Estimation of the value of convenience in taking influenza antivirals in Japanese adult patients between baloxavir marboxil and neuraminidase inhibitors using a conjoint analysis

Aims: Estimating the monetary value of the convenience of using influenza antivirals approved in Japan from a patient perspective using a conjoint analysis. Methods: An online survey (August 2020) was performed on individuals aged 20–64 years living in Japan who had taken oral or inhalant antivirals for influenza treatment in the 2018/19 or 2019/20 seasons. Efficacy and safety were assumed to be equivalent among the antivirals. The attributes for the conjoint analysis included route (oral or inhalant), duration, frequency of administration, and out-ofpocket expenses. A conditional logit model was applied as a baseline model. The monetary value of each attribute was calculated by comparing the same utility of the linearly interpolated level of the out-of-pocket attribute. Another survey to determine the experiences of the latest antiviral intake was also conducted on the same respondents. Results: Of the respondents, 1,550 were men and 1,587 were women. The monetary value for oral antivirals was estimated to be higher, saving JPY 741 (USD 7.06, as of August 2020), compared with inhalant. Regarding the length and frequency of administration, five days corresponds to an increase of JPY 2,072, compared with one day, and twice a day corresponds to a JPY 574 increase compared to once a day. Conclusions: The results suggest that – among the antivirals approved in Japan – the monetary value of the utility is the highest in the single dose oral antiviral, baloxavir marboxil (baloxavir). Although the drug cost was highest in baloxavir among the brand antivirals, the difference in the value of utility for influenza patient was estimated to be larger than the difference in the drug costs. Limitations: Although individuals with diverse attributes from all over the country were included in the survey, they are not necessarily a representative population of the Japanese society

Radiation Exposure from CT Examinations in Japan

<p>Abstract</p> <p>Background</p> <p>Computed tomography (CT) is the largest source of medical radiation exposure to the general population, and is considered a potential source of increased cancer risk. The aim of this study was to assess the current situation of CT use in Japan, and to investigate variations in radiation exposure in CT studies among institutions and scanners.</p> <p>Methods</p> <p>Data-sheets were sent to all 126 hospitals and randomly selected 14 (15%) of 94 clinics in Gunma prefecture which had CT scanner(s). Data for patients undergoing CT during a single month (June 2008) were obtained, along with CT scan protocols for each institution surveyed. Age and sex specific patterns of CT examination, the variation in radiation exposure from CT examinations, and factors which were responsible for the variation in radiation exposure were determined.</p> <p>Results</p> <p>An estimated 235.4 patients per 1,000 population undergo CT examinations each year, and 50% of the patients were scanned in two or more anatomical locations in one CT session. There was a large variation in effective dose among hospitals surveyed, particularly in lower abdominal CT (range, 2.6-19.0 mSv). CT examinations of the chest and upper abdomen contributed to approximately 73.2% of the collective dose from all CT examinations. It was estimated that in Japan, approximately 29.9 million patients undergo CT annually, and the estimated annual collective effective dose in Japan was 277.4 *10³Sv person. The annual effective dose per capita for Japan was estimated to be 2.20 mSv.</p> <p>Conclusions</p> <p>There was a very large variation in radiation exposure from CT among institutions surveyed. CT examinations of the chest and upper abdomen were the predominant contributors to the collective dose.</p

Should the provision of home help services be contained?: Validation of the new preventive care policy in Japan

<p>Abstract</p> <p>Background</p> <p>To maintain the sustainability of public long-term care insurance (LTCI) in Japan, a preventive care policy was introduced in 2006 that seeks to promote active improvement in functional status of elderly people who need only light care. This policy promotes the use of day care services to facilitate functional improvement, and contains the use of home help services that provide instrumental activity of daily living (IADL) support. However, the validity of this approach remains to be demonstrated.</p> <p>Methods</p> <p>Subjects comprised 241 people aged 65 years and over who had recently been certified as being eligible for the lightest eligibility level and had began using either home help or day care services between April 2007 and October 2008 in a suburban city of Tokyo. A retrospective cohort study was conducted ending October 2009 to assess changes in the LTCI eligibility level of these subjects. Cox's proportional hazards model was used to calculate the relative risk of declining in function to eligibility Level 4 among users of the respective services.</p> <p>Results</p> <p>Multivariate analysis adjusted for factors related to service use demonstrated that the risk of decline in functional status was lower for users of home help services than for users of day care services (HR = 0.55, 95% CI: 0.31-0.98). The same result was obtained when stratified by whether the subject lived with family or not. Furthermore, those who used two or more hours of home help services did not show an increase in risk of decline when compared with those who used less than two hours.</p> <p>Conclusions</p> <p>No evidence was obtained to support the effectiveness of the policy of promoting day care services and containing home help services for those requiring light care.</p

