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勞働科学 83巻（2007年）

＜１号＞＜２号＞＜３号＞＜４号＞

　83巻１号

山本真二, 岩本美江子, 井上正岩, 原田規章
暑熱曝露の生体影響評価に関する検討（その１）−心拍変動、尿中カテコールアミンを用いて−
労働科学，83(1),1〜6,(2007)

　暑熱曝露の生体影響の評価指標についての検討を目的とし，暑熱曝露による自律神経機能影響を心拍変動（HRV），尿中カテコールアミン(CA)を用いて測定した。健常男子学生６名を被験者とし，快適条件 (湿球黒球温度（WBGT）19℃)及び暑熱条件 (WBGT 30℃)に，座位にて30分間曝露した。快適条件における曝露により体重減少，収縮期血圧低下に有意な変化を認めた。暑熱条件曝露では体重減少，拡張期血圧上昇，体温上昇，高周波成分(HF)%の減少，低周波成分/高周波成分(LF/HF)比の増加，熱感，発汗の変化を認めた。心拍変動解析により交感神経機能の亢進および副交感神経機能の低下が示された。このことはその他の生体反応変化と一致した。以上より心拍変動が暑熱曝露の生体影響の指標となりうることが示唆された。(表5)（自抄）
キーワード：自律神経系；WBGT；暑熱曝露；心拍変動；尿中カテコールアミン

Shinji YAMAMOTO, Mieko IWAMOTO, Masaiwa INOUE , Noriaki HARADA　
Evaluation of The Effect of Heat Exposure on the Autonomic Nervous System (Part 1)
-Using Heart Rate Variability and Urinary Catecholamines-
THE JOURNAL OF SCIENCE OF LABOUR,83(1),1〜6,(2007)

　The aim of this study was to investigate the usefulness of heart rate variability (HRV) and urinary catecholamines (CA) as the objective indices of heat stress. We measured physiological responses, subjective symptoms, HRV and urinary CA for evaluating the effect of heat exposure on the autonomic nervous system. Six healthy male students volunteered for this study. They were exposed on different days to either a thermoneutral condition at wet bulb globe temperature (WBGT) 19_C or a heated condition at WBGT 30_C for 30 min, while seated on a chair. In the thermoneutral condition, body weight and systolic blood pressure significantly decreased after 30 min exposure. In the heated condition, body weight significantly decreased where as diastolic blood pressure, body temperature and scores for subjective symptoms (feverishness and sweating) significantly increased after 30 min exposure. Heart rate and breath rate tended to increase. Also, the percent high-frequency component of HRV (HF%) significantly decreased and the low-frequency/high-frequency (LF/HF) ratio significantly increased after 30 min exposure to the heated condition. There were no significant differences between the amounts of urinary CA before and after 30 min exposure. The heat exposure (WBGT 30_C) thus induced an activation of the sympathetic nervous system and a withdrawal of the parasympathetic nervous system. These findings coincided with observed changes of heart rate, breath rate and subjective symptoms. It is concluded that HRV (HF% and LF/HF ratio) is useful as the objective indices of the heat stress and that HRV indices are more sensitive than urinary CA.
Key words: Autonomic nervous system; WBGT; Heat exposure; Heart rate variability;Urinary catecholamine

安達悠子，臼井伸之介，篠原一光，松本友一郎，青木喜子
看護業務における違反事例の収集とその心理的生起要因に関する検討
労働科学，83(1),7〜23,(2007)

　本研究では，看護師を対象に，業務中にしたあるいは見た違反内容とその違反理由の記述を求めた質問紙調査を行った。また同時に，その違反をどの程度しているあるいは見かけるという主観的な違反頻度と，違反の生起に関与していると考えられるリスク評価等の心理的要因に関する4件法の質問への回答を求め，違反頻度と心理的要因との関連を検討した。記述された違反内容と違反理由はKJ法により分類し，違反頻度と心理的要因については得点化ののち相関係数を算出した。その結果，違反内容21項目，違反理由13項目が得られた。心理的要因は，リスク評価よりもベネフィットや抵抗感が違反頻度に関与していることが示唆された。(表10)（自抄）
キーワード：医療事故；看護；違反；事例分析；心理的要因
　
Yuko ADACHI, Shinnosuke USUI, Kazumitsu SHINOHARA, Tomoichiro MATSUMOTO, Yoshiko AOKI
Cases of Rule Violations in Nursing and Analyses of their Reasons Based on Psychological Factors
THE JOURNAL OF SCIENCE OF LABOUR,83(1),7〜23,(2007)

