産業保健サービスの存在は企業における高血圧および糖尿病のEffective Coverageを向上させる
WHOは「各国・地域において，人々が経済的困難を伴わず保健医療サービスを享受すること」を目標としており，その指標としてEffective Coverage（EC）という概念を提唱している．ECとは“その国または地域における健康システムを通して，実際に人々に健康増進をもたらすことができる割合”と定義されており，産業保健の場面では治療が必要，もしくは治療を受けているうち，適切に疾病管理されている率に該当すると考えられる．本研究では産業保健サービスの効果を評価することを目的とし，「常勤の産業保健スタッフ（産業医または産業看護職）による労働者への産業保健サービスの提供は，高血圧，糖尿病，脂質異常症の各...
Saved in:
| Published in | Journal of UOEH Vol. 41; no. 3; pp. 271 - 282 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English Japanese |
| Published |
学校法人 産業医科大学
01.09.2019
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0387-821X 2187-2864 |
| DOI | 10.7888/juoeh.41.271 |
Cover
| Abstract | WHOは「各国・地域において，人々が経済的困難を伴わず保健医療サービスを享受すること」を目標としており，その指標としてEffective Coverage（EC）という概念を提唱している．ECとは“その国または地域における健康システムを通して，実際に人々に健康増進をもたらすことができる割合”と定義されており，産業保健の場面では治療が必要，もしくは治療を受けているうち，適切に疾病管理されている率に該当すると考えられる．本研究では産業保健サービスの効果を評価することを目的とし，「常勤の産業保健スタッフ（産業医または産業看護職）による労働者への産業保健サービスの提供は，高血圧，糖尿病，脂質異常症の各項目について，ECを向上させる」という仮説をたてて検証した．2011年度の一般健康診断，人事情報，及びレセプトからの個々のデータを分析した横断的研究である．特定の大規模企業グループの91,351人の男性労働者を対象とした．常勤の産業保健スタッフがいる事業場に所属する労働者（OH群）とそれ以外の事業場に所属する労働者（non-OH群）において高血圧，糖尿病，脂質異常症の各項目別にECを算出し，比較した．OH群はnon-OH群に比べて，高血圧・糖尿病において有意にECが高率であったが，脂質異常症については有意な差を認めなかった（高血圧aOR 1.41: 95%CI 1.20-1.66，糖尿病aOR 1.53: 95%CI 1.17-2.00，脂質異常症aOR 1.11: 95%CI 0.92-1.34）．常勤の産業保健スタッフによる産業保健サービスの提供は，健康診断後の適切な管理に大きく影響する． |
|---|---|
| AbstractList | WHOは「各国・地域において，人々が経済的困難を伴わず保健医療サービスを享受すること」を目標としており，その指標としてEffective Coverage（EC）という概念を提唱している．ECとは“その国または地域における健康システムを通して，実際に人々に健康増進をもたらすことができる割合”と定義されており，産業保健の場面では治療が必要，もしくは治療を受けているうち，適切に疾病管理されている率に該当すると考えられる．本研究では産業保健サービスの効果を評価することを目的とし，「常勤の産業保健スタッフ（産業医または産業看護職）による労働者への産業保健サービスの提供は，高血圧，糖尿病，脂質異常症の各項目について，ECを向上させる」という仮説をたてて検証した．2011年度の一般健康診断，人事情報，及びレセプトからの個々のデータを分析した横断的研究である．特定の大規模企業グループの91,351人の男性労働者を対象とした．常勤の産業保健スタッフがいる事業場に所属する労働者（OH群）とそれ以外の事業場に所属する労働者（non-OH群）において高血圧，糖尿病，脂質異常症の各項目別にECを算出し，比較した．OH群はnon-OH群に比べて，高血圧・糖尿病において有意にECが高率であったが，脂質異常症については有意な差を認めなかった（高血圧aOR 1.41: 95%CI 1.20-1.66，糖尿病aOR 1.53: 95%CI 1.17-2.00，脂質異常症aOR 1.11: 95%CI 0.92-1.34）．常勤の産業保健スタッフによる産業保健サービスの提供は，健康診断後の適切な管理に大きく影響する． |
| Author | 永田, 智久 森, 晃爾 伊藤, 正人 橋口, 克頼 永田, 昌子 藤野, 善久 |
| Author_xml | – sequence: 1 fullname: 永田, 昌子 organization: 産業医科大学 産業保健データサイエンスセンター – sequence: 1 fullname: 永田, 智久 organization: 産業医科大学 産業生態科学研究所 産業保健経営学 – sequence: 1 fullname: 藤野, 善久 organization: 産業医科大学 産業生態科学研究所 環境疫学 – sequence: 1 fullname: 森, 晃爾 organization: 産業医科大学 産業生態科学研究所 産業保健経営学 – sequence: 1 fullname: 橋口, 克頼 organization: パナソニック健康保険組合 健康管理センター – sequence: 1 fullname: 伊藤, 正人 organization: 産業医科大学 産業生態科学研究所 環境疫学 |
| BookMark | eNo9UF1LAkEUHcIgtd76Af0BbWZn1519ihD7AKGXgt6W2d2ZdDGNXZN6a1aCqJfsU8geIqRArECCAsEfM27Wv2itCC73Xu4953A4CRArV8oMgFkE0zohZN7drbBCWkVpRUcTIK4goqcUklFjIA5xtBMFbU6BhO-7EGpERVoc7I0u7j_a3eHgNhRtGbzKel_Wz2XwLsVT2G2GrUcpnod9EWGk6EhxLEVDBidfnebn3UHYehhfgiMpeqPeVfgyGF0fRsQc58yuFmtsLlupMY9uMRmchaeN4VtEv5TiJlKYBpOclnw28zeTYGMpt55dSeXXllezi_mUi3SDpnSsQGSpFjKisjUVIoYynDu2YRFqZVSGCDcMQglyNJtQGyqqDh3OsaJTh2GMk2DhV9f1q5ERc8crblNv36RetWiXmPmTmakiE49bFNz_xy5Qz3Qp_gZAF46H |
