平成 28 年度 第 1 回班会議
ᖹᡂ28ᖺᗘཌ⏕ປാ⛉Ꮫ◊✲ ࡀࢇᑐ⟇᥎㐍⥲ྜ◊✲ᴗ ➨1ᅇⓗሙ⌜㆟
A G E N D A
᪥㸸ᖹᡂ28ᖺ5᭶20᪥㸦㔠㸧 13㸸00 㹼 17㸸00
ሙ㸸᪥ᮏ㉥༑Ꮠ♫་⒪ࢭࣥࢱ࣮ 12㝵ከ┠ⓗᐊ
㸺◊✲௦⾲⪅ᣵᣜ㸼
ە᪥ᮏ㉥༑Ꮠ♫་⒪ࢭࣥࢱ࣮ ⓗሙ ඖᘯ
㸺◊✲ศᢸ⪅࠾ࡼࡧ◊✲༠ຊ⪅Ⓨ⾲㸼
ە㟷᳃┴㝔ᒁ ྜྷ⏣ ⱱ㸦Ⓨ⾲10ศ ㉁ᛂ⟅5ศ㸧
㟷᳃┴❧୰ኸ㝔࠾ࡅࡿ࡚ࡢࡀࢇᝈ⪅ࡢࢫࢡ࣮ࣜࢽࣥࢢࡢຠᯝᆅᇦࡢᬑཬຠᯝ
ەᅜ❧ࡀࢇ◊✲ࢭࣥࢱ࣮ ᮾ ᑦᘯ࣭ᴬཎ ┤႐㸦Ⓨ⾲10ศ ㉁ᛂ⟅5ศ㸧 ཧຍタ࡛ࡢࢫࢡ࣮ࣜࢽࣥࢢࡢಶࠎࡢ≉ᚩࢹ࣮ࢱࡽࡳࡿධࡍࡁᝈ⪅ീ
ە୰ி㝔 ྜྷᮏ 㕲㸦Ⓨ⾲10ศ ㉁ᛂ⟅5ศ㸧
ಶࠎࡢタ࡛ࡢᑐᛂᅔ㞴࡞㧗ᗘ࡞ⱞ③ࡢホ౯⒪ᨭࡢࡓࡵࡢࢸࣞࣅ㆟➼ࡼࡿᨭࢩࢫࢸ࣒
㸦③ࡳ࣭ᝏᚰྤ࣭྾ᅔ㞴࣭ࡏࢇዶཱྀ࣭Ῥ࣭ᛰឤ࡞㸧
ە㛗ᓮᏛ㝔 㱟 ᜨ⨾㸦Ⓨ⾲10ศ ㉁ᛂ⟅5ศ㸧
⦆ࢣ⸆≀⒪ἲᑓ㛛⸆ᖌࡼࡿࢸࣞࣅ㆟ࢆ㏻ࡌࡓ⸆≀⒪ἲᨭ
ۑ⪷㞔ᯇ㝔 ሷᕝ ‶㸦ࢥ࣓ࣥࢺ5ศ㸧
⦆ࢣ⸆≀⒪ἲᑓ㛛⸆ᖌࡀᆅᇦ㐃ᦠࡋ࡚ᨭ࡛ࡁࡿࡇ
ە㟷᳃┴❧୰ኸ㝔 ᒣୗ ឿ㸦௦⌮㸸✰Ỉ㸧㸦Ⓨ⾲10ศ ㉁ᛂ⟅5ศ㸧
ྛタ࡛ࡢࢫࢡ࣮ࣜࢽࣥࢢᑟධࡢ㐍ࡵ᪉
Ѝከタ࡛ࡢᑟධ࣭ᐇࡢࡓࡵࡢࣀ࢘ࣁ࢘ᐇࡼࡾఱࡀኚࢃࡿࡢ㸽
ە㮵ᒇ་⒪ࢭࣥࢱ࣮ すᑠ㔝 ⨾ဏ㸦Ⓨ⾲10ศ ㉁ᛂ⟅5ศ㸧
㮵ᒇ་⒪ࢭࣥࢱ࣮࠾ࡅࡿ࡚ࡢࡀࢇᝈ⪅ࢆᑐ㇟ࡋࡓࢫࢡ࣮ࣜࢽࣥࢢࡢᑟධࣉࣟࢭࢫᐇࡼࡿ
⌧ሙࡢᨵၿ࠾ࡼࡧᚋࡢᒎᮃ
ەᒾᡭ┴❧⯪Ώ㝔 Ṋ⏣ ᙬ㸦Ⓨ⾲10ศ ㉁ᛂ⟅5ศ㸧
ᒾᡭ┴❧⯪Ώ㝔࡛ࡢ࡚ࡢࡀࢇᝈ⪅ࢆᑐ㇟ࡋࡓࢫࢡ࣮ࣜࢽࣥࢢࡢᑟධヨ㦂㐠⏝ẁ㝵࡛ࡢ⤖ᯝ
ၥ㢟Ⅼ
ᖹᡂ28ᖺᗘཌ⏕ປാ⛉Ꮫ◊✲ ࡀࢇᑐ⟇᥎㐍⥲ྜ◊✲ᴗ ➨1ᅇⓗሙ⌜㆟
ۑᒾᡭ┴❧⯪Ώ㝔 ᮧୖ 㞞ᙪ㸦ࢥ࣓ࣥࢺ5ศ㸧
ࢫࢡ࣮ࣜࢽࣥࢢ࡛ᢳฟࡉࢀࡓ㧗ᗘ࡞ⱞ③ᑐᛂ㸦⒪ධ㸧ࡍࡿࡓࡵࡢྛ⛉་ᖌᑐࡍࡿ㹎㹁㹒་ᖌࡢ ᑐᛂ
Ѝ┳ㆤᖌࡢホ౯ࢆ㏿ࡸ⒪ᫎࡍࡿࡓࡵࡢ㝔ෆ࡛ࡢព㆑ඹ᭷ᚲせ࡞ࡇ
ەᕷ❧୕ḟ୰ኸ㝔 ᪂℈ ఙỤ㸦Ⓨ⾲10ศ ㉁ᛂ⟅5ศ㸧
ᕷ❧୕ḟ୰ኸ㝔࠾ࡅࡿ࡚ࡢࡀࢇᝈ⪅ࢆᑐ㇟ࡋࡓࢫࢡ࣮ࣜࢽࣥࢢࡢᐇ㝿ᖺᗘࡲ࡛ࡢ⤖ᯝ࠾ࡼ
ࡧ⌧ሙ࡛ࡢά⏝
ە༡㒊㝔 ➲Ⰻ ๛ྐ㸦Ⓨ⾲10ศ ㉁ᛂ⟅5ศ㸧
㇏ぢᇛ୰ኸ㝔࡛ࡢ㐣ཤࡢࢫࢡ࣮ࣜࢽࣥࢢࢹ࣮ࢱࡢゎᯒ⤖ᯝᚋࡢࢫࢡ࣮ࣜࢽࣥࢢࢩࢫࢸ࣒ᑟධࡢࣟ
࣮ࢻ࣐ࢵࣉ
Ѝᖺᗘࡇࡲ࡛⤖ᯝࢆฟࡍ㸽
ۑ⌰⌫Ꮫ་Ꮫ㒊㝃ᒓ㝔 ቑ⏣ ᫀே㸦ࢥ࣓ࣥࢺ5ศ㸧 Ἀ⦖ᆅᇦ࡛ࡢࢫࢡ࣮ࣜࢽࣥࢢᑟධࡢᨭࡘ࠸࡚
Ѝ㇏ぢᇛ୰ኸ㝔ࡢࢫࢡ࣮ࣜࢽࣥࢢࡢᑟධᨭࡘ࠸࡚ࡢࢥ࣓ࣥࢺ
㸺ࢹࢫ࢝ࢵࢩࣙࣥ㸼
ە㟷᳃┴❧୰ኸ㝔 ୕ᾆ ᾈ⣖㸦Ⓨ⾲10ศ㸧