　Rule violations have been indicated as causes of medical accidents. It is crucial to clarify what kinds of rule violations are made in hospitals. We conducted a questionnaire survey asking 155 nurses to report cases of rule violations and the reasons for the violations in order to assess what was really going on. In the questionnaire, the nurses were requested to verify the relation between violations and psychological factors using a 4-point scale. As a result, 169 cases of rule violations and 97 reasons for the violations were collected. These replies were classified by means of the KJ method and 21 items on violations and 13 items on reasons were identified. In the replies on reasons for violating a rule, there were many descriptions of psychological factors such as underestimating the risk or overestimating the benefit. The results of the questionnaire showed that rule violations positively correlated with a psychological factor, benefit and showed an inverse correlation between a psychological factor, aversion to rules.
Key words：Medical accident；Nursing；Violation；Case analysis；Psychological factors

堀口俊一､寺本敬子､西尾久英､林 千代
小児科学教科書等における鉛毒性脳症(所謂脳膜炎)に関する記述の変遷について
労働科学，83(1),24〜32,(2007)

　京都大学初代小児科学教授平井毓太郎博士はわが国でかつて原因不明であった乳幼児の所謂脳膜炎が母親の用いていた白粉中の鉛に起因することを究明した｡この業績はその後に起った砒素ミルク事件等の社会的中毒研究の魁をなし，今日的意義を有する｡しかし，最近の小児科学教科書等における平井の業績の記述は乏しく，忘れ去られた感がある｡著者らは1914年から2003年に至るまでに発刊された小児科学教科書等38冊を対象として，所謂脳膜炎と鉛中毒に関する記載を調べ，その変遷について検討した｡その結果，1967年頃を境に，当該記述の乏しくなっていることを認めた｡鉛による環境汚染がなお危惧されている現在，平井の業績は後世に伝えてゆくべきである。(表2)（自抄）
キーワード：鉛中毒；鉛毒性脳症；所謂脳膜炎；平井毓太郎；小児科学教科書

Shun’ichi HOIGUCHI, Keiko TERAMOTO, Hisahide NISHIO, Chiyo HAYASHI
Changes of the Description of Lead Encephalopathy (So-Called Meningitis)
in Pediatrics Textbooks.
THE JOURNAL OF SCIENCE OF LABOUR,83(1),24〜32,(2007)

　Ikutarou Hirai, the first professor of the Department of Pediatrics at Kyoto University, clarified in 1923 that “so-called meningitis named tentatively” of infants was caused by lead-contained face powder being used by mothers. This work of Hirai led to serial studies of socially induced poisonings that occurred in later periods. Prominent examples were arsenic poisoning due to contaminated milk, Minamata disease, "itai-itai" disease and "yusho" (poisoning due to rice oil contaminated by polychlorinated biphenyl and poly chlorinated dibenzofuran ). The work of Hirai is of important significance still in these days. The description of so-called meningitis or lead poisoning, however, is either only very brief or lacking in pediatrics textbooks and materials recently published, This is deplorable in view of the relevance of the work of Hirai to public health .The present authors conducted a survey of 38 books of pediatrics and found that the description of so-called meningitis or lead poisoning had come to be scarcely cited since around 1967.On the other hand, textbooks of occupational health or public health described precisely in no small way the work of Hirai still in these days. This is relevant to the fact that Japan today continues to suffer from the fear of environmental pollution due to lead. It is highly suggested to publicize the work of Hirai so as not to be forgotten forever.
Key words：Lead poisoning；Lead encephalopathy；So-called meningitis；Ikutarou Hirai； Pediatrics textbook

83巻2号

久保　真人
日本版バーンアウト尺度の因子的，構成概念妥当性の検証
労働科学，83（2），39〜53，（2007）

　本論の目的は，看護師とホーム･ヘルパーを対象とした調査データから，日本版バーンアウト尺度の因子的ならびに構成概念妥当性を検証することである。また，日本版バーンアウト尺度をホーム･ヘルパーに適用することの妥当性についてもあわせて検討する。調査対象は看護師1827名，ホーム･ヘルパー6037名であった。探索的，検証的因子分析の結果，日本版バーンアウト尺度で想定されていた3因子構造の妥当性が支持された。さらに，ストレッサなどの関連指標との分析の結果，日本版バーンアウト尺度の構成概念妥当性についても支持する結果が得られた。また，これらの分析において，看護師とホーム･ヘルパーでは，ほぼ同一の結果が得られた。この結果は，日本版バーンアウト尺度の交差妥当性を支持するものである。（表７）　（自抄）　　　　　　　　　　　　　　　　　
キーワード：バーンアウト；日本版バーンアウト尺度；看護師；ホーム･ヘルパー；検証的因子分析

Makoto KUBO
The Factorial and Construct Validity of the Japanese Burnout Scale
THE JOURNAL OF SCIENCE OF LABOUR，83（2），39〜53，（2007）

