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A Realistic Path Towards A More Affordable Healthcare System For The United States, James Loome

Honors Theses

This study was performed in order to try to discover ways in which the American healthcare system can improve and become more affordable for its citizens. The main focus was to see how implementing a universal healthcare system could benefit the United States. I analyzed aspects of many different universal healthcare system structures and chose aspects that I think should or should not be included in a revised version of the US healthcare system. There was a strong focus on the aspects of Japan and Costa Rica’s healthcare systems. I also pointed out weaknesses in the US healthcare system that …

Pandemic And Õen Consumption In Japan: Deliberate Buying To Aid The Seller, Kosuke Mizukoshi, Yuichiro Hidaka

Markets, Globalization & Development Review

This dialogue contribution discusses whether it is possible to create favorable new social assistance under the market principles, based on the Ouen or Õen (aid) consumption in Japan. The meaning of consumption has changed due to the COVID-19 pandemic. In Japan, aid consumption is increasing. This means helping local restaurants and producers by willfully and proactively buying and consuming their services and products. This is a favorable form of new social assistance and the result of strong marketing and market functions. The penetration of market forces may surpass pure altruistic behavior such as donations and gifts, by creating new market-linked …

Evidence For Gene-Smoking Interactions For Hearing Loss And Deafness In Japanese American Families, Jia Y Wan, Christina Cataby, Andrew Liem, Emily Jeffrey, Trina M Norden-Krichmar, Deborah Goodman, Stephanie A Santorico, Karen L Edwards

Journal Articles

BACKGROUND: This study investigated the relationship between smoking and hearing loss and deafness (HLD) and whether the relationship is modified by genetic variation. Data for these analyses was from the subset of Japanese American families collected as part of the American Diabetes Association Genetics of Non-insulin Dependent Diabetes Mellitus study. Logistic regression with generalized estimating equations assessed the relationship between HLD and smoking. Nonparametric linkage analysis identified genetic regions harboring HLD susceptibility genes and ordered subset analysis was used to identify regions showing evidence for gene-smoking interactions. Genetic variants within these candidate regions were then each tested for interaction with …

Nonlinear Associations Between Working Hours And Overwork-Related Cerebrovascular And Cardiovascular Diseases (Ccvd), Ro-Ting Lin, Lung-Chang Chien, Ichiro Kawachi

Public Health Faculty Publications

Long working hours are recognized as a risk factor for cerebrovascular and cardiovascular diseases (CCVD). We investigated the relationship between working hours and different CCVD severity outcomes—death, disability, and illness—across industries in Taiwan from 2006 to 2016. We applied a generalized additive mixed model to estimate the association between working hours and the rate of each severity outcome, adjusted for salary, unemployment rate, time, and a random intercept. Industry-average working hours were significantly associated with each outcome level of overwork-related CCVD, especially when monthly working hours increased from 169 (relative risk [RR] = 1.46, 95% confidence interval [CI] 1.002–2.12) to …

Complementary And Alternative Medicine And Japanese Chronic Disease Patients’ Quality Of Life And Perceived Stress, Hideaki Tanaka

FIU Electronic Theses and Dissertations

This mixed methods study examined the association between the frequency of five lifestyle-related complementary and alternative medicine (CAM) practices and perceived quality of life (QOL) and stress among patients in Japan diagnosed with chronic disease, and also examined why patients decided to receive Okada purifying therapy [(OPT) biofield therapy]. Data from 1,190 patients were analyzed using bivariate and multiple regression analysis, followed by analysis of one-on-one in-depth interviews conducted among 25 patients on reasons why patients decided to practice OPT. Grounded theory methodology was used to analyze transcribed interview data.

