Effects of an increase in patient copayments on medical service demands of the insured in japan

Objectives:To examine quantitatively the effects of an increase in patient copayments from 10% to 20% on the demand for medical services in Japan. Methods: The subjects of the study were the employees insured by the 1,797 health insurance societies, belonging to the National Federation of Health Insurance Societies, in 1996 and 1998. Indicators of medical service demands analyzed include the inpatient, outpatient, and dental case rates, the number of serviced days per case, the medical cost per day and the medical cost per insured. Results: When the effects of an increase in patient copayments from 10% to 20% were evaluated, taking into account the average age, the average monthly salary, the total number, the gender (male-tofemale) ratio and the dependent ratio of the insured, the estimated change in the case rate was &#8722;6.96% for inpatient, &#8722;4.79% for outpatient, and &#8722;5.77% for dental care. The estimated change in the number of serviced day per case was &#8722;4.66% for inpatient, &#8722;5.67% for outpatient, and &#8722;1.82% for dental care. The estimated change in the medical cost per day was &#8722;3.15% for inpatient, &#8722;13.00% for outpatient, and &#8722;11.48% for dental care. The estimated change in the medical cost per insured was &#8722;14.08% for inpatient, &#8722;21.54% for outpatient, and &#8722;18.11% for dental care. Conclusions: The increase in patient copayments from 10% to 20% enabled insurers to substantially reduce medical costs by cost shifting from the insurer to the insured, with resultant changes in the case rate and the number of service days per case.</p

Training intensities for aerobic exercise determined on untrained healthy men.

The purpose of this study was to determine the aerobic training intensity from the maximal and submaximal running exercise in 21 untrained adult men. To accomplish this, we evaluated the relationship between physiological (oxygen intake and heart rate) and physical parameters (running speed) of training intensity, and determined the training intensity at the submaximal exercise. Oxygen intake and heart rate were measured by a treadmill test. The maximal oxygen intake (VO2 max), and the aerobic threshold (AerT) and anaerobic threshold (AT) were measured to determine respiratory gas exchange. Running capacity was measured by a 12-min running and treadmill test. For the maximal exercise, there was a significant correlation (r = 0.88, P &#60; 0.01) between VO2 max and 12-min running distance (speed). In addition, the oxygen intake and heart rate at AerT and AT in the submaximal exercise were linearly correlated with running speed. Three levels of training intensity at the submaximal exercise were termed: light, moderate, and heavy. Since AerT was the lower limit intensity and AT was the upper limit, we took the middle of their values as the moderate intensity. The end point for the determination of the training intensity at the submaximal exercise was estimated to be 85% VO2 max and 180 beats.min-1.</p

Effects of medical education on attitudes towards mental illness among medical students: a five-year follow-up study.

In order to clarify the effects of medical education on attitudes towards mental illness among medical students, a follow-up study was conducted. All 100 students entering Kochi Medical School in 1988 were subjects. The initial questionnaire survey was conducted in 1988, and followed up in 1993. Response rate was 69% in the initial survey, and 83% in the follow-up study. By the time of the follow-up, all of the students had completed their medical education, including courses in psychiatry and mental health. Results were as follows: At the follow-up study, 1) a significantly higher percentage of students replied that they accepted the mentally ill as co-workers; 2) significantly favorable changes were observed in attitudes towards psychiatric services; 3) optimism about the effectiveness of treatment for mental illness at an early stage and prevention of mental illness had decreased; and 4) no change was observed in attitudes toward human rights of the mentally ill, except in the case of one item stating that the mentally ill should not have children in order to avoid hereditary handicaps, with which a lower percentage agreed. Conclusively, medical education can play an important role in attitudes towards mental illness. </p

Comparative analysis on the physique and batting records of the players in the National Summer High School Baseball Tournaments before and after the adoption of metal bats.