The validity of the factorial construct in applying the Japanese Burnout Scale was investigated. The study included a sample of 1827 nurses and 6037 care workers. Confirmatory factor analyses of each of the two professional groups separately indicated that the original three factor model referring to emotional exhaustion, depersonalization and the decline in the sense of personal accomplishment provided a reasonable fit to the data. To examine construct validity, the three subscales of the Japanese Burnout Scale were then related to selected work characteristics. The means of the subscales were different between different groups of the nurses or the care workers, and, for instance, higher among the nurses and care workers with the intention to quit the current job. Based on the definitions of the three subscales, differential patterns of the effects studied were predicted by means of the correlates and these subscales. The predictions were largely supported. It should be noted that by using the Scale, the similar results were obtained for the two professional groups.
Keywords：Burnout；Japanese burnout scale；Nurses；Care workers；Confirmatory factor analysis

川上　剛，小木和孝，氏田由可
アジア5カ国における国家労働安全衛生プログラムの比較−ILO技術協力の経験から−
労働科学，83（2），54〜58，（2007）

　中国、ラオス、モンゴル、タイ、ベトナムの国家労働安全衛生プログラムの策定過程及び内容を比較した。5カ国はILOの「職業上の安全及び健康促進枠組み条約(第187号、2006年)」を参照しながら政労使の意見を反映してプログラムを策定した。法体系整備・監督官制度強化等が5カ国に共通する重点課題であったが、一方で各国の事情を反映した職種別の優先課題が取り上げられた。また、参加型安全衛生トレーニングが実績ある手法として組み込まれていた。いずれの国でも国家労働安全衛生プログラム策定の共同作業が、関連省庁および労使団体の協力関係強化に役立った。立ち上がった国家労働安全衛生プログラムの効果的な実施とそれをサポートする国際的な技術協力が次の課題である。（図１）（自抄）
キーワード：国家労働安全衛生計画；ILO；発展途上国；政労使協力；参加型トレーニング

Tsuyoshi Kawakami, Kazutaka Kogi, Yuka Ujita
Comparison of national occupational safety and health programmes in five Asian countries
- From an ILO technical cooperation experience -
THE JOURNAL OF SCIENCE OF LABOUR，83（2），54〜58，（2007）

National Occupational Safety and Health (OSH) Programmes of China, Laos, Mongolia, Thailand and Vietnam are compared and discussed. The five countries recently launched their National OSH Programmes referring to ILO Promotional Framework for Occupational Safety and Health Convention (No. 187, 2006), and took similar steps to develop their national OSH programmes. These steps comprised: organizing national tripartite OSH workshops, reviewing national OSH situations by tripartite and inter-ministerial taskforces, drafting national OSH programmes by the taskforces; and launching the programmes officially. These steps facilitated dialogues and cooperation in OSH among different ministries, and workersﾕ and employersﾕ organizations. The adopted national OSH programmes of the five countries commonly aimed to: strengthen OSH legislative frameworks, improve labour inspection, establish practical workplace OSH mechanisms, address construction, mining and other hazardous occupations, reinforce occupational injury reporting systems, and extend OSH protection to informal and rural sectors. In addition, each country aimed to address its emerging OSH issues such as coal mining in China, small enterprises in Laos, home workplaces in Mongolia and Thailand, or agriculture in Vietnam. Participatory training approaches were incorporated to the programmes as a practical measure to extend OSH protection into informal and rural sectors. In conclusion, the National OSH programmes launched in the five Asian countries well framed their OSH priority actions for impacts and synergy. International cooperation that can support self-help efforts of the countries to implement the national OSH programmes will further improve OSH performance in Asia.
Key words: National occupational safety and health programme； ILO； Developing countries； Tripartite cooperation； Participatory training

森田　健，Emmert Clevenstine、横手規子，佐々木史歩，山本　都，森川　馨
GHS対応に向けた国際化学物質安全性カードの新たな取組み
労働科学，83（2），59〜71，（2007）

　ICSC（国際化学物質安全性カード）は、GHS（化学品の分類および表示に関する世界調和システム）への対応に取り組んでいる。新規・更新カードへのGHS情報の記載ならびにICSC作成の基となる標準語句やその適用基準を記載した“コンパイラーズガイド”の更新と共に、ICSC作成と集中管理の効率化のための新システムを構築中である。GHSとICSCは互換的かつ相補的であり、両システムの適用基準の調和により、有用性を増すとともに互いの信頼性が高められると考えられる。国際的な両システムのより緊密な協調が、ハザードコミュニケーション、労働安全衛生ならびに化学物質管理の今後の発展に資するものと期待される。（図2，表２）（自抄）　
キーワード：国際化学物質安全性カード（ICSC）；GHS；ハザードコミュニケーション；労働安全衛生；化学物質管理

