeting policy- and decision- makers.The development of Team ACCESS represents a unique approach to CRC research. We anticipate that the skills, tools, and knowledge generated from our work will also advance the study of other cancer disease sites in NS. Given the increasing prevalence of cancer, and with national and provincial funding agencies promoting collaborative research through increased funding for research team development, the work carried out by Team ACCESS is important in the Canadian context and exemplifies how a team approach is essential to comprehensively addressing issues surrounding not only cancer, but other chronic diseases in Canada.In Canada, an estimated 22,200 new cases of colorectal cancer (CRC) were diagnosed in 2011, making it the third most commonly diagnosed cancer in both men and women in Canada [1]. Despite a modest decrease in national mortality rates over the last 20 years, CRC mortality still accounts for approxim
Nonlinear Acoustic Shadow Method to Reduce Reverberation Artifact  [PDF]
Kei Fujisawa, Akira Asada
Journal of Flow Control, Measurement & Visualization (JFCMV) , 2016, DOI: 10.4236/jfcmv.2016.42005
Abstract: A novel technique for reducing reverberation artifact in acoustic shadow imaging using nonlinear ultrasound interaction, called nonlinear acoustic shadow method, has been developed and experimentally studied. In this technique, the conventional acoustic shadow method is modified by using the secondary wave generated by nonlinear interaction of two primary sound waves emitted from parametric array. Either conventional or nonlinear acoustic shadow imaging is carried out for aluminum square cylinder and the size of the shadow is compared. The result shows that the nonlinear acoustic shadow method reduces reverberation artifact inside the square cylinder and has better accuracy in the size measurement than conventional acoustic shadow method.
Assessment of Long-Term Compost Application on Physical, Chemical, and Biological Properties, as Well as Fertility, of Soil in a Field Subjected to Double Cropping  [PDF]
Yukiko Yanagi, Haruo Shindo
Agricultural Sciences (AS) , 2016, DOI: 10.4236/as.2016.71004
Abstract: The aim of this article was to assess the influence of long-term application of compost on the physical, chemical, and biological properties, as well as the fertility, of soil in a field subjected to double cropping (paddy rice and barley), mainly by integrating previous studies of the effects of compost and manure on soil qualities. Continuous compost application, especially at a high level (30 Mg·ha-1·y-1), into the double cropping soils increased the activities of organic C-, N-, and P-decomposing enzymes and the contents of organic C, total N, and microbial biomass N, as well as the cation exchange capacity, thereby contributing to the enhancement of soil fertility. Also, the compost application increased the degree of water-stable soil macroaggregation (>0.25 mm), which was correlated significantly (r > 0.950, p < 0.05) with the contents of hydrolyzable carbohydrates (with negative charge) and active Al (with positive charge), and resulted in the modification of soil physical properties. Furthermore, the application increased the amount of soil organic matter, including humic acid with a low degree of darkening and fulvic acid, and contributed to C sequestration and storage. Physical fractionation of soil indicated that about 60% of soil organic C was distributed in the silt-sized (2 - 20 μm) aggregate and clay-sized (<2 μm) aggregate fractions, while about 30% existed in the decayed plant fractions (53 - 2000 μm). The results obtained unambiguously indicate that long-term application of compost can improve soil qualities in the field subjected to double cropping, depending on the amount applied.
Growth versus environment in dynamic models of capital accumulation
Toichiro Asada
Discrete Dynamics in Nature and Society , 2002, DOI: 10.1080/1026022021000000266
Abstract: In this paper, we study the economic implications of the trade off between growth and environment in the context of dynamic models of capital accumulation. The collective solution is formulated in terms of dynamic optimization of the central planner, and the decentralized solution is formulated in terms of differential game between workers and capitalists. We compare the economic properties of two solutions.
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