Results of multiple regression analysis indicated that engaging in arts …

Unnecessary Dieting Intention And Behavior Among Female Students In Naha City, Japan, Khin Zay Yar Myint, Daisuke Nonaka, Masamine Jimba, Keiko Nanishi, Krishna C. Poudel, Junko Yasuoka, Masaya Miyagi, Masaki Shinjo, Jun Kobayashi

Krishna C. Poudel

Weight concerns and dieting are prevalent among female adolescents both in Western and Asian countries. They can result in negative psychological and physiological consequences. This study aimed to examine the relative importance of social and personal facts on the decision to diet of female adolescent students in Japan, applying the Theory of Planned Behavior. Data were collected from 5 junior high schools and 3 high schools in Naha City, Okinawa Prefecture, in 2010, through self-administered questionnaires. The data of 756 female students were assessed. The independent variables included social factor variables (norms) and personal factor variables (attitude to dieting, perceived …

Continuing To Confront Copd International Surveys: Comparison Of Patient And Physician Perceptions About Copd Risk And Management, Ana M. Menezes, Sarah H. Landis, Meilan K. Han, Hana Muellerova, Zaurbek Aisanov, Thys Van Der Molen, Yeon-Mok Oh, Masakazu Ichinose, David M. Mannino, Kourtney J. Davis

Preventive Medicine and Environmental Health Faculty Publications

PURPOSE: Using data from the Continuing to Confront COPD International Physician and Patient Surveys, this paper describes physicians' attitudes and beliefs regarding chronic obstructive pulmonary disease (COPD) prognosis, and compares physician and patient perceptions with respect to COPD.

METHODS: In 12 countries worldwide, 4,343 patients with COPD were identified through systematic screening of population samples, and 1,307 physicians who regularly saw patients with COPD were sampled from in-country professional databases. Both patients and physicians completed surveys about their COPD knowledge, beliefs, and perceptions; physicians answered further questions about diagnostic methods and treatment choices for COPD.

RESULTS: Most physicians (79%) responded …

Continuing To Confront Copd International Physician Survey: Physician Knowledge And Application Of Copd Management Guidelines In 12 Countries, Kourtney J. Davis, Sarah H. Landis, Yeon-Mok Oh, David M. Mannino, Meilan K. Han, Thys Van Der Molen, Zaurbek Aisanov, Ana M. Menezes, Masakazu Ichinose, Hana Muellerova

Preventive Medicine and Environmental Health Faculty Publications

AIM: Utilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease) International Physician Survey, this study aimed to describe physicians' knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease) Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs) and respiratory specialists.

MATERIALS AND METHODS: Physicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one) who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face …

The Impact Of Vaccination Schedules On Infants' And Children's Physio-Psychological Health: A Qualitative Investigation, Dina A. Alsalih

Walden Dissertations and Doctoral Studies

Many people may have become increasingly concerned about the risks associated with vaccines. At the same time, there is a lack of qualitative research on the impact of various vaccinations schedules on individuals' physio-psychological health. In addition, "mandatory" versus "nonmandatory, but recommended" vaccines are still under debate in some Western countries. The purpose of this ethnographic study was to provide an in-depth understanding of the beliefs, experiences, and perceptions of adolescents, parents, and health care providers regarding different vaccination schedules. The health belief model was used as the theoretical framework. The sample consisted of adolescents and parents from different vaccination …

Smoking Cessation Increases Short-Term Risk Of Type 2 Diabetes Irrespective Of Weight Gain: The Japan Public Health Center-Based Prospective Study, Shino Oba, Mitsuhiko Noda, Kayo Waki, Akiko Nanri, Masayuki Kato, Yoshihiko Takahashi, Kalpana Poudel-Tandukar, Yumi Matsushita, Manami Inoue, Tetsuya Mizoue, Shoichiro Tsugane

Kalpana Poudel-Tandukar

Smoking Cessation Increases Short-Term Risk Of Type 2 Diabetes Irrespective Of Weight Gain: The Japan Public Health Center-Based Prospective Study, Shino Oba, Mitsuhiko Noda, Kayo Waki, Akiko Nanri, Masayuki Kato, Yoshihiko Takahashi, Kalpana Poudel-Tandukar, Yumi Matsushita, Manami Inoue, Tetsuya Mizoue, Shoichiro Tsugane