Takeshi MORITA，Emmert CLEVENSTINE，Noriko YOKOTE，Shiho SASAKI，Miyako YAMAMOTO，Kaoru MORIKAWA
New Efforts of the International Chemical Safety Cards toward the Implementation of the Globally Harmonized System of Classification and Labelling of Chemicals
THE JOURNAL OF SCIENCE OF LABOUR，83（2），59〜71，（2007）

The partner institutions of the International Programme on Chemical Safety (IPCS) are committed to promoting the implementation of the Globally Harmonized System of Classification and Labelling of Chemicals (GHS). One way to do this is to see that the GHS is reflected in the International Chemical Safety Cards (ICSC), one of the hazard communication tools produced by the IPCS. The ICSC project began implementing the GHS several years ago and the new and updated ICSCs (79 ICSCs as of June 2007) have been incorporaing GHS information (pictograms, signal words and hazard statements). Currently, the standard phrases and their criteria that are described in the ﾒCompiler's Guideﾓ are being updated to take account of the GHS. In addition, for effective preparation, collection and administration of the ICSCs, a new system is being constructed at the International Labour Office. The new ICSC system would reduce the variability in ways of expressing a given fact that one sees in some ICSCs today. This variability puts a heavy burden on translators (the ICSCs are translated into at least 25 languages) and undermines the ability of the highly structured compilation process to make the ICSCs a uniquely coherent information source. It is clear that the GHS and the ICSC project are compatible and complementary, although their processes for generating hazard communication material are not identical or interchangeable because their outputs have different purposes. Harmonization of criteria for statements of hazards and their prevention will ensure that users of outputs from the two systems receive consistent messages, enhancing the credibility of both. Given the international vocation of the two systems, collaboration could be of immense benefit to both the GHS and the ICSC project in the production of hazard communication documents in languages other than English. The closer collaboration of the two systems is expected to contribute to the future development of hazard communication, occupational health and safety and chemicals management.
Key words：International chemical safety cards (ICSC)；GHS； Hazard communication；Occupational health and safety；Chemical management

過重労働と人的資源管理
鈴木　安名
労働科学，83（2），72〜75，（2007）

　近年のわが国において、過重労働が生じる背景を検討すると以下のようになる。
�@日本における職務構造は固定したものではなく、境界不明瞭な業務が存在する。従って、労働者におけるチームワークが乱れた場合、特定の労働者に負荷が増大するリスクがある。�Aこれを防ぐべき管理職の数は１９９０年以降減少し、同時に組織のフラット化が進行した（ダウンサイジングを伴うフラット化）。その結果、管理職による人材マネジメントが弱体化し、業務負荷の平準化が不十分となった。�B管理職が適切な人材マネジメントを行えるように、管理職を教育する人事部門の役割が重要となる。本論文は人事部の過重労働対策を行うための課題を明らかにした。（図１）（自抄）
キーワード：職務構造の曖昧さ；組織のフラット化：ダウンサイジング：人事部

Yasuna SUZUKI, M.D.
Overwork and Human Resource Management
THE JOURNAL OF SCIENCE OF LABOUR，83（2），72〜75，（2007）

As a background leading to overworking of workers in recent years in Japan, the relevant aspects of human resources management are discussed. The following are found particularly important. (1) The duty structure at enterprise level in Japan is not firmly stabilized and there are jobs worked with indistinct boundaries. Therefore, when the teamwork of workers is disorderly organized, there is a risk that workload levels increase for particular workers. (2) Since around 1990, the number of managers who should prevent this disparity in workload levels has decreased as the flattening of corporate structures proceeded simultaneously in accordance with corporate downsizing trends. As a result, the quality of human resources management has declined with the leveling of duty loads becoming insufficient. (3) In order that managers can function appropriately, the roles of human resources management sections in educating managers are increasingly important. The investigation of these aspects has revealed that human resources management sections are facing challenges for taking effective measures to prevent overworking situations.
Key words: Ambiguity of duty structure;Flat conversion of organization;Down sizing；Personnel division.