| ContentType | Journal Article |
| Copyright | 2019 産業医科大学 |
| Copyright_xml | – notice: 2019 産業医科大学 |
| DOI | 10.7888/juoeh.41.271 |
| DatabaseTitleList | |
| DeliveryMethod | fulltext_linktorsrc |
| EISSN | 2187-2864 |
| EndPage | 282 |
| ExternalDocumentID | article_juoeh_41_3_41_271_article_char_ja |
| GroupedDBID | --- 5GY ALMA_UNASSIGNED_HOLDINGS F5P JMI JSF JSH KQ8 MOJWN RJT RZJ |
| ID | FETCH-LOGICAL-j179a-73201b4b19b19c5401e16ffdc9b8ab64e18f998a81d5c8ac02470dff327ade333 |
| ISSN | 0387-821X |
| IngestDate | Wed Sep 03 05:56:36 EDT 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | false |
| IsScholarly | true |
| Issue | 3 |
| Language | English Japanese |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-j179a-73201b4b19b19c5401e16ffdc9b8ab64e18f998a81d5c8ac02470dff327ade333 |
| OpenAccessLink | https://www.jstage.jst.go.jp/article/juoeh/41/3/41_271/_article/-char/ja |
| PageCount | 12 |
| ParticipantIDs | jstage_primary_article_juoeh_41_3_41_271_article_char_ja |
| PublicationCentury | 2000 |
| PublicationDate | 2019/09/01 |
| PublicationDateYYYYMMDD | 2019-09-01 |
| PublicationDate_xml | – month: 09 year: 2019 text: 2019/09/01 day: 01 |
| PublicationDecade | 2010 |
| PublicationTitle | Journal of UOEH |
| PublicationTitleAlternate | 産業医大誌 |
| PublicationYear | 2019 |
| Publisher | 学校法人 産業医科大学 |
| Publisher_xml | – name: 学校法人 産業医科大学 |
| References | 17. Adachi T, Matsumoto K, Irisawa Y, Ikuta J, Tashiro T, Konishi E, Okuma C, Yokota T & Tagami A (1989): Referral compliance improved by a letter of introduction to a specific physician following mass screening. Nihon Koshu Eisei Zasshi 36: 413–420 (in Japanese) 16. Yamaguchi N, Okubo T, Yamamura J, Takahashi K, Nakamura R & Funatani F (1990): A prospective study of access to medical services following a community-based screening program. Nihon Koshu Eisei Zasshi 37: 281–288 (in Japanese) 13. Sullivan R, Peppercorn J, Sikora K et al (2011): Delivering affordable cancer care in high-income countries. Lancet Oncol 12: 933–980 6. Ishikawa H, Nomura K, Sato M & Yano E (2008): Developing a measure of communicative and critical health literacy: A pilot study of Japanese office workers. Health Promot Int 23: 269–274 14. Hirobe K, Terai T, Fujioka S, Goto K & Dohi S; 3M-Study Project Committee of the Japan Association of Occupational Physicians “San-yu-kai” (2005): Morbidity of Myocardial Infarction Multicenter Study in Japan (3M Study): Study design and event rates for myocardial infarction and coronary death by age category in Japanese workers. Circ J 69: 767–773 20. Burton WN, Chen CY, Conti DJ, Schultz AB, Pransky G & Edington DW (2005): The association of health risks with on-the-job productivity. J Occup Environ Med 47: 769–777 8. Shengelia B, Tandon A, Adams OB & Murray CJ (2005): Access, utilization, quality, and effective coverage: An integrated conceptual framework and measurement strategy. Soc Sci Med 61: 97–109 10. Lozano R, Soliz P, Gakidou E, Abbott-Klafter J, Feehan DM, Vidal C, Ortiz JP & Murray CJ (2006): Benchmarking of performance of Mexican states with effective coverage. Lancet 368: 1729–1741 11. Rubinstein A, Zerbino MC, Cejas C & López A (2018): Making universal health care effective in Argentina: A blueprint for reform. Health Syst Reform 4: 203–213 21. Mori K (2018): Current status and issues for the role of occupational health physicians in Japan. JMA J 1: 15–21 1. Ministry of Health, Labour and Welfare (MHLW): Ordinance on Industrial Safety and Health. MHLW, Tokyohttps://www.jaish.gr.jp/anzen/hor/hombun/hor1-2/hor1-2-1-m-0.htm (in Japanese) (Accessed 1 Feb 2019) 19. Tatemichi M, Hamaguchi T, Hashira M et al (2002): Acceptability and long-term compliance with drug treatment for hypercholesterolemia in Japanese male workers: I. Acceptability of drug treatment. J Occup Health 44: 166–175 7. Goto E, Ishikawa H, Okuhara T, Kato M, Okada M & Kiuchi T (2018): Factors associated with adherence to recommendations to visit a physician after annual health checkups among Japanese employees: A cross-sectional observational study. Ind Health 56: 155–159 5. Aono Y, Aisaka A, Gohno M, Hida T & Shimizu T (2000): Visiting a doctor by individuals who need medical diagnosis after screening and kinds of screening. Sangyo Igaku Journal 23(5): 43–49 (in Japanese) 15. Horie S, Sone S, Nakano S, Taguchi M & Hirobe K (2005): Investigation of occupational mortality rate for 5 years in a workplace where a dedicated industrial physician is located. Sangyo Eiseigaku Zassi 47(suppl): 442 (in Japanese) 22. Tatemichi M, Hamaguchi T, Hashira M et al (2002): Acceptability and long-term compliance with drug treatment for hypercholesterolemia in Japanese male workers: II. Long-term compliance with drug treatment. J Occup Health 44: 307–314 12. Leslie HH, Malata A, Ndiaye Y & Kruk ME (2017): Effective coverage of primary care services in eight high-mortality countries. BMJ Glob Health 2: e000424. doi: 10.1136/bmjgh-2017-000424 18. Tateishi S, Watase M, Fujino Y & Mori K (2016): The opinions of occupational physicians about maintaining healthy workers by means of medical examinations in Japan using the Delphi method. J Occup Health 58: 72–80 24. Sato K, Yamazaki S, Hayashino Y, Takegami M, Tokuda Y, Takahashi O, Shimbo T, Hinohara S, Fukui T & Fukuhara S (2011): Associations between hours worked, symptoms and health resource utilization among full-time male Japanese workers. J Occup Health 53: 197–204 2. National Federation of Industrial Health Organization: Greeting. National Federation of Industrial Health Organization, Tokyo http://www.zeneiren.or.jp/about/index.html (in Japanese) (Accessed 1 Feb 2019) 3. Fukuda H (2016): Evaluation and future tasks of specified health examination and specific health guidance at health insurance associations based on employers and enterprises. Hoken No Kagaku 58: 162–171 (in Japanese) 9. Ng M, Fullman N, Dieleman JL, Flaxman AD, Murray CJ & Lim SS (2014): Effective coverage: A metric for monitoring universal health coverage. PLoS Med 11: e1001730. doi: 10.1371/journal.pmed.1001730 