This paper reviews the literature on health economics assessment (HEA) for liver transplantation (LT) in Europe and USA, and considers prospects in Japan where HEA is currently rarely performed.
 LT is one of the most expensive health technologies but the health outcome is generally good. It provides the only well-established treatment for end-stage liver disease (ESLD) in the Western world, while in Japan it has yet to be fully implemented because public acceptance is still very low.
 MEDLINE and Japana Centra Revuo Medicina WEB version Ver. 2 (JCRM2) were systematically used for the literature search. As a result, 6 original papers in Europe and USA that employed accurate methods for HEA were identified through MEDLINE, indicating that LT is cost-effective on long term follow-up. In Japan, however, only one study could be good which tried to estimate it's cost-effectiveness, and the methodology was different from that used in Europe and USA. Through accurate HEA for LT in Japan, we hope that this procedure may become a well-accepted health technology in the future.

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Purpose Male caregivers are growing in number, as the frequency of spouse caregiving rapidly increases. This study aimed to examine gender differences in family caregivers with reference to the mode of caregiving and caregiver distress in Japan. It was designed to clarify the characteristics of both female and male caregivers.
Methods The subjects were 2,020 users of public Long-term Care Insurance, randomly stratified and sampled in Higashi-osaka city, Osaka prefecture. Data were collected through mailed, anonymous self-report questionnaires. 1,287 (63.7%) surveys were collected and data from 868 caregivers and care recipients were analyzed, after excluding incomplete cases from 947 participants who were family caregivers. We compared males and females for the level of nursing needs, cognitive disorders of their care recipients, the types and amounts of care provided, the levels of their burdens and the depression associated with providing care, the availability of informal support, the frequency of usage of Long-term care insurance services, and the types of stress coping strategies.
Results Of the total, 27.1% of the caregivers were male. Their age was higher than that of females, but the age of care recipients of female caregivers was significantly higher than that of care recipients of males. There were no significant gender differences in the level of nursing needs of recipients. However, cognitive disorders of care recipients of female caregivers were more severe. Female caregivers spent more time providing care, and performed a greater number of care activities. In particular, female caregivers assisted their care recipients in taking medications, dressing, bathing, eating, meal preparation, shopping, laundry, and money management more often to a significant degree. Furthermore, the average scores for burden and depression were higher in female than in male caregivers. Concerning the usage of Long-term care insurance services, males used a Home-helper service more often. Female caregivers used types of Informal support seeking and Positive acceptance of caregiving role as coping strategies more often than the men. Multiple logistic regression analysis indicated that caregiver's subjective burden and types of informal support seeking, as well as acceptance of the caregiving role were significantly higher in female caregivers.
Conclusions These results suggest that there are significant gender differences regarding the mode of caregiving and experience of caregiver distress in Japan. It is important that future research be focused on supplying appropriate social support for family caregivers, taking gender differences into account.

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Purpose To assess a smoking rate survey using the coming-of-age ceremony to examine the practicality for estimating the under twenties' smoking rate as a baseline and a long term assessment index for action plans to prevent smoking in the young.
Methods We undertook the survey at village A (with a population of about 6,500) and town B (with about 12,000 residents) in Niigata Prefecture. Village A started a comprehensive anti-smoking policy featuring cooperation between schools and the community. Subjects were twenty-year young adults (69 in village A and 118 in town B) who attended rural coming-of-age ceremonies in 2002. The self-rated questionnaire included smoking habits, age of first smoking experience, and age of becoming a regular smoker (only in village A).
Results Smoking rates were 68.0% for men and 48.6% for women in village A. Of these, approximately 90% smoked daily and more than 70% became regular smokers before the age of 20. Smoking rates in town B were similar. The results were about 20% higher than found by a smoking rate survey performed at high schools.
Conclusion Smoking rate surveys at coming-of-age ceremonies offer a practical and easy approach to estimate under twenties' smoking rate and assess the effects of smoking prevention strategies among the young.