酒井一博
産業安全保健の視点からみた医師の働き方と改善方向
労働科学，83（2），76〜80，（2007）

　医師の過剰な働き方が注目されている。長時間残業と「宿日直」による深夜の業務などを頻繁に繰り返すことによって，過労状態のまま業務を遂行することもよくみられる。 本稿では，医師の働き方を俯瞰し，パラダイムチェンジのための改善提案を行なった。
　医師の過剰な残業時間を減らし，ワークライフバランスのとれた生活を可能にするような医療システムの構築が必要である。産業安全保健の視点からは「医師でなければできない業務」と「医師でなくてもできる業務」を識別するための業務精査や，「宿日直」制度のかわりに交代勤務制の導入の可能性を早急に検討する必要がある。その場合，先行事例（good practice）に学びながら，実現可能な方策を講じることが望まれる。（自抄）
キーワード：医師の労働条件；過労；ストレス；医療安全

Kazuhiro　SAKAI
Work Stress and Chronic Fatigue of Doctors in Hospitalsand Measures for Improving Working Conditions
THE JOURNAL OF SCIENCE OF LABOUR，83（2），76〜80，（2007）

Social concerns are growing about the overworking of physicians performing intensive health care work. Many physicians are often obliged to perform their duties in overfatigued conditions due to long overtime hours and frequent night duties combined with prior and subsequent daytime duties. Recent reports on how such physicians work are reviewed and measures to improve existing situations based on paradigm changes are suggested. It is found urgent to construct health care systems so as to enable physicians to avoid excessive overtime hours and establish a reasonable work-life balance. From occupational health and safety points of view, it is essential to avoid overworking conditions leading to work-related accidents and illnesses and serious work-life imbalances. It is suggested to undertake detailed studies of these conditions by distinguishing between tasks to be done exclusively by physicians and those that can be shared with other members of health care teams. The application of proper shift systems instead of currently prevalent night duties combined with daytime work should be explored by coordinated efforts of health care institutions. It is useful to learn from innovative good teamwork practices involving different health care professionals. It is recommended to focus on practical measures that can respond to both health care needs of people and the issues of overworking and work-life balance of health care workers.
Key words: Working conditions of doctors in hospitals；　Fatigue caused by overwork； Job stress； Safety in healthcare

松田文子，竹内由利子，池上 徹，水野有希，吉川 徹，酒井一博
高感度差異抽出法を用いた介護者の作業選好の傾向と作業負担感との関連−経験年数による傾向の比較−
労働科学，83（2），81〜86，（2007）

　介護職を対象に、介護作業の選好や意欲の程度を抽出し、その序列化をSDM（Sensitive Differentiation Method：高感度差異抽出法）を用いて行った。介護者の作業に対する選好や意欲には、利用者とのコミュニケーションのあり方、利用者の体重、他の介護者や家族などの協力、工夫の余地、高度なスキルの必要性、利用者への負担感などの要因が関わっていることが明らかになった。また、作業要素の序列化（順位付け）には個人差があるものの、介護度の高低や認知症の有無が必ずしも作業選好の主要因とならないケースも散見された。加えて、一定の経験年数に達すると、比較的大変な介護にやりがいを見いだし、積極的に関わることを望む傾向に移行することも示唆された。（図１，表１）（自抄）
キーワード：介護；作業選好；労働負担；高感度差異抽出法(SDM)；主観評価

Fumiko MATSUDA, Yuriko TAKEUCHI, Thor IKEGAMI,Yuki MIZUNO, Toru YOSHIKAWA, Kazuhiro SAKAI
The Relationship between Preferred Types of Work and Workload of Care Workers Revealed by the Sensitive Differentiation Method; Comparison of Tendencies by Years of Experience
THE JOURNAL OF SCIENCE OF LABOUR，83（2），81〜86，（2007）

Preferences concerning the types of work tasks and the extent of willingness to work of care workers were studied by applying the sensitive differentiation method. It was found that preferences as to caring tasks and motivation to work were influenced by a number of job-related factors. Communication with users, the weight of users, cooperation with other care workers and usersﾕ families, possibilities of implementing improvements, the need for advanced skills and the feeling of burdens on the part of users were related to the preferred types of tasks and the willingness to perform the assigned tasks. While there were individual differences in the rankings of work tasks, neither the grades of care work nor the presence of dementia patients were necessarily recognized as a main factor for determining task preferences. Further, a shift was noted among care workers having a certain amount of years of experience toward a tendency to find the tasks requiring intensive care efforts as worthwhile and to be engaged in these comparatively tough tasks in a positive manner.
Key words：Care Work, Work Preference； Workload； SDM(Sensitive Differentiation Method)；
Subjective Evaluation

83巻3号

瀬尾明彦，堂本槙一郎，土井幸輝
寄りかかり型立位作業補助具の腰部と下肢の負担軽減効果
労働科学，83（3），97〜106，（2007）

　 本研究では，寄りかかり姿勢を取りやすくすることで立位あるいは座位での作業負担の軽減を目指す新しい寄りかかり型立位作業補助具の効果を検討した。製造現場の立ち作業を模した作業を，補助具に寄りかかった姿勢で作業する場合と通常の座位および立位で作業する場合とで比較した。その結果，本補助具使用時は，通常座位に比べて腰部椎間板圧縮力が約25％，通常立位に比べて腰部の関節モーメント比が約60％減少し，腰部負担が軽減されることが明らかになった。しかし下肢負担については，通常座位に比べて下肢活動量は約3倍と高いものの，通常立位と比べると下腿腫脹が約2.5倍と大きく，下肢負担の軽減効果は限定的であることが明らかになった。（図９）（自抄）
キーワード :立位作業；寄りかかり型立位作業補助具；腰部負担；静的下肢負担 ;足底圧