ᖺᗘࡲ࡛ᵓ⠏ࡉࢀࡓࢫࢡ࣮ࣜࢽࣥࢢࢩࢫࢸ࣒ࡢᴫせಶࠎࡢᝈ⪅ࢹ࣮ࢱࡢ⌧ሙ࡛ࡢά⏝✚
ࢹ࣮ࢱࢆ࠸⌧ሙ࡛ά⏝ࡍࡿ
ͤ Ⓨ⾲⪅ࡣەࠊࢥ࣓ࣥࢺᢸᙜ⪅ࡣۑ࡚⾲グ
ͤ タྡ␎⛠࣭ᩗ⛠␎
ᖹᡂ28ᖺᗘཌ⏕ປാ⛉Ꮫ◊✲ ࡀࢇᑐ⟇᥎㐍⥲ྜ◊✲ᴗ ➨1ᅇⓗሙ⌜㆟
ۑᒾᡭ┴❧⯪Ώ㝔 ᮧୖ 㞞ᙪ㸦ࢥ࣓ࣥࢺ5ศ㸧
ࢫࢡ࣮ࣜࢽࣥࢢ࡛ᢳฟࡉࢀࡓ㧗ᗘ࡞ⱞ③ᑐᛂ㸦⒪ධ㸧ࡍࡿࡓࡵࡢྛ⛉་ᖌᑐࡍࡿ㹎㹁㹒་ᖌࡢ ᑐᛂ
Ѝ┳ㆤᖌࡢホ౯ࢆ㏿ࡸ⒪ᫎࡍࡿࡓࡵࡢ㝔ෆ࡛ࡢព㆑ඹ᭷ᚲせ࡞ࡇ
ەᕷ❧୕ḟ୰ኸ㝔 ᪂℈ ఙỤ㸦Ⓨ⾲10ศ ㉁ᛂ⟅5ศ㸧
ᕷ❧୕ḟ୰ኸ㝔࠾ࡅࡿ࡚ࡢࡀࢇᝈ⪅ࢆᑐ㇟ࡋࡓࢫࢡ࣮ࣜࢽࣥࢢࡢᐇ㝿ᖺᗘࡲ࡛ࡢ⤖ᯝ࠾ࡼ
ࡧ⌧ሙ࡛ࡢά⏝
ە༡㒊㝔 ➲Ⰻ ๛ྐ㸦Ⓨ⾲10ศ ㉁ᛂ⟅5ศ㸧
㇏ぢᇛ୰ኸ㝔࡛ࡢ㐣ཤࡢࢫࢡ࣮ࣜࢽࣥࢢࢹ࣮ࢱࡢゎᯒ⤖ᯝᚋࡢࢫࢡ࣮ࣜࢽࣥࢢࢩࢫࢸ࣒ᑟධࡢࣟ
࣮ࢻ࣐ࢵࣉ
Ѝᖺᗘࡇࡲ࡛⤖ᯝࢆฟࡍ㸽
ۑ⌰⌫Ꮫ་Ꮫ㒊㝃ᒓ㝔 ቑ⏣ ᫀே㸦ࢥ࣓ࣥࢺ5ศ㸧 Ἀ⦖ᆅᇦ࡛ࡢࢫࢡ࣮ࣜࢽࣥࢢᑟධࡢᨭࡘ࠸࡚
Ѝ㇏ぢᇛ୰ኸ㝔ࡢࢫࢡ࣮ࣜࢽࣥࢢࡢᑟධᨭࡘ࠸࡚ࡢࢥ࣓ࣥࢺ
㸺ࢹࢫ࢝ࢵࢩࣙࣥ㸼
ە㟷᳃┴❧୰ኸ㝔 ୕ᾆ ᾈ⣖㸦Ⓨ⾲10ศ㸧
ᖺᗘࡲ࡛ᵓ⠏ࡉࢀࡓࢫࢡ࣮ࣜࢽࣥࢢࢩࢫࢸ࣒ࡢᴫせಶࠎࡢᝈ⪅ࢹ࣮ࢱࡢ⌧ሙ࡛ࡢά⏝✚
ࢹ࣮ࢱࢆ࠸⌧ሙ࡛ά⏝ࡍࡿ
ͤ Ⓨ⾲⪅ࡣەࠊࢥ࣓ࣥࢺᢸᙜ⪅ࡣۑ࡚⾲グ
ͤ タྡ␎⛠࣭ᩗ⛠␎