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Purpose The purpose of this study was to explore processes and strategies for developing community health projects directed by public health nurses (PHNs) in municipalities of Japan.
Method Yin's case study design was adopted into the 5-step Policy Making Process Model as the theoretical framework. The first two steps involving agenda setting and project planning were the focus of this study. PHNs who had developed new community health projects in municipalities were interviewed as study participants. In order to maintain the quality of projects at a certain level, only these approved officially by municipalities with a program and budget were selected.
Results Common strategies emerged for developing community health projects in the cases presented by the 5 PHNs. Out of 891codes, twenty-six sub-categories were identified and integrated into 9 categories. When categories were analyzed in a time series, the following common processes were found: integration of related data, identification of the health problems in the community and recognition of project needs (Phase 1); refining the concept and characteristics of the project plan (Phase 2); and assuring that resources were available for the optimal implementation of the project by consolidating ideas (Phase 3).
 In Phase 1, PHNs integrated the information about previous experimental cases or social circumstances to identify community health problems needing solution. PHNs' thoughts were given to problems of existing projects and daily practices were grouped to make comprehensive plans for improvement. In Phase 2, PHNs discussed ideas for the project plans and considered resources and strategies that were necessary for putting new projects into place. In Phase 3, PHNs were attentive to the factors reviewed in Phase 2, kept account of necessary resources, and made certain of timing for immediate implementation of plans. The dual roles of PHNs, both as nurses and public servants, helped to clarify and solve the community health problems.
Conclusion Common strategies of developing programs were explored; “Identifying the community health problems through analyzing the causes of difficult cases,” “Recognizing the necessity of coverall-projects which will improve the existing projects,” “Understanding the awareness of those involved and discuss ideas for the project plan.” The findings have based solely on the experiences of PHNs, they can provide suggestions that are keys to efficient development of new projects.

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[in Japanese]

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Objective This study was performed to assess changes over a 5-year period in the number of patients with intractable diseases living in Kyoto city who received public financial aid for treatment. Variation in the quality of their lives was also investigated.
Methods Questionnaires were mailed to all patients with intractable diseases who lived in Kyoto city and who applied for financial aid for treatment in 1996 and in 2001.
Results 1. The total number of patients increased 1.4-fold over the 5 years (from 4,097 to 5,891).
 2. The number of patients who required medical treatments increased. Especially a considerable number of patients required treatments for secondary conditions ascribable to a long-term bed-confined state or prolonged treatment for primary diseases.
 3. The number of patients who required care to support daily life or hospital visits increased 2-fold.
 4. It was demonstrated that 52.8% of patients felt their lives had improved after the introduction of long-term care insurance system.
Conclusions The number of patients with intractable diseases appears to be increasing and their clinical courses are becoming chronic and more severe. This situation can be expected to persist in the near future, so that further consideration of measures to provide medical care and welfare is necessary.

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Objectives This paper reports the results of a qualitative study on domestic violence (DV) and interventions against DV in Khon Kaen province in northeastern Thailand. We analyzed the roles of health professionals for identifying, treating and supporting abused women, and examined a network model of DV interventions in developing countries.
Methods We interviewed abused women, health professionals, staff of the government and legal authorities, community health workers and other relevant people in Khon Kaen city and surrounding areas. We analyzed the health consequences of DV, and the roles of health professionals and other actors regarding care and assistance for abused women. We also visited and observed homes of the victims and health facilities where those women were treated.
Results and Discussion We interviewed 4 abused women in a slum area. One of the women was identified by a nurse of a nearby health center and a social worker when they visited homes in the area. Another woman was successfully supported by nurses of the health center, a community leader and a Buddhist monk. Health professionals played important roles in identifying, treating and protecting abused women. The Khon Kaen provincial hospital established an One-Stop Crisis Center (OSCC) to provide counseling, care and protection for physically or sexually abused women, with a team consisting of doctors, nurses and social workers who were trained in the care of abused women. The Nampol community hospital in a suburban area also established an OSCC to work together with health centers and communities for effective intervention. OSCC team members pointed out several problems: insufficient mental care, shortage of staff, and the difficulty of caring for women coming to the hospital at night or early in the morning. In Thailand, a legal framework against DV has yet to be established and government agencies are not greatly involved in DV interventions. Health professionals play leading roles in identifying, treating and supporting abused women in Thailand. It is important to provide relevant training for health professionals and to develop cooperation networks with government staff and legal authorities, community health workers, and community leaders. Legal frameworks for protecting and supporting DV victims are often insufficient in developing countries, while health care systems tend to be more reliable. Taking into account the social background, health professionals in developing countries can be expected to continue to play the most important role in looking after abused women.

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