Akihiko SEO，Shinichiro DOMOTO， Koki DOI
Effect of Leaning Aid for Standing Work on Low Back and Lower Leg Load
THE JOURNAL OF SCIENCE OF LABOUR，83（3），97〜106，（2007）
　
　 This study investigated the effectiveness of a new leaning aid for reducing the loads on the lower back and the lower leg while performing work while standing. One experiment was conducted to draw a comparison between work performance while using the leaning aid and normal sitting and standing work. The inclination angles of the aidﾕs seating surface were 30 and 60 degrees relative to 0 degree as the horizontal seating face. Ten healthy male subjects were asked to work under the following four working conditions: using the 30 and 60 degree leaning aids, during normal standing, and while in a sitting posture. Each work period was 30 minutes. We used 2-dimensional static biomechanical analysis to estimate the compression force on the lumbosacral discs and the low back moment ratio for each condition. Low back load was evaluated on the basis of these estimated values. We also measured foot pressure as an index of lower leg activity and monitored lower leg swelling through the use of bioelectrical impedance measurement during work. We evaluated lower leg load based on the above two sets of data. Regarding lower back load, the compression force when using the aid decreased by about 25 percent compared to that during sitting. The low back moment ratio when using the aid was reduced by about 60 percent compared with that during standing. In regard to lower leg load, the amount of lower leg activity when using the aid was about 3 times larger than that when sitting. However, lower leg swelling when using the aid was about 2.5 times larger than when in a standing posture. These results suggest that lower back load can be decreased by the use of our leaning aid. We also found that using the aid has a restrictive effect on reducing lower leg load.
Key words : Standing work， Leaning aid for standing work， Low back load， Static lower leg load, Foot pressure.

内藤堅志，阿部眞雄，飯田裕康，前原直樹，村上保夫
医療情報管理・伝達システムの運用と医療事故防止効果についての調査研究
−情報伝達および看護記録の実態と病棟業務との関連−
労働科学，83（3），107〜137，（2007）

　紙カルテと各種伝票類による病棟医療業務の実態を解析し、現状の問題点と今後の方向性を検討した。対象病棟では、伝票処理用具（管理ボックス）が病棟内情報共有に役立っていた。一方、他の部署への情報伝達・確認および各種記録類の作成が看護業務を圧迫していた。看護記録に関しては、記録内容や時刻記録の不正確さなどの問題点が見出された。これらの記録実態の背景には、業務の煩雑さや過密状況の存在が推測された。今後導入される総合的な医療情報システムでは、ベッドサイドでの記録、および患者毎に集約されているlongitudinalな情報を、看護スタッフ毎の業務に合わせてcross-sectionalな情報に変換・呈示し、現場での情報処理負担を軽減させることが重要課題である。（図11，表９）（自抄）
キーワード：医療事故防止；病棟看護業務；医療情報処理；看護記録；記録過程

Kenshi NAITO, Masao ABE, Hiroyasu IIDA, Naoki MAEHARA, Yasuo MURAKAMI
A Study on Operations of Medical Information Management and Communication Systems and Their Implications for Accident Prevention: Relation Between Actual Practices of Transmitting Information and Keeping Nursing Records and Ward Nursing Services
THE JOURNAL OF SCIENCE OF LABOUR，83（3），107〜137，（2007）