Die Arbeitsverwaltung im Protektorat Böhmen und Mähren (1939-1945)

System of forced and directed labour was characteristic for protectorate labour law. In order for this system to work effectively, it was necessary to create some required effective managing and controlling mechanisms. Of major importance was a newly created system of employment offices and their subsidiaries which was directed by the Ministry of Social and Health Administration, later by the Ministry of Economy and Labour. Employment offices constituted one of the most important and key instruments in the process of performing directed and forced labour. During World War II, their tasks and authority gradually grew and at the end of the war they applied basically to all areas related to work performance. Although the employment offices belonged to the so-called autonomous (Czech) administration, their leading positions were taken by German officers which had a considerable influence on their actual activity. The Ministry of Social and Health Administration (later Ministry of Economy and Labour) represented an institution where legal regulations for the labour law area were made. Since 1942, mostly German officers were in charge of this area amongst whom can be named primarily Dr. Walter Bertsch and Dr. Wilhelm Dennler. German office workers transferred here from the Office of Reich Protector, thus they directly contributed to creating drafts of legislation.Pro protektorátní pracovní právo byl charakteristický systém nucené a řízené práce. Aby tento systém mohl efektivně fungovat, bylo nutné vytvořit potřebné účinné řídící a kontrolní mechanismy. Hlavní roli zde hrál nově vytvořený systém úřadů práce a jeho poboček, který byl direktivně řízen Ministerstvem sociální a zdravotní správy, později Ministerstvem hospodářství a práce. Úřady práce představovaly jeden z nejdůležitějších a klíčových instrumentů v procesu výkonu řízené a nucené práce. V průběhu druhé světové války se postupně rozrůstaly jejich úkoly a kompetence, které se na jejím konci vztahovaly prakticky na všechny oblasti související s výkonem práce. Ačkoli úřady práce organizačně náležely k tzv. autonomní (české) správě, jejich vedoucí místa byla obsazena německými úředníky, což mělo značný vliv na jejich praktickou činnost. Ministerstvo sociální a zdravotní správy (později Ministerstvo hospodářství a práce) představovalo instituci, kde vznikaly právní předpisy pro pracovněprávní oblast, kterou měli od roku 1942 v gesci z převážné většiny němečtí úředníci, z nichž je možné jmenovat především Dr. Waltera Bertsche a Dr. Wilhelma Dennlera. Německé úřednictvo sem přešlo z Úřadu Říšského protektora a přímo se tak podílelo na vytváření osnov právních předpisů.System of forced and directed labour was characteristic for protectorate labour law. In order for this system to work effectively, it was necessary to create some required effective managing and controlling mechanisms. Of major importance was a newly created system of employment offices and their subsidiaries which was directed by the Ministry of Social and Health Administration, later by the Ministry of Economy and Labour. Employment offices constituted one of the most important and key instruments in the process of performing directed and forced labour. During World War II, their tasks and authority gradually grew and at the end of the war they applied basically to all areas related to work performance. Although the employment offices belonged to the so-called autonomous (Czech) administration, their leading positions were taken by German officers which had a considerable influence on their actual activity. The Ministry of Social and Health Administration (later Ministry of Economy and Labour) represented an institution where legal regulations for the labour law area were made. Since 1942, mostly German officers were in charge of this area amongst whom can be named primarily Dr. Walter Bertsch and Dr. Wilhelm Dennler. German office workers transferred here from the Office of Reich Protector, thus they directly contributed to creating drafts of legislation

