International trade and determinants of price differentials of insulin medicine

Empirical studies on pharmaceuticals pricing across countries have found evidence that prices vary according to per capita income. These studies are typically based on survey data from a subset of countries and cover only one year. In this paper, we study the international trade and price of insulin by using detailed trade data for 186 importing countries from 1995 to 2013. With almost 12,000 observations, our study constitutes the largest comparative study on pharmaceutical pricing conducted so far. The large dataset allows us to uncover new determinants of price differentials. Our analysis shows that the international trade of insulin increased substantially over this time period, clearly outpacing the increasing prevalence of diabetes. Using the unit values of imports, we also study the determinants of price differentials between countries. Running various panel regressions, we find that the differences in prices across countries can be explained by the following factors: First, corroborating earlier studies, we find that per capita GDP is positively correlated with the unit price of insulin. Second, the price of insulin drugs originating from Organisation for Economic Co-operation and Development countries tends to be substantially higher than for those imported from developing countries. Third, more intense competition among suppliers leads to lower insulin prices. Fourth, higher out-of-pocket payments for health care are associated with higher prices. Finally, higher volumes and tariffs seem to result in lower unit prices

Essays on Health Inequality in Low- and Middle-income Countries in Asia

The main objectives of this PhD thesis are to investigate health inequality in low- and middle-income countries in Asia. The thesis consists of four independent chapters. The first two chapters explore the inequality of opportunity in health and the last two chapters evaluate the conditional cash transfer programmes. Chapter 1 explores the inequality of opportunity in child health in ten developing countries in Asia, i.e. Bangladesh, Nepal, Pakistan, Maldives, India, Cambodia, Myanmar, East Timor, Tajikistan and Kyrgyzstan. We quantify the degree of inequality in child nutritional status between children with advantaged parental socio-economic backgrounds and those with disadvantaged parental socio-economic backgrounds. We then investigate the factors contributing to the observed disparities. The results provide strong evidence that priority should be given to protecting children from marginalised households in order to mitigate the inequality in child health. Chapter 2 proposes a new approach to measuring the inequality of opportunity with copulas to overcome some of the shortcomings of the existing methods. The proposed approach is applied to the inequality in body mass associated with its intergenerational transmission from parents to children in Indonesia. Chapter 3 evaluates the conditional cash transfer programme in Indonesia, the Program Keluarga Harapan (PKH). We estimate its impacts on the entire distributions of child health and household expenditure. We explore the mechanism by which the PKH affects child nutritional status by decomposing the treatment effect on health into the part that can be explained by the change in household expenditure and the remaining part that is due to behavioural changes. An improvement in height among children aged 24-36 months is observed. Its improvement is explained not by the increase in household expenditure but by the behavioural changes of the beneficiaries. Chapter 4 re-visits the conditional cash transfer programme in India, the Janani Suraksha Yojana (JSY) and examines the existing non-experimental evidence of its impact on maternal healthcare use through the partial identification approach. We find that the average treatment effects estimated in the previous studies are outside of the average treatment effect bounds estimated under weaker but more credible assumptions, thereby suggesting that average treatment effect in previous studies may have been over- or under-estimated due to untenable identification assumptions

A danger of induction of Brugada syndrome during pill-in-the-pocket therapy for paroxysmal atrial fibrillation

Rhythm control therapy by sodium channel blockers is widely performed for the treatment of paroxysmal atrial fibrillation. Here, we present a case of acquired Brugada syndrome by pill-in-the-pocket treatment using pilsicainide. It is important that this therapy should be applied only after confirming the drug safety to the patients