　Actual situations of ward medical services by means of paper-based medical charts and various information slips were analyzed and related issues from the viewpoint of medical accident prevention were discussed with a view to examining future directions toward electronic medical information processing systems. We studied a relationship between actual records of medical charts and nursing-care work through examining work tasks of two nurses by field studies in a ward with 34-beds of a cardiovascular disease hospital in Tokyo. In the study, nursing-care of those work, while tasks of general nursing-care and leaderﾕs those, were observed in nine hours of day-time work by time-budjet studies. In the hospital wards studied, information control boxes each indicating existing information slips relating to a particular patient were used and contributed to sharing care-related information and detecting newly generated information within each ward. However, much time was being spent for transmitting and confirming information involving other posts and for creating various nursing records. This resulted in hampering the execution of primary nursing duties.
In keeping nursing records, many problems were noted as to inaccurate contents of the records and inaccuracy of time recorded resulting from a variety of reasons, such as plan entries after performing tasks, joint seal impressions after serial procedures, non-placing of seals after performing procedures, trying to balance accounts, etc. As factors behind these recording practices, cumbersome procedures and overloaded tasks could be pointed out. Examples of trying to balance accounts were seen in cases where the formal permissions from an attending physician were delayed due to inability to contact the physician as to abrupt withdrawal of medication following the complaints of patients. In such cases, recording of the withdrawal were done after prolonged delays. Delays in communicating verbal instructions of physicians added to overloaded work due to redoing the tasks instructed. It appeared necessary to establish recording systems allowing entries at bed side with automatic time records and to secure flexible communication routes for consulting physicians and other responsible persons regarding ward nursing services. The need for introducing slip forms for recording verbal instructions received was also suggested.
In developing comprehensive medical information systems (including electronic medical records and ordering systems) it remains critical from the perspective of accident prevention to transform and display the longitudinal information gathered and individualized for each patient into the cross-sectional form arranged in accordance with serial tasks performed by each member of the nursing staff. The information systems thus reducing the information processing loads of the nursing staff are considered essential.
Key words: Prevention of a medical accident; Ward nursing servies; Medical information processing; Nursing Documentation; Recording process

83巻4号

白土男女幸，宮本直和，濱田明美，饗庭照美，飯　聡，西村由二三，仲井朝美，宇治橋貞幸，芳田哲也
包丁研ぎにおける熟練者と非熟練者の動作分析と筋活動様式の比較
労働科学，83（4），139〜150，（2007）

　本研究では，熟練者2名と非熟練者1名を対象とし，包丁研ぎ動作の3次元動作解析，筋電図計測，および包丁の刃先評価を行った。その結果，以下のことが明らかとなった。
熟練者は非熟練者と比較すると，全身を使った研ぎ動作を行い，1研ぎの動作範囲が大きく動作時間も短かった。また，それらの再現性も熟練者において高かった。
熟練者は尺側手根屈筋を用いて包丁を上からしっかりと押さえつけるながら研ぎ，手前に引く際，三角筋後部で肘を後方に引いていた。
熟練者によって研がれた包丁の刃は刃先および中央部において凹凸形状に変化したが，非熟練者によって研がれた刃には変化が見られなかった。（図10）　（自抄）
キーワード：バイオメカニクス，筋電図，熟練者および非熟練者，包丁研ぎ，刃先形状

Minayuki SHIRATO, Naokazu MIYAMOTO, Akemi HAMADA, Terumi AIBA,
Akira II, Yoshifumi NISHIMURA, Asami NAKAI, Sadayuki UJIHASHI, Tetsuya YOSHIDA
Comparison of Body Movement and Muscle Activity Patterns During Sharpening a Kitchen Knife Between Skilled and Unskilled Subjects
THE JOURNAL OF SCIENCE OF LABOUR，83（4），139〜150，（2007）

　The purpose of the study was to investigate the differences between skilled and unskilled subjects in the motion and muscle activity patterns during sharpening a kitchen knife. Two skilled subjects and an unskilled subject conducted sharpening of a kitchen knife at a freely chosen pace. The shape of the knife blade sharpened by each subject was examined under a microscope. The motions were recorded by four cameras (60 Hz) and surface electromyograms of four muscles of the upper limbs were recorded. The skilled subjects had shorter motion durations, longer motion pathways and higher reproducibility of strokes than the unskilled subject. In each stroke, prominent EMG activities were observed in the flexor carpi ulnaris and posterior deltoid muscles in the case of skilled subjects. The front edge and the central region of the knife sharpened by the skilled subjects changed to be odd-shaped, while those of the knife sharpened by the unskilled subject remained unchanged.
Key words: Biomechanics, Electromyography, Expert and non-expert, Sharpening kitchen knife, Shape of kitchen knife-edge

木村菊二，島影喜久子
綿を取扱っている作業場における綿塵について
労働科学，83（4），151〜168，（2007）

　米国で綿塵の測定に使用されているVE sampleとほぼ同じ捕集特性を持つTR samplerを試作し，さらに作業者に装着して個人曝露濃度が測定可能なTR 個人サンプラーの開発を行った。
　綿塵の調査を実施した作業場は，中小企業の綿の打ち直し，タオルの製造，太糸の紡績工場等の4社，および，大企業の紡績工場２社について実施した。
　中小企業の綿を直接取り扱っている作業場の綿塵濃度は許容濃度の値をかなり超えていた。タオルの製造，紡績等では許容濃度の値前後の濃度であった。
　大企業の紡績工場では，混綿，梳綿，精紡と工程がすすむに従って綿塵濃度は低下していた。R綿塵濃度は，いずれも1mg/m3 以下であった。
　採取した粒子を顕微鏡によって観測した結果，混綿では土砂の外，葉，茎の砕片などの夾雑物が多数認められ，精紡では夾雑物はほとんど認められなかった。
　フィルター上に採取したサンプルを過熱処理して不燃性物質を求めた結果，かなりの不燃性物質が含まれているところもあった。（図12，表7，写真28）（自抄）
キーワード：綿塵；綿肺症；吸入性粉塵；垂直型分粒装置付き綿塵サンプラー；綿塵用TRサンプラー；綿塵用TR個人サンプラー
Cotton Dust Concentrations in Workplaces Treating Cotton
Kikuzi KIMURA , Kikuko SHIMAKAGE
THE JOURNAL OF SCIENCE OF LABOUR，83（4），151〜168，（2007）

