Study on workloads of human care worker with the introduction of IT system - the characteristics of work loads by observational research and the suggestions for KAIZEN

The purpose of this study was to clarify the characteristic of workloads on human care worker with the introduction of IT system, and suggested the support measures for KAIZEN in Japan. The investigation method is workflow line and hearing with a focus on work observation. The objects were 8 human care workers of the acute hospital that introduced an electronic system. By the introduction of the electronic chart, the nurse station sojourn time decreased, sickroom sojourn time increased, and time about direct nursing care to a patient increased. In addition, access to patient information became easy, and the offer of the health care service based on correct information came to be possible in real time. By The point of workflow line, it was effect that moving lengths decreased in order to install the electronic chart in patients' rooms. Though, it was a problem that it hasn't formed where to place the instruments such as sphygmomanometer, clinical thermometer and others.     

Effect of Particle Size on Risk Assessment of Direct Soil Ingestion and Metals Adhered to Children's Hands at Playgrounds

The quantity of heavy metals in soil is measured after 2‐mm sieving in Japan for risk assessment of direct soil ingestion. A study was conducted on the relationship between the size of soil particles and quantity of heavy metals in soil, and the particle‐size distribution of soil adhered to children's hands, and the risks of direct intake of soil considering the particle sizes ingested were evaluated. The results showed that smaller particles had a tendency to contain more heavy metals than bigger ones, that the particle size of approximately 90% of the soil particles from playgrounds adhered to children's hands was less than 100 μm, and that 2‐mm sieving in preparation for measuring heavy metal content caused underestimation of the risk of direct soil intake. The amount of heavy metals on children's hands after playing outside was investigated. Various metals and soil were adhered to their hands, and the amount of soil adhered could be estimated from the concentration of metals. To develop accurate risk assessment, the particle‐size distribution of ingested soil and more detailed scenarios of soil intake are necessary.     

Bioaccessibility of Fukushima‐Accident‐Derived Cs in Soils and the Contribution of Soil Ingestion to Radiation Doses in Children

Ingestion of contaminated soil is one potential internal exposure pathway in areas contaminated by the Fukushima Daiichi Nuclear Power Plant accident. Doses from this pathway can be overestimated if the availability of radioactive nuclides in soils for the gastrointestinal tract is not considered. The concept of bioaccessibility has been adopted to evaluate this availability based on in vitro tests. This study evaluated the bioaccessibility of radioactive cesium from soils via the physiologically‐based extraction test (PBET) and the extractability of those via an extraction test with 1 mol/L of hydrochloric acid (HCl). The bioaccessibility obtained in the PBET was 5.3% ± 1%, and the extractability in the tests with HCl was 16% ± 3%. The bioaccessibility was strongly correlated with the extractability. This result indicates the possibility that the extractability in HCl can be used as a good predictor of the bioaccessibility with PBET. In addition, we assessed the doses to children from the ingestion of soil via hand‐to‐mouth activity based on our PBET results using a probabilistic approach considering the spatial distribution of radioactive cesium in Date City in Fukushima Prefecture and the interindividual differences in the surveyed amounts of soil ingestion in Japan. The results of this assessment indicate that even if children were to routinely ingest a large amount of soil with relatively high contamination, the radiation doses from this pathway are negligible compared with doses from external exposure owing to deposited radionuclides in Fukushima Prefecture.     

Japan's Radical Reform of Long-term Care

Japan's mandatory long‐term care social insurance system started in 2000. Many important choices about the basic shape and size of the system, as well as a host of details, were necessary when the program was being planned. It represents a reversal from earlier steps toward a tax‐based direct‐service system, and is based on consumer choice of services and providers. The benefits are in the form of institutional or community‐based services, not cash, and are aimed at covering all caregiving costs (less a 10 percent co‐payment) at six levels of need, as measured by objective test. Revenues are from insurance contributions and taxes. The program costs about $40 billion, and is expected to rise to about $70 billion annually by 2010 as applications for services go up. There are about 2.2 million beneficiaries, about 10 percent of the 65+ population. The program has operated within its budget and without major problems for two years and is broadly accepted as an appropriate and effective social program.     

Allocating Health Resources

To clarify the polemics surrounding public and private responsibilities in health care, this article deals with the economic justification for the commitment of public resources. Public health measures do possess the properties of public goods or physical externalities, and yet may not have the sufficient conditions for allocating resources by political procedures. To publicly allocate resources to personal health care can only be justified by the properties of informational externalities, or regard for the humanitarian spillovers. Paradoxically, it is precisely in this latter area that a concern about minimum standards has led to a philosophical commitment to achieving maximum standards. The pursuit of such universal standards in the health sector has been the subject of growing disquiet. This dilemma is best resolved by reorientating the role of government towards an analysis of the costs and benefits of present and projected health practices.     

Choices, Policy Logics and Problems in the Design of Long–term Care Systems

Establishing a public, comprehensive, independent, mainly community–based long–term care system, separate from medical care and social services, can lead to the provision of more effective and consumer–oriented services, and also to a more appropriate mix of public/private financing. Of the two main approaches to financing long–term care (LTC), a tax–based model is more flexible in providing benefits according to the individual's need, since income levels and the family's ability to provide care will be taken into consideration, while a social insurance model is more rigid because the individual's rights are more explicitly defined. The latter system is likely to provide more opportunities for choice, including decisions about the mix of health and social services. Policy–makers must decide which approach to take after weighing the positive and negative aspects of each, and the existing organizational infrastructure. Decisions must also be made on the practical issues of coverage, fairness, form of benefits, service delivery patterns, relationship with medical and social services, and controlling costs. With increasing pressure to contain public sector expenditures and improve efficiency, the focus of care will gradually shift from medical care to LTC, and within LTC, from institutions to housing. How to make this process proactive and planned, instead of ad hoc and reactive, is the challenge for public policy.     

Policy learning and cross-national diffusion in social long-term care insurance: Germany, Japan, and the Republic of Korea

Recently, many developed countries have moved toward comprehensive Long-Term Care (LTC) systems. Along with the conventional explanations of these policy changes based on domestic factors, learning from abroad should be considered. We focus on the social insurance model of LTC, particularly how Japan learned from Germany and the Republic of Korea learned from Japan. Some approaches for how to think about policy learning in general as well as cross-border learning are suggested.