Hiroshi Okajima

Social services on wheels: A sustainable model to improve access in unreached communities

Unreached communities require access to fundamental social services such as healthcare, education, learning and purchasing opportunities to improve their economic sustainability. Unreached communities are characterized by informal and unsafe transport. Villagers have to travel long distances to urban centres to attain social services. In this article, we introduce an Information Communication Technology (ICT) concept called Social Services on Wheels (SSW) to provide quality transit and overcome access problems by bringing e-services directly to the community. SSW is based on a community vehicle that is as a college bus service and mobile ICT platform. SSW takes a healthcare worker, an ICT assistant and their equipment to a service point allowing villagers to access telemedicine and Internet services. SSW was tested on a rural community in Bangladesh in 2012 and 2013. A cost analysis shows that 52% of the total operating cost was covered using the existing business model. The research contributes to the discussion on sustainable ICT for Development (ICT4D).

Demand Responsive Mobility as a Service

Fundamental requirements in mobility are time, cost and comfort. Individual car ownership satisfies comfort component and to some extent, the time component as well. However, owning and maintaining a car is prohibitive for many due to cost and convenience implications. In selecting other public modes of transportation, a taxi or rental car would provide a more comfortable ride with little to none waiting time and conforms to the passengers mobility requirements. However, the cost is too high and cannot be sustained as a regular mode of transport. On the other hand, shared public transport such as bus or train is more affordable but requires the passenger to conform their schedule to a set timetable that operates no matter the changes in demand. In developing countries, however, the shared public transport alternatives do not have timetables and waiting time could be up to an hour. Recent research in shared mobility systems, specifically Demand Responsive Transport (DRT), addresses this situation. Solutions to DRT trip scheduling are constrained to the variation of DRT specifications but does not vehicle schedule and quorum specifications considerations. We aim to reduce passenger waiting time for shared mobility and propose a design of a DRT-based Demand Responsive MaaS (Mobility as a Service) model that provides centralized management and ICT support. Our design adds time constraints of vehicle schedule to the DRT problem. We propose a trip scheduling and cost sharing algorithm for our designed model and base our approach on a DRT heuristic algorithm and a quorum to enforce a minimum demand. A simulation experiment showed average waiting time reduced by 44.4% compared to other DRT time optimization solutions. We conducted a pilot study in Dhaka, Bangladesh for 4 months. Actual average waiting time reduced to 25% compared to current public transport in Dhaka.

Association between kidney function and genetic polymorphisms in atherosclerotic and chronic kidney diseases: A cross-sectional study in Japanese male workers.

Background Several single nucleotide polymorphisms (SNPs) have been implicated in the predisposition to chronic kidney disease (CKD). Atherosclerotic disease is deeply involved in the incidence of CKD; however, whether SNPs related to arteriosclerosis are involved in CKD remains unclear. This study aimed to identify SNPs associated with CKD and to examine whether risk allele accumulation is associated with CKD. Methods We conducted a cross-sectional study using data of 4814 male workers to examine the association between estimated glomerular filtration rate (eGFR) and 59 candidate polymorphisms (17 CKD, 42 atherosclerotic diseases). We defined the genetic risk score (GRS) as the total number of risk alleles that showed a significant association in this analysis and examined the relationship with CKD (eGFR < 60 ml/min/1.73m2). Multivariate logistic regression, discrimination by area under the receiver operating characteristic curve, integrated discrimination improvement (IDI), and category-free net reclassification improvement (cNRI) were evaluated. Results In total, 432 participants were categorized as having CKD. We found eight candidate SNPs with P value < 0.05 (CX3CR1 rs3732379, SHROOM3 rs17319721, MTP rs1800591, PIP5K1B rs4744712, APOA5 rs662799, BRAP rs3782886, SPATA5L1 rs2467853, and MCP1 rs1024611) in the multivariate linear regression adjusted for age, body mass index, systolic blood pressure, and fasting blood glucose. Among these eight SNPs, BRAP rs3782886 and SPATA5L1 rs2467853 were significantly associated with eGFR (false discovery rate < 0.05). GRS was significantly associated with CKD (odds ratio, 1.17; 95% confidence interval, 1.09–1.26). C-statisics improved from 0.775 to 0.780 but showed no statistical significance. However, adding GRS significantly improved IDI and cNRI (0.0057, P = 0.0028, and 0.212, P < 0.001, respectively). Conclusions After adjustment for clinical factors, kidney function was associated with BRAP rs3782886 and SPATA5L1 rs2467853 and the GRS for CKD that we developed was associated CKD.