4. Ministry of Health, Labour and Welfare (MHLW) (2008): Guidelines on measures to be taken by employers based on results of health examination. MHLW, Tokyohttps://www.mhlw.go.jp/file/04-Houdouhappyou-11202000-Roudoukijunkyoku-Kantokuka/shishin.pdf. (in Japanese) 23. Tsuda K, Tsutsumi A & Kawakami N (2004): Work-related factors associated with visiting a doctor for a medical diagnosis after a worksite screening for diabetes mellitus in Japanese male employees. J Occup Health 46: 374–381 25. Azami Y, Morita K, Nakada A & Suzuki M (2000): The factors associated with visiting a doctor for male diabetes workers. Practice 17: 177–182 (in Japanese) |
| References_xml | – reference: 18. Tateishi S, Watase M, Fujino Y & Mori K (2016): The opinions of occupational physicians about maintaining healthy workers by means of medical examinations in Japan using the Delphi method. J Occup Health 58: 72–80 – reference: 9. Ng M, Fullman N, Dieleman JL, Flaxman AD, Murray CJ & Lim SS (2014): Effective coverage: A metric for monitoring universal health coverage. PLoS Med 11: e1001730. doi: 10.1371/journal.pmed.1001730 – reference: 24. Sato K, Yamazaki S, Hayashino Y, Takegami M, Tokuda Y, Takahashi O, Shimbo T, Hinohara S, Fukui T & Fukuhara S (2011): Associations between hours worked, symptoms and health resource utilization among full-time male Japanese workers. J Occup Health 53: 197–204 – reference: 7. Goto E, Ishikawa H, Okuhara T, Kato M, Okada M & Kiuchi T (2018): Factors associated with adherence to recommendations to visit a physician after annual health checkups among Japanese employees: A cross-sectional observational study. Ind Health 56: 155–159 – reference: 15. Horie S, Sone S, Nakano S, Taguchi M & Hirobe K (2005): Investigation of occupational mortality rate for 5 years in a workplace where a dedicated industrial physician is located. Sangyo Eiseigaku Zassi 47(suppl): 442 (in Japanese) – reference: 25. Azami Y, Morita K, Nakada A & Suzuki M (2000): The factors associated with visiting a doctor for male diabetes workers. Practice 17: 177–182 (in Japanese) – reference: 20. Burton WN, Chen CY, Conti DJ, Schultz AB, Pransky G & Edington DW (2005): The association of health risks with on-the-job productivity. J Occup Environ Med 47: 769–777 – reference: 22. Tatemichi M, Hamaguchi T, Hashira M et al (2002): Acceptability and long-term compliance with drug treatment for hypercholesterolemia in Japanese male workers: II. Long-term compliance with drug treatment. J Occup Health 44: 307–314 – reference: 16. Yamaguchi N, Okubo T, Yamamura J, Takahashi K, Nakamura R & Funatani F (1990): A prospective study of access to medical services following a community-based screening program. Nihon Koshu Eisei Zasshi 37: 281–288 (in Japanese) – reference: 4. Ministry of Health, Labour and Welfare (MHLW) (2008): Guidelines on measures to be taken by employers based on results of health examination. MHLW, Tokyohttps://www.mhlw.go.jp/file/04-Houdouhappyou-11202000-Roudoukijunkyoku-Kantokuka/shishin.pdf. (in