Elaine Marieb College of Nursing Faculty Publication Series

Objective: The effect of smoking cessation on the risk of diabetes has been reported previously. However, it is unknown whether the association is influenced by weight gain and other potential risk factors. Methods: The Japan Public Health Center-Based Prospective Study established in 1990 for Cohort I and in 1993 for Cohort II provided data, and 25,875 men and 33,959 women were analyzed. The response rate to the baseline questionnaire was 80.9%, and 68.4% of the respondents participated both the 5- and 10-year follow-up surveys. Smoking cessation was noted during the initial five years and the development of diabetes was reported …

The Law Of Medical Misadventure In Japan, Robert B. Leflar

Robert B Leflar

This paper offers a comprehensive overview of Japanese law and practice relating to iatrogenic (medically-caused) injury, with comparisons to other nations’ medical law systems. The paper addresses criminal sanctions for Japanese physicians’ negligent and illegal acts; civil law principles of substantive law and related issues of procedure, practice, and liability insurance; and administrative measures including health ministry programs aimed at expanding and improving the quality of peer review within Japanese medicine, and a recently implemented no-fault compensation system for birth-related injuries. Among the paper’s findings are these. Criminal and civil actions increased rapidly after highly publicized medical error events at …

Social Support And Suicide In Japanese Men And Women E The Japan Public Health Center (Jphc)-Based Prospective Study, Kalpana Poudel-Tandukar, Akiko Nanri, Tetsuya Mizoue, Yumi Matsushita, Yoshihiko Takahashi, Mitsuhiko Noda, Manami Inoue, Shoichiro Tsugane

Elaine Marieb College of Nursing Faculty Publication Series

Although the important role of social support in mental health is acknowledged, no prospective study has yet examined the relation of social support to suicide. Here, we investigated the associationbetween social support and suicide in a cohort of Japanese men and women. A total of 26,672 men and 29,865 women aged 40e69 years enrolled in the Japan Public Health Center-based prospective study in1993e1994 completed a self-administered questionnaire which included four items of social support, and were followed for death through December 2005. Hazard ratios (HRs) and 95% confidence intervals (95% CI) of suicidal death by social support index were estimated …

Social Support And Suicide In Japanese Men And Women E The Japan Public Health Center (Jphc)-Based Prospective Study (Journal Of Psychiatric Research), Kalpana Poudel-Tandukar, Akiko Nanri, Tetsuya Mizoue, Yumi Matsushita, Yoshihiko Takahashi, Mitsuhiko Noda, Manami Inoue, Shoichiro Tsugane

Kalpana Poudel-Tandukar

Differences In Suicide Risk According To Living Arrangements In Japanese Men And Women – The Japan Public Health Center-Based (Jphc) Prospective Study, Kalpana Poudel-Tandukar, Akiko Nanri, Tetsyta Mizoue, Yumi Matsushita, Yoshihiko Takahashi, Mitsuhiko Noda, Manami Inoue, Shoichiro Tsugane

Elaine Marieb College of Nursing Faculty Publication Series

Background: Living alone has been suggested as a risk factor for suicide. However, the effect on suicide risk of living together with spouse, child(ren) and parent(s) is unclear. This study aims toexamine the association between living arrangements with spouse, child(ren), and parent(s) and suicide in a Japanese men and women.Methods: Altogether 104, 528 participants aged 40–69 years, who completed baseline questionnaire (1990–1994), were followed for death through December 2005. We used Cox proportional hazards regression model to estimate the hazard ratio (HR) and 95% confidence intervals (95% CI) for suicide according to living arrangements.Results: During an average 13.2-year follow up, …

Differences In Suicide Risk According To Living Arrangements In Japanese Men And Women – The Japan Public Health Center-Based (Jphc) Prospective Study (Journal Of Affective Disorders), Kalpana Poudel-Tandukar, Akiko Nanri, Tetsyta Mizoue, Yumi Matsushita, Yoshihiko Takahashi, Mitsuhiko Noda, Manami Inoue, Shoichiro Tsugane

Kalpana Poudel-Tandukar

Public And Private Justice: Redressing Health Care Harm In Japan, Robert B. Leflar