Effect of dietary energy and polymorphisms in BRAP and GHRL on obesity and metabolic traits

OBJECTIVE Obesity, a risk factor for all-cause and cardiovascular mortality, is a major health concerns among middle-aged men. The aim of this study was to investigate a possible association of dietary habits and obesity related single nucleotide polymorphisms (SNPs) with obesity and metabolic abnormalities. METHODS We conducted a retrospective cohort study using annual health examination data of 5112 male workers, obtained between 2007 and 2011. Average dietary energy was estimated using electronically collected meal purchase data from cafeteria. We examined 8 SNPs related to obesity: GHRL rs696217, PPARG rs1175544, ADIPOQ rs2241766, ADIPOQ rs1501299, PPARD rs2016520, APOA5 rs662799, BRAP rs3782886, and ITGB2 rs235326. We also examined whether SNPs that were shown to associate with obesity affect other metabolic abnormalities such as blood pressure (BP), glucose, and lipid profile. RESULTS Average dietary energy significantly associated with increased abdominal circumference (AC) and body mass index (BMI). The odds ratios (ORs) of overweight and obesity also increased. The major allele of rs696217 significantly increased BMI and an increased OR with obesity, while the minor allele of rs3782886 was associated with significantly decreased AC and the decreased ORs with overweight and obesity. The minor allele of rs3782886 was also associated with significantly decreased systolic BP (SBP), triglyceride (TG), high-density lipoprotein (HDL), and fasting blood sugar (FBS), while rs696217 was not associated with other metabolic abnormalities. CONCLUSIONS Average dietary energy in lunch, rs3782886, and rs696217 were associated with obesity, and rs3782886 was associated with other metabolic abnormalities.

eHealth Consumer Behavior

Numerous studies have been conducted on eHealth’s structure, technological aspects, current status, problems and prospects. However, there are only a few studies conducted in regards to the consumer behavior of eHealth. This chapter describes the necessity of behavioral research in eHealth. eHealth initiatives and current status in Bangladesh is reported. The chapter also explores and analyzes the current level of, reasons behind and factors affecting consumer acceptance of Portable Health Clinic (PHC), an e-Health initiative in Bangladesh, currently serving on experimental basis. In order to conduct an in-depth consumer behavior research, a sample of 600 rural respondents has been selected through stratified random sampling method. Data has been collected through structured questionnaire survey and analyzed with statistical tools including central tendency, frequency analysis, chi-square test of association and simple linier regression. This chapter also analyzes consumer’s demographic and socio-economic factors that affect their acceptance of eHealth. Our finding says, consumer’s age, occupation and purchasing power have very strong influence on their acceptance of eHealth services from PHC while their gender, level of education, access to cell phone and previous eHealth knowledge have very insignificant or weaker impact. Finally, the major applications of behavioral research are reported through which eHealth initiatives can be more socially acceptable and financially viable.

Providing safe and affordable transportation to reduce female students dropout: A case study on college girls in rural Bangladesh

We carried out an experiment to observe the role of transportation for adolescent female students in rural Bangladesh. A senior high school (in Bangladesh, they call it a college) student spends 180-230 minutes to travel only 22km (11 km, single trip) on an average to commute from home to college. Local transport (Tomtom) stops are not always close to their home. The walk 4km to get to the nearest Tomtom stop. The Tomtom does not have a regular timetable. In worst case, the students wait 30 minutes until the Tomtom driver finds sufficient number of passengers. This 11km distance is Female students find it uncomfortable to share congested space with male passengers. They cannot raise their voice when they face sexual harassment inside the car or when they walk. The parents of the female students find it safer to stop their education and arrange a marriage. We proposed a regular college bus service with an adaptive time schedule that follows the routine of the students. In order to make the service sustainable, we designed a model of multi service vehicle named SSW, so that it can earn extra income during its idle time. We concluded that the operational cost can be covered through the SSW model. We identified new requirements for multiservice vehicle to satisfy the needs of a rural community.