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൱ापेॊেણ૩થ૮धಯৎ൱ ╒ 156ऊैभजोझोभযਯ ൱ापेॊেણ૩થ૮धৎ൱ ╒ 156ऊैभजोझोभযਯ ൱ापेॊেણ૩થ૮ध൱ाभ ╒ 156ऊैभजोझोभযਯ ಯৎभਘः൱ा956ڬऊैگभजोझोभযਯ
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जभभඪ૾
䠏䠊ᅾᏯ䛾ⱞ③䛾䝇䜽䝸䞊䝙䞁䜾ᬑཬ䛻ྥ䛡䛯㻌 㻌 ゼၥデ⒪་䚸ゼၥ┳ㆤ䝇䝔䞊䝅䝵䞁䜈䛾ᑟධ㻌 㻌
㻌 ␊እ⛉⫶⭠⛉་㝔䛸䛒䜣䛥䜣ゼၥ┳ㆤ䝇䝔䞊䝅䝵 䞁䛻ᅾᏯ䛾ⱞ③䛾䝇䜽䝸䞊䝙䞁䜾ᑟධ䛻䛴䛔䛶౫㢗䚸 ᢎㅙ䜢ᚓ䛶䛔䜛䚹
␊እ⛉⫶⭠⛉་㝔䛾ᴫせ
㻌 ẕయ䛿␊እ⛉⫶⭠⛉་㝔䛷䚸䛭䛾ᅾᏯㆤᨭ䝉䞁䝍䞊 㻌 ㆤ⪁ேಖタ䛸䛧䛶⤌⧊䛥䜜䛶䜛䚹ㆤ⪁ேಖタ䚸 㻌 ᅾᏯ䚸ධ㝔䚸እ᮶䛾䝣䜱䞊䝹䝗䛜☜ಖ䛥䜜䚸ᖺ㛫䠄ϮϬϭϱᖺ 㻌 ᗘ䠅ᅾᏯ䛾䛜䜣ᝈ⪅ཷ䛡ධ䜜ேᩘ䛿ϰϬྡ䚸ᅾᏯ┳ྲྀ䜚௳ᩘ䛿 㻌Ϯϳྡ䛷䛒䜛䚹
䛒䜣䛥䜣ゼၥ┳ㆤ䝇䝔䞊䝅䝵䞁䛾ᴫせ
㻌 ⦆䜿䜰ㄆᐃ┳ㆤᖌ䛜ᡤ㛗䜢ᢸ䛔䚸䛜䜣ᝈ⪅䜢ከ䛟ཷ䛡ධ䜜 㻌 䛶䛔䜛䚹ᖺ㛫䠄ϮϬϭϱᖺᗘ䠅ᅾᏯ䛜䜣ᝈ⪅ཷ䛡ධ䜜ேᩘ䠄᪂つ䠅 㻌 䛿㻌ϭϬϵྡ䚸ᅾᏯ┳ྲྀ䜚௳ᩘ䛿ϱϳྡ䛷䛒䜛