Health and safety at work

Protection at work with regard to health and safety at work is an important part of Albanian Labour Legislation. Determination of general obligation of the employer aims at protecting the employees’ health and security. With regard to health security and protection, Albanian Labour Code foresees that the employer is responsible in cases of accidents and professional diseases considering that it should clearly define rules for technical security. With the regard to employers’ responsibility, it should be mentioned that this might be administrative or penal, depending on the violations occurred a few of which contain elements of criminal acts. An important step forward in regulating labour relations is to strengthen inter-institutional cooperation and cooperation between employees, employers, trade unions and state and to further dialogue between those. However, implementation of the Labour Law plays an important role in the stabilization of labour relations in general. An important role remains with institutions such as Ministry of Labour and Equal Opportunities, National Labour Council and State Labour Inspectorate

Development Partner Group-Health Retreat

Following the publication of the draft Tanzanian Joint Assistance Strategy (JAS) in July 2005 which outlined a medium-term framework for enhancing aid effectiveness through the rationalisation and alignment of development partner approaches, a series of consultations on this draft strategy took place both within government agencies and among Development Partners. The Development Partner Group in Health (DPG-H) took this opportunity to hold a two-day workshop in late September with the first day devoted to discussing the implications of the JAS for Development Partners, Ministry of Health and President's Office Regional Administration and Local Government. The second day was used as a time to internally reflect on the present functioning of the DPG-H Group, identifying ways of enhancing the work of the group in response to the changing environment. Discussions on the first day of the Retreat were structured around the five key elements of the JAS, i.e., Sector Dialogue, Aid Modalities, TA and Capacity Building, Division of Labour and Monitoring & Evaluation. Presentations were made by Development Partners with input/comments and clarification given by the Ministry of Health, President's Office Regional Administration and Local Government; and Ministry of Finance. Group work was undertaken in the afternoon to further address pertinent issues that were raised from the plenary discussions in the morning session. This resulted in a number of recommendations that included the following: supporting an effective division of labour; harmonising support with government plans and priorities irrespective of the funding modality; complementarity and coordination enhanced between the various aid modalities; basket funding to continue as a transition towards General Budget Support (GBS); demand driven technical assistance; and over time developing an agreed competency/profile skills mix of health development partners. The second day was an opportunity for members of the DPG-H to come together and reflect on the work of the group - where it had come from, the current functioning of the group (strengths/challenges) and looking forward. A number of presentations were made that covered the background of the group; the history of the Sector Wide Approach (SWAp) and the role of development partners; the sector dialogue structures, the expectations and challenges with respect to communication; strengthening the ways of working as a group and the development of an activity plan for prioritising activities. During the plenary sessions a number of recommendations were agreed that included better structuring of the DPG-H meetings; regularity of meetings (once month but more frequently when required); enhancing the coherency and linkages with the overall Development Partner Group; developing and agreeing a work plan and communication strategy; re-visiting the division of labour in terms of roles and responsibilities; putting in place a fully staffed DPG-H Secretariat and organising a troika chairing structure for the group. Moreover, a number of critical suggestions and recommendations were made for further strengthening sector dialogue that centred around revising the structure of the SWAp. As they had implications beyond the mandate of the DPG-H, it was concluded that this would require further discussions, elaboration and agreement by the Ministry of Health/PORALG.\u

Governing the regulators – applying experience

Emphsizing more effective law rather than more law, this paper provides a perpective from within government that argues for a better appreciation of what is required to ensure that regulation is effective in a New Zealand context. Using building controls, financial markets regulation and occupational health and safety as examples, this paper presents an analysis of the changes to the regulatory landscape, and in particular the role of regulators as a particular facet of regulatory design. • Gaye Searancke, Peter Mumford, Karl Simpson and Mark Steel are all members of the Labour and Commercial Environment Group in the Ministry of Business, Innovation and Employment

Поліпшення медичних оглядів плавскладу - шлях до збереження здоров'я і працездатності членів екіпажів

Labour conditions of the water environment specify definite requirements for the crews' level of health. The authors offer to modify the existing national normative acts, and especially the orders of Ministry of Public Health connected to crews' medical examinations. In particular it is offered to estimate level of health in the occupational group under study depending on navigation district, type of a vessel and type of a job fulfilled. Perfection of medical examinations will favour labour conditions improvement and satisfaction of social rights of reverine and marine vessels crews