Japanese) – reference: 12. Leslie HH, Malata A, Ndiaye Y & Kruk ME (2017): Effective coverage of primary care services in eight high-mortality countries. BMJ Glob Health 2: e000424. doi: 10.1136/bmjgh-2017-000424 – reference: 3. Fukuda H (2016): Evaluation and future tasks of specified health examination and specific health guidance at health insurance associations based on employers and enterprises. Hoken No Kagaku 58: 162–171 (in Japanese) – reference: 6. Ishikawa H, Nomura K, Sato M & Yano E (2008): Developing a measure of communicative and critical health literacy: A pilot study of Japanese office workers. Health Promot Int 23: 269–274 – reference: 8. Shengelia B, Tandon A, Adams OB & Murray CJ (2005): Access, utilization, quality, and effective coverage: An integrated conceptual framework and measurement strategy. Soc Sci Med 61: 97–109 – reference: 19. Tatemichi M, Hamaguchi T, Hashira M et al (2002): Acceptability and long-term compliance with drug treatment for hypercholesterolemia in Japanese male workers: I. Acceptability of drug treatment. J Occup Health 44: 166–175 – reference: 21. Mori K (2018): Current status and issues for the role of occupational health physicians in Japan. JMA J 1: 15–21 – reference: 5. Aono Y, Aisaka A, Gohno M, Hida T & Shimizu T (2000): Visiting a doctor by individuals who need medical diagnosis after screening and kinds of screening. Sangyo Igaku Journal 23(5): 43–49 (in Japanese) – reference: 14. Hirobe K, Terai T, Fujioka S, Goto K & Dohi S; 3M-Study Project Committee of the Japan Association of Occupational Physicians “San-yu-kai” (2005): Morbidity of Myocardial Infarction Multicenter Study in Japan (3M Study): Study design and event rates for myocardial infarction and coronary death by age category in Japanese workers. Circ J 69: 767–773 – reference: 17. Adachi T, Matsumoto K, Irisawa Y, Ikuta J, Tashiro T, Konishi E, Okuma C, Yokota T & Tagami A (1989): Referral compliance improved by a letter of introduction to a specific physician following mass screening. Nihon Koshu Eisei Zasshi 36: 413–420 (in Japanese) – reference: 13. Sullivan R, Peppercorn J, Sikora K et al (2011): Delivering affordable cancer care in high-income countries. Lancet Oncol 12: 933–980 – reference: 10. Lozano R, Soliz P, Gakidou E, Abbott-Klafter J, Feehan DM, Vidal C, Ortiz JP & Murray CJ (2006): Benchmarking of performance of Mexican states with effective coverage. Lancet 368: 1729–1741 – reference: 2. National Federation of Industrial Health Organization: Greeting. National Federation of Industrial Health Organization, Tokyo http://www.zeneiren.or.jp/about/index.html (in Japanese) (Accessed 1 Feb 2019) – reference: 23. Tsuda K, Tsutsumi A & Kawakami N (2004): Work-related factors associated with visiting a doctor for a medical diagnosis after a worksite screening for diabetes mellitus in Japanese male employees. J Occup Health 46: 374–381 – reference: 1. Ministry of Health, Labour and Welfare (MHLW): Ordinance on Industrial Safety and Health. MHLW, Tokyohttps://www.jaish.gr.jp/anzen/hor/hombun/hor1-2/hor1-2-1-m-0.htm (in Japanese) (Accessed 1 Feb 2019) – reference: 11. Rubinstein A, Zerbino MC, Cejas C & López A (2018): Making universal health care effective in Argentina: A blueprint for reform. Health Syst Reform 4: 203–213 |