Real-space observation of short-period cubic lattice of skyrmions in MnGe

Emergent phenomena and functions arising from topological electron-spin textures in real space or momentum space are attracting growing interest for new concept of states of matter as well as for possible applications to spintronics. One such example is a magnetic skyrmion, a topologically stable nanoscale spin vortex structure characterized by a topological index. Real-space regular arrays of skyrmions are described by combination of multi-directional spin helixes. Nanoscale configurations and characteristics of the two-dimensional skyrmion hexagonal-lattice have been revealed extensively by real-space observations. Other three-dimensional forms of skyrmion lattices, such as a cubic-lattice of skyrmions, are also anticipated to exist, yet their direct observations remain elusive. Here we report real-space observations of spin configurations of the skyrmion cubic-lattice in MnGe with a very short period (~3 nm) and hence endowed with the largest skyrmion number density. The skyrmion lattices parallel to the {100} atomic lattices are directly observed using Lorentz transmission electron microscopes (Lorentz TEMs). It enables the first simultaneous observation of magnetic skyrmions and underlying atomic-lattice fringes. These results indicate the emergence of skyrmion-antiskyrmion lattice in MnGe, which is a source of emergent electromagnetic responses and will open a possibility of controlling few-nanometer scale skyrmion lattices through atomic lattice modulations

Housing Policies for Asia: A Theoretical Analysis by Use of a Demand and Supply Model

The main objective of this paper is to give an overview of the most commonly used housing policies and to illustrate their economic impact. To facilitate the analysis, we first introduce a simple two-period housing demand model for owner-occupied houses and rental houses. We then add a standard stock-flow housing supply model. Using this modelling framework, we explain the qualitative effects of various housing policies on supply and demand. In the last section of the paper, we provide a quantitative estimation of the impact of each policy and assess its effectiveness using a simple analysis of cost effectiveness. We hope that the model's versatility makes it a simple tool for policymakers to better understand the economic consequences of various housing policies

25-Gauge Microincision Vitrectomy to Treat Vitreoretinal Disease in Glaucomatous Eyes after Trabeculectomy

Purpose. To determine the feasibility of using 25-gauge microincision vitrectomy surgery (25GMIVS) to treat vitreoretinal disease in glaucomatous eyes which have previously undergone trabeculectomy (TLE). Methods. A consecutive, interventional case series. We performed 25GMIVS in 15 glaucomatous eyes that had undergone TLE. Follow-up period was 11.5 months. Results. 25GMIVS was successfully used and led to improvement in visual acuity (P<0.01). We performed 25GMIVS for proliferative diabetic retinopathy with neovascular glaucoma in 53% of eyes (8 of 15). Although 3 eyes needed further TLE following 25GMIVS, final IOP was below 21 mmHg in all eyes except one eye (93%) and was comparable to pre-25GMIVS IOP (P=0.20) without an increase in the number of glaucoma medications (P=0.14). Conclusions. 25GMIVS is a feasible treatment for vitreoretinal disease in eyes with preexisting TLE, effective in both significantly improving BCVA and preserving the filtering bleb, while not excluding further glaucoma surgery

Neurological Analysis Based on the Terminal End of the Spinal Cord and the Narrowest Level of Injured Spine in Thoracolumbar Spinal Injuries

This study aimed to clarify neurological differences among the epiconus, conus medullaris, and cauda equina syndromes. Eighty-seven patients who underwent surgery for acute thoracolumbar spinal injuries were assessed. We defined the epiconus as the region from the terminal end of the spinal cord to the proximal 1.0 to 2.25 vertebral bodies, the conus medullaris as the region proximal to < 1.0 vertebral bodies, and the cauda equina as the distal part of the nerve roots originating from the spinal cord. On the basis of the distance from the terminal end of the spinal cord to the narrowest level of the spinal canal, the narrowest levels were ordered as follows: the epiconus followed by the conus medullaris and cauda equina. The narrowest levels were the epiconus in 22 patients, conus medullaris in 37 patients, and cauda equina in 25 patients. On admission, significantly more patients had a narrowed epiconus of Frankel grades A-C than a narrowed cauda equina. At the final follow-up, there were no significant differences in neurological recovery among those with epiconus, conus medullaris, or cauda equina syndrome. Anatomically classifying the narrowest lesion is useful for clarifying the differences and similarities among these three syndromes

Drug evaluation using pharmacologically induced aortic dissection prone model mice