Robert B Leflar

Japanese legal structures addressing health care-related deaths and injuries rely more on public law institutions and rules than do the common-law North American jurisdictions, where private law adjudication is predominant. This article explores four developments in 21st-century Japanese health care law. The first two are in the public law sphere: criminal prosecutions of health care personnel accused of medical errors, and a health ministry-sponsored “Model Project” to analyze medical-practice-associated deaths. The article addresses a private law innovation: health care divisions of trial courts in several metropolitan areas. Finally, the article introduces Japan’s new no-fault program for compensating birth-related obstetrical injuries. …

Muscular And Performance Fitness And The Incidence Of Type 2 Diabetes: Prospective Study Of Japanese Men, Susumu S. Sawada, I-Min Lee, Hisashi Naito, Koji Tsukamoto, Takashi Muto, Steven N. Blair

Faculty Publications

Background: Limited data are available on the relationship between muscular and performance fitness (MPF) and the incidence of type 2 diabetes.

Methods: A cohort of 3792 Japanese men completed a medical examination that included MPF and cardiorespiratory fitness tests. MPF index composite score was calculated using Z-scores from vertical jump, sit-ups, side step, and functional reach tests.

Results: The mean follow-up period was 187 months (15.6 years). There were 240 patients who developed type 2 diabetes during follow-up. Relative risks and 95% confidence intervals (CI) for incidence of diabetes across baseline quartiles of MPF index composite score were obtained using …

The Regulation Of Medical Malpractice In Japan, Robert Leflar

Robert B Leflar

How Japanese legal and social institutions handle medical errors is little known outside Japan. For almost all of the 20th century, a paternalistic paradigm prevailed. Characteristics of the legal environment affecting Japanese medicine included few attorneys handling medical cases, low litigation rates, long delays, predictable damage awards, and low-cost malpractice insurance. However, transparency principles have gained traction and public concern over medical errors has intensified. Recent legal developments include courts' adoption of a less deferential standard of informed consent; increases in the numbers of malpractice claims and of practicing attorneys; more efficient claims handling by specialist judges and speedier trials; …

Is American Health Care Uniquely Inefficient?, Alan M. Garber, Jonathan Skinner

Dartmouth Scholarship

No abstract provided.

Medical Error As Reportable Event, As Tort, As Crime: A Transpacific Comparison, Robert B. Leflar, Futoshi Iwata

Robert B Leflar

All nations seek to reduce the human toll from medical error, but variations in legal and institutional structures guide those efforts into different trajectories. This article compares legal and institutional responses to patient safety problems in the United States and Japan, addressing developments in civil malpractice law (including discoverability of internal hospital documents), administrative practice (including medical accident reporting systems), and - of particular significance in Japan - criminal law. In the U.S., battles over rules of malpractice litigation are fierce; tort law occupies center stage. The hospital accreditation process plays a critical role in medical quality control, and peer …

Informed Consent And Patients' Rights In Japan: 2001 Epilogue, Robert B. Leflar

Robert B Leflar

Japan is on a steeper trajectory toward the incorporation of informed consent principles into medical practice than the “gradual transformation” observed in a 1996 article, Informed Consent and Patients’ Rights in Japan. Among the most significant recent developments from 1996 to 2001 have been these seven: (1) the 1997 enactment of the Organ Transplantation Law permitting the use of brain death criteria in limited circumstances in which informed consent is present; (2) the strengthening of patients’ rights in clinical drug trials; (3) the continued trend toward increasing disclosure to patients of cancer diagnoses; (4) initiatives by the health ministry toward …

Informed Consent And Patients' Rights In Japan, Robert B. Leflar

Robert B Leflar

This article analyzes the development of the concept of informed consent in the context of the culture and economics of Japanese medicine, and locates that development within the framework of the nation's civil law system. Part II sketches the cultural foundations of medical paternalism in Japan; explores the economic incentives (many of them administratively directed) that have sustained physicians' traditional dominant roles; and describes the judiciary's hesitancy to challenge physicians' professional discretion. Part III delineates the forces testing the paternalist model: the undermining of the physicians' personal knowledge of their patients that accompanies the shift from neighborhood clinic to high-tech …