To clarify the influence of the introduction of metal bats on the physique and batting records of the players in the National Summer High School Baseball Tournaments, a comparative analysis was conducted between height, body weight, body-weight ratio (body weight/height), batting average and home run average of the best four teams' players (n = 493) and those of the other teams' players (n = 4,590) in three periods: the period of the use of wooden bats, that of the use of both wooden and metal bats and that of the use of metal bats. In the period of metal bat use, the mean values of physique of the best four teams' players were significantly larger (P &#60; 0.05) and their average number of home runs was significantly higher than those of the other teams' players (P &#60; 0.01). The only significant differences between the two groups in those indices for each time period were for height in the wood and metal/wood periods. This study demonstrated that the differences between the home run average and physique, including height, body weight and body-weight ratio of the best four teams and the rest of the teams were the greatest after the use of metal bats. These findings suggest that the importance of the home run average increased and was associated with large-size of physique after the use of metal bats in the National Summer High School Baseball Tournaments.</p

Determination of Inorganic Anions in Environmental Samples by Capillary Electrophoresis

Concept and recent topics on environmental epidemiology have been introduced in the article. First, the authors presented the basic concept on epidemiology. Answers to the question "Is a particular exposure influent to human health?" can be obtained only from studies of human beings, using an epidemiologic approach. Environmental epidemiology is an application of epidemiology to environmental problem. Then, we presented four examples on environmental epidemiologic research. The four recent topics are residential radon exposure and lung cancer, ingested arsenic and cancer, increase incidence of childhood leukaemia around the English neuclear reprocessing facilities, and magnetic field and excess incidence of childhood leukaemia near Swedish high-voltage power lines

Comparative study of the work load between one-man buses and two-man buses.

The differences in physiological and safety conditions of one-man buses and two-man buses were examined from the view point of occupational fatigue. This survey consisted of a work load study which included a time study, study of subsidiary behavior, auditory task, memory test, Galvanic Skin Response (GSR) and physiological function tests and a self-administered questionnaire which involved items concerning safety and subjective fatigue complaints. The visual and postural restrictions in the one-man bus were greater than in the two-man bus. The mental capacity of the one-man bus drivers was found to be less. Greater mental fatigue and stress were observed in the one-man bus. More subjective fatigue complaints were observed in the one-man bus. More cases of near accidents were observed in the one-man bus. From these results it was concluded that the one-man bus caused bus drivers a greater mental and physical work load.</p

Relation between the instrumental activities of daily living and physical fitness tests in elderly women.

A cross-sectional study was conducted to quantitatively evaluate the relationship between the instrumental activities of daily living (IADL) and various physical fitness tests in elderly women living at home. The study focused on the total population of those women aged 65 years and over living in Y Town, Hyogo Prefecture, Japan, who visited a nursing home for day services. A total of 128 subjects were divided into two groups: dependent in IADL group (n = 49) and independent in IADL group (n = 79). The magnitude of the relation was evaluated by the odds ratio (OR). The following tests showed a significant decrease in IADL: knee-raising test [age-adjusted OR = 4.23, 95% confidence interval (CI) 1.81-9.87], height (age-adjusted OR = 4.09, 95% CI 1.75-9.56), grip strength (age-adjusted OR = 3.68, 95% CI 1.57-8.60), sit-and-reach test (age-adjusted OR = 2.76, 95% CI 1.20-6.34), and standing on one leg with closed eyes (age-adjusted OR = 2.56, 95% CI 1.09-5.97). Multivariate analysis using Hayashi's quantification method I indicated that knee-raising was the test most highly correlated with decreased IADL. These results suggest that measurement of knee-raising ability, muscle strength of the lower extremities and flexibility of hip joint could be the most useful factors to assess the level of instrumental self-support ability.</p

ショウガイ ノ アル コドモ ノ カゾク シエン ジドウ デイ サービス オ リヨウ シテイル カゾク ノ EE ト QOL

AbstractObjet : Recently, Evidence Based Practice (EBP) has become important in order to improvea quality of social services and professional accountability. We spotlight Expressed Emotion(EE) of family to aim to construct Evidence based family support and demonstrate \u27evidence\u27for family with children with disability. EE was begun to study about family impact onschizophrenia patients, and is already established. Now it is applied to another disease anddisabilities, and that studies applied for family with children with disability are increasing.This is a first study to investigate EE of family with children with disability in this country.Methods : Subjects were 42 mothers\u27 EE whose children used a day service for child lived. EEwas evaluated using Five Minutes Speech Sample (FMSS). Quality of life (QOL) was evaluatedusing SF-36v2 as subscale. Result : It is possible that EE of family with children withdisability is different from disability, and it is necessity to change cut-off-point of high EEbecause of Japanese characteristic. In addition, family QOL is lower than national standardexcept Physical functioning (PF), and three subcategories of Role physical (RP), Mental Health(MH), and General Health perceptions (GH) is significant difference between Low EE and HighEE. Conclusion : We obtained important evidences that it should focus disability characteristicand family QOL to support family with children with disability through this study