ィ⏬䛾ᴫせ
䠎䠊ᆅᇦ䛜䜣デ⒪㐃ᦠᣐⅬ㝔䛸ⱞ③䛾䝇䜽䝸䞊 㻌 㻌 䝙䞁䜾㢖ᗘ䜢༠㆟
┠ⓗ㻌 ᆅᇦ䛜䜣デ⒪㐃ᦠᣐⅬ㝔䠎タ䠄ᙜ㝔䜢ྵ䜐䠅䛜 㻌 㻌 㻌 ᐃᮇⓗ䛻䚸䛭䛾ϰタ䛿䇾䛜䜣䛸デ᩿䛥䜜䛯䇿䛾 㻌 㻌 㻌 䜏䛻䝇䜽䝸䞊䝙䞁䜾䜢ᐇ䛧䛶䛔䜛䚹䛜䜣䛾≧䛿 㻌 㻌 㻌 ⥅⥆ⓗ䛻ኚ䛩䜛䛣䛸䛛䜙䚸⦆䜿䜰䝏䞊䝮ධ౫ 㻌 㻌 㻌 㢗ᝈ⪅䜢ᑐ㇟䛻③䜏䛾䝇䜽䝸䞊䝙䞁䜾䛾㢖ᗘ䜢᳨ウ ᪉ἲ䠖ᆅᇦ䛜䜣デ⒪㐃ᦠᣐⅬ㝔ϲタ䛻䚸ϮϬϭϱᖺϰ᭶ 㻌 㻌 㻌ϭ᪥䡚ϳ᭶ϯϭ᪥䛻⦆䜿䜰䝏䞊䝮䛻⑊③䝬䝛䝆䝯㻌 㻌 㻌 㻌 㻌 䞁䝖౫㢗䛷⤂䛥䜜䛯䛜䜣ᝈ⪅䛾ึᅇ䝇䜽䝸䞊䝙䞁 㻌 㻌 㻌 䜾⤖ᯝ䚸౫㢗䜎䛷䛾䝇䜽䝸䞊䝙䞁䜾ᅇᩘ➼䜢㞟ィ ༠㆟䠖㟷᳃┴䛜䜣デ⒪㐃ᦠ༠㆟⦆䜿䜰㒊ϲ᭶䛻༠㆟
㻌 㻌 㻌 ணᐃ
ィ⏬䛾ᴫせ
䠍䠊ᆅᇦ䛜䜣デ⒪㐃ᦠᣐⅬ㝔䛻⦆䜿䜰ᥦ౪యไ䛾ホ౯䛸ᨵ 㻌 㻌 ၿ䜢┠ᣦ䛧䛯ᐇែㄪᰝ
ϰ᭶Ϯϴ᪥
㻌 ┴ෆ䛷ᙜ㝔௨እ䛷䚸၏୍ᐃᮇⓗ䛺䝇䜽䝸䞊䝙䞁䜾䜢ᐇ䛧䛶䛔䜛༑⏣ᕷ
❧୰ኸ㝔䛷䚸ŝWĂĚ䜎䛯䛿ŝWŽĚƚŽƵĐŚ䜢ά⏝䛧䛯③䜏䛸䛴䜙䛥䛾䝇䜽䝸䞊䝙䞁 䜾䝅䝇䝔䝮䛾ヨ⾜ⓗᑟධ䛻䛴䛔䛶᳨ウ䜢౫㢗䛧䚸䝅䝇䝔䝮䛾ᴫせ䛸⦆䜿䜰 యไ䛻䛴䛔䛶ㄝ᫂䛧䛯䚹
㻌 ᅇ⟅
䞉┳ㆤ㒊䛛䜙㟁Ꮚ䜹䝹䝔䛾᳨ ⾲ෆᐜ䠄EZ^➼䠅䛸䚸ၥデ⤖ᯝ䛜ྠ䛻ぢ䜛 㻌 䛣䛸䛜䛷䛝䛺䛔䛾䛷䛒䜜䜀䜐䛧䜝䝇䝮䞊䝈䛻㐠䜀䛺