The Science Council of Japan represents the scientific community in Japan. It monitors the general status of scientific activities and their development，and provides scientific advice to society for making social decisions. Regarding legal anti-smoking actions，Japan regretfully belongs to one of the most underdeveloped countries. Research has generated evidence that secondhand smoke causes the same problems as direct smoking，including lung cancer, cardiovascular disease and lung ailments. Understanding that it is the responsibility and obligation for scientists to protect citizens from the direct and indirect damage by tobacco，the Science Council of Japan is going to take an action to propose anti-smoking regulations and campaigns by the government.

Back ground : Due to recent increases in medical costs and national deficits, effective utilization of limited medical resources is indispensable. Thus, cost-effectiveness of anti-hypertensive treatment is an important social and medical issue in western as well as in eastern countries including Japan. Home blood pressure (HBP) measurements have a stronger predictive power for cardiovascular events than casual clinic blood pressure (CBP) measurements. Therefore, the introduction of HBP measurement for the diagnosis and treatment of hypertension would lead to a decrease in medical expenditures.

Methods : In this study, we investigated the cost-effectiveness of using HBP instead of CBP measurement. To estimate the costs and effects associated with changing from CBP to HBP measurement as the diagnostic tool, we constructed a simulation model (Markov model) using data from the Ohasama study and a national database. The Ohasama study provided the prognostic value of HBP as compared to CBP measurement.

Results : As a result of the cost analysis, the change from CBP to HBP measurement as a diagnostic tool would result in the decrease in medical cost by ￥3.85 trillion in men per 10 years and by ￥6.39 trillion in women per 10 years. Thus, the total reduction was ￥10.24 trillion per 10 years. The reductions in medical costs vary from￥4.64 trillion to￥13.02 million per 10 years, when sensitivity analysis is performed. This is attributable to the reduction of medical costs by avoiding the start of treatment in untreated subjects who are diagnosed as hypertension by CBP but normotension by HBP. Furthermore, it could be expected that adequate BP control mediated by the change in the diagnostic method from CBP to HBP measurement would improve the prognosis for hypertension. In addition, stroke prevention due to adequate BP control based on HBP measurement would lead to decrease the estimates of death as well as stroke incident. If we assume that BP control improves, and systolic blood pressure decreases by 10 mmHg in all patients due to reinforcement of the need for antihypertensive treatment because of the use of HBP measurement, the change from CBP to HBP measurement as a diagnostic tool would result in the extent in living year by 0.001 year per 10 years. On the other hand, the change from CBP to HBP measurement as a diagnostic tool would result in the decrease in the estimate of death and stroke incidence by 12,300 and 40,900, respectively.

Conclusion : Therefore, we conclude that the introduction of HBP measurement for the diagnosis and treatment of hypertension would be very cost-effective. Given the cost savings，extensive application of HBP measurement in the clinical practice of hypertension is expected.

Background: Demand for nursing care is expected to increase in Japan based on factors such as a graying of society and changes in disease structure. However, not all workplaces currently have an enough nursing staff. Specifically, Home-visit Nursing Care Stations（Stations）are expected to be an important role in at-home care, but they are currently understaffed. Surveys have been conducted on the workplace attributes when nurses are seeking employment with the objective of eliminating this labor shortage, but little research has been done to quantitatively evaluate the relative importance among attributes.

Objectives: The objective of this study was to investigate workplace selection behavior among visiting nurses.

Methods: An initial survey was conducted covering all 313 Stations in Kanagawa Prefecture to confirm willingness to participate in the survey. A mail survey was then conducted targeting 369 nurses working at 77 Stations based on the initial survey results. Ten hypothetical workplace scenarios were presented to the nurses based on 5 attributes {（full-time/part-time situation, monthly salary, overtime, workplace environment and organizational culture (such as clear delineation of work responsibilities and presence of a backup system）, education and training（participation in training outside the station and the holding of case review meetings within the station.）} The respondents were then asked to indicate their order of preference for these hypothetical workplaces from 1 to 10. A conjoint analysis was used to determine the relative importance among attributes in the hypothetical workplace.

Results: The employment preference order for hypothetical workplace scenarios was analyzed for 221 respondents. The gender of the respondents was 99% female with a mean age of 41 years old and a mean of 5 years of home visiting nurse experience. Nurses place the most relative importance on full-time/part-time. Workplace environment and organizational culture was next. A relationship was found between full time/part-time preference in a hypothetical workplace and the actual full-time/part-time situation of the nurses. The monthly salary utility value was related to household annual income and respondent's actual salary.

Conclusions: We found the attributes which are important in attracting Station employees included offering several full-time/part-time options, a well-established workplace environment and organizational culture that clearly delineates responsibilities and provides organizational backup system and opportunities for education and training. In future study, an additional attribute covering the different types of workplaces should be added to the current 5 attributes and all nurses seeking employment should be surveyed.

The purpose of our research is to investigate whether providers produce high or low quality service in the Japanese care service market. Though the Japanese Care Insurance has a kind of quasi-market，providers are subject to a fixed price system and consumers are faced with imperfect information about suppliers. Under these market conditions，we find that providers can put high quality on their service by adapting a higher fixed price for service, by regulating quality norm, or by educating consumers. We also confirm these results by economic experiments.