Aortic dissection (or dissecting aortic aneurysm) is a condition in which the aortic wall is separated into two layers at the medial level to form a pseudocavity. The intima crack, called the “entry”, allows blood to tear through the medial layer and flow in. The location of the “entry” and the extent of the dissection can cause a variety of serious complications, including rupture, cardiac tamponade, and obstruction of branched vessels. According to the Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection 2020, it is estimated that 61.4% of the onset of dissection die before arrival at the hospital, and 93% will die within 24 hours after the onset. It has been suggested that the morbidity rate has been increasing in recent years. Since many of them have a fatal prognosis, it is an important issue to prevent the onset itself. However, no effective therapeutic agent or preventive strategy has been established so far. The first reason is that it is extremely difficult to design clinical studies because aortic dissection traced the rapid onset and progression. The second is that the pathophysiology and preventive drug search are not sufficiently conducted even at the basic research level. Epidemiologically, the results of the International Registry of Aortic Dissection (IRAD) revealed that aging, hypertension, atherosclerosis, and hereditary connective tissue diseases are risk factors. The aortic aneurysm also shows similar pathological conditions caused by these risk factors. However, one of the major differences between aneurysm and dissection is the presence of aortic intima rupture. Therefore, we attempted to establish a mouse model developing dissection at a high rate by adding the endothelial dysfunction to a pharmacologically induced aortic aneurysm model mouse. Furthermore, we evaluated the efficacy of pitavastatin and several nutrients using our novel model mice and verified its usefulness as a model animal

Large Right Pulmonary Vein Is a Predictor of Atrial Fibrillation Recurrence after Pulmonary Vein Isolation in Patients with Persistent Atrial Fibrillation

Pulmonary vein isolation（PVI）is an effective treatment for atrial fibrillation（AF）. However, outcomes differ between paroxysmal AF and persistent AF. We analyzed the predictors of recurrence by examining the recurrence group after ablation. Of 372 consecutive patients with AF who underwent PVI between June 2016 and December 2018, we evaluated 250 patients（age, 67±12y, 65％ men）whose left atrium（LA）was constructed using the PENTARAY catheter（BioSense Webster, Los Angeles, CA）, a multipolar electrode catheter with a novel shape and excellent mapping capability. We measured the LA total volume（LATV）, right pulmonary vein＋antrum volume（RPAV）, left PV＋antrum volume（LPAV）, LA central volume（LACV）, and LA bipolar voltage. Of the 250 patients, 78 had persistent AF（recurrence, 20）and 172 had paroxysmal AF（recurrence, 16）. In all patients, LATV, LACV, RPAV, and LPAV were significantly larger in patients with persistent AF than those with paroxysmal AF. The mean LA bipolar voltage in patients with persistent AF was significantly lower than those with paroxysmal AF. In cases of persistent AF, RPAV was significantly larger in the recurrence group than that in the non-recurrence group（15.9±4.8 vs 13.4±5.4ml; P＜0.05）. In cases of paroxysmal AF, there were no differences in any volume between the recurrence and non-recurrence groups. In conclusion, larger right PV is a predictor of AF recurrence after PVI in patients with persistent AF. The right PV is close to the atrial septum and the septopulmonary bundle, and the expansion of RPAV reflects the disruption of these structures, which may be involved in this result

Socioeconomic Inequity in Excessive Weight in Indonesia

Exploiting the Indonesian Family Life Survey, this paper studies the transition of socioeconomic related disparity of excess weight, including overweight and obesity, from 1993 to 2014. First, we show that the proportions of overweight and obese people in Indonesia increased rapidly during the time period and that poorer income groups exhibited the strongest growth of excess weight. Using the concentration index we find that prevalence of overweight and obesity affected increasingly poorer segments of Indonesian society. Third, decomposing the concentration index of excess weight in 2000 and 2014 for both sexes, our results suggest that most parts of the concentration index can be explained by the unequal distribution of living standards, sanitary conditions, the possession of vehicles, and home appliances. Finally, decomposing the change in the concentration index of excess weight from 2000 to 2014, we show that a large part of the change can be explained by the decrease in inequality in living standards, and improved sanitary conditions and better availability of home appliances in poorer households