　Byssinosis suffered by workers at workplaces dealing with cotton has been a serious social issue in many industrialized countries including Japan. A special committee on guidelines for suppressing cotton dust was organized in 1977 in Japan, and the one of the authors was in charge of developing measuring methods of airborne cotton dust concentrations and investigating the actual situation in workplaces dealing with various kinds of cotton materials.
A new device for measuring cotton dust concentrations in the air was developed that had the same dust collection efficiency as a vertical elutriator cotton dust sampler (VE sampler) used in the United States for measuring cotton dust. This new device was called a total and respirable cotton dust sampler (TR sampler), and based on the method of this device, a total and resprable cotton dust personal sampler was also developed and put into use.
The TR sampler could collect cotton dust by first collecting particles of 15 _m or more in hydrodynamic diameter on an impact glass plate coated with silicone oil and by collecting remaining particles through a glass fiber filter. The weight of the impact plate and that of the glass fiber filter were measured before and after dust collection, the differences in weight divided by the volume of suction air giving the dust concentrations. The particles collected by the glass fiber filter corresponded to respirable dust and the sum of the respirable dust and the dust collected on the impact plate gave the amount of total dust.
The cotton dust concentrations measures by the TR sampler were compared with those obtained by a VE sampler at the same workplaces. The dust levels measured by the TR sampler ranged between 110-120% of those obtained by the VE sampler. When the differences in measurement conditions were taken into account, we may assess that both these samplers give the approximately same dust concentrations for cotton dust.
Cotton dust concentrations were measured in four small and medium-sized companies undertaking purifying cotton materials, wadding cotton into futons, manufacturing towels and spinning coarse yarns as well as in two large cotton spinning mills. The measurements at the small and medium-sized companies were done in 1981, while those at the large mills were done in 1978-1979. The results showed that cotton dust concentrations in workplaces dealing directly with cotton as in the case of purifying cotton materials were much higher than the permissible concentration for cotton dust. The cotton dust concentrations in workplaces for manufacturing towels, and for carding or fine spinning of cotton were around the permissible concentration. The cotton dust concentrations in large spinning mills were becoming lower as the spinning process proceeded from blending and carding cotton to fine spinning, with repirable cotton dust concentrations of less than 1 mg/m3.
The coarse particles collected on the impact plate of the TR sampler in cotton blending sections mainly consisted of foreign substances such as earth or sand particles and contained only a small amount of long fibers. On the contrary, particles collected in carding and fine spinning sections comprised a large number of long cotton fibers. This was presumably because noncombustible particles such as earth and sand particles had been removed when cotton materials were pneumatically transported from the blending section to the subsequent sections.
The microscopic observation of the particles collected on the impact plate of the TR sampler revealed, in addition to earth and sand particles, a large amount of foreign substances such as leaves and stalks as well as bacteria and spores sometimes. The air in carding sections contained a less amount of such substances than that in blending sections, while the air in fine spinning sections contained numerous fragmented cotton fibers with a very small amount of foreign substances.
The proportion of non-combustible substances determined by superheating respirable dust collected by the TR sampler was considerably high in the workplaces of the small and medium-sized companies, as high as 70% in extreme cases. The proportion of non-combustible substances was 20% in carding sections, and only 2 % in the case of fine spinning. In large spinning mills, the corresponding proportion was the highest in blending sections at 37% and lower as the spinning process proceeded, with the lowest 2% in fine spinning sections.
The results indicated the need for protecting workers dealing with cotton against both large and respirable particles commonly seen in their workplaces. Large particles of 15 _m or more in diameter contained organic debris particles and foreign substances that could cause allergic diseases. The effects on health of cotton dust were found to depend on the dust contents, and this should be taken into account in protecting the workers. The TR sampler has made it possible to measure concentrations of both large and respirable particles, and has proven suitable for assessing the cotton dust concentrations.
Keywords：Cotton dust; Byssinosis; Respirable dust; Vertical elutriator cotton dust sampler; Total and respirable cotton dust sampler; Total and respirable cotton dust personal sampler