| SSID | ssj0058415 |
| Score | 2.2082913 |
| Snippet | WHOは「各国・地域において，人々が経済的困難を伴わず保健医療サービスを享受すること」を目標としており，その指標としてEffective... |
| SourceID | jstage |
| SourceType | Publisher |
| StartPage | 271 |
| SubjectTerms | EC UHC 横断的研究 産業保健スタッフ 診療報酬明細書 |
| Title | 産業保健サービスの存在は企業における高血圧および糖尿病のEffective Coverageを向上させる |
| URI | https://www.jstage.jst.go.jp/article/juoeh/41/3/41_271/_article/-char/ja |
| Volume | 41 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | Journal of UOEH, 2019/09/01, Vol.41(3), pp.271-282 |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnR1NaxUxcCn14kUUFb8qPZiTvPJ2k-wmx93nlqKoCC30tuwn0kMr0kLx5L4iiF6snwXrQaQolKpQBIVCf8z2Wf0XziTZ7VYq1MIjDMlkMh_Jm0k2H5Z1hdEY_FJedJyUMpiggC0SVmQdL3Z5IuPUydWa7s1b7sQUuz7Np4eGR1q7lhbmk7H0wYHnSo5iVcgDu-Ip2f-wbEMUMgAG-0IKFob0UDYmoUckIz4loUt8TvxrJGQkGCcSAA5BImaGlAiHBBqgJOgZQNK6SCoAkEOsBUSkQED2iC_qonFFuYfwXlu6KDCA8A0gbUNZQJFEBCQoiG_jvgpD2dtfC5DrtgKKckEqXUQOuigRSuoRwRtW9bXLuO-ph7tQ4W_R0JGOaqKr2ACeRYuxuroMGg7_EZ1P3Q6bj2goMXIhjL4Bho6JuSCX6NVK6x4CX5LAV1xJot8Q0vgChfMZakuAlKHG56gBwQ7Ad9HmftgiK5TSQIdB2F7Isfd2qumhZ5j1XUWkizZBbqnSDUPuAv_qQf2Ko6RBgEVgO9QtR47RjoZiy6fgVcrCUa8UgftXeRDkeR1H6Mvka6eobyMzg5-2PZx-MccES45-OepvP4zrKuiHF-byu2PMHmsq7bvZ3IybSKFFzI4oJoAb1SV48jCagenPMcfz1C6MG3eaj4QQOusHSmqZ9LkWtabTbhliyxmYadW7NFXgOHnSOmH61KivGztlDeWzp63F3Zcffq5t7Gy_G5RrVf9btbRVLb2o-j-q8vNgY2Ww-qkqv-xslYBTletV-aQql6v-09_rK7_ePxysfsSc_uOq3NzdfD34ur375hFUbIbEaD0kqv7zwbPlne9Q_VVVvgUKZ6yp8XCyN9Exj6B0ZsBXxh2PQl9JWGJL-KUwv7Jz2y2KLJWJiBOX5bYopBQxzDt5KuIUYm6vmxUFdbw4yymlZ63h2bnZ_Jw1mkEJzyDE95yU5YmT8BxCDJ6JnPM0Ed55S2hFRff0TTfRoS104ehVL1rH90bDJWt4_v5CPgKB_nxyWZn7Dy0-3ks |
| linkProvider | Colorado Alliance of Research Libraries |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=%E7%94%A3%E6%A5%AD%E4%BF%9D%E5%81%A5%E3%82%B5%E3%83%BC%E3%83%93%E3%82%B9%E3%81%AE%E5%AD%98%E5%9C%A8%E3%81%AF%E4%BC%81%E6%A5%AD%E3%81%AB%E3%81%8A%E3%81%91%E3%82%8B%E9%AB%98%E8%A1%80%E5%9C%A7%E3%81%8A%E3%82%88%E3%81%B3%E7%B3%96%E5%B0%BF%E7%97%85%E3%81%AEEffective+Coverage%E3%82%92%E5%90%91%E4%B8%8A%E3%81%95%E3%81%9B%E3%82%8B&rft.jtitle=Journal+of+UOEH&rft.au=%E6%B0%B8%E7%94%B0%2C+%E6%98%8C%E5%AD%90&rft.au=%E6%B0%B8%E7%94%B0%2C+%E6%99%BA%E4%B9%85&rft.au=%E8%97%A4%E9%87%8E%2C+%E5%96%84%E4%B9%85&rft.au=%E6%A3%AE%2C+%E6%99%83%E7%88%BE&rft.date=2019-09-01&rft.pub=%E5%AD%A6%E6%A0%A1%E6%B3%95%E4%BA%BA+%E7%94%A3%E6%A5%AD%E5%8C%BB%E7%A7%91%E5%A4%A7%E5%AD%A6&rft.issn=0387-821X&rft.eissn=2187-2864&rft.volume=41&rft.issue=3&rft.spage=271&rft.epage=282&rft_id=info:doi/10.7888%2Fjuoeh.41.271&rft.externalDocID=article_juoeh_41_3_41_271_article_char_ja |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0387-821X&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0387-821X&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0387-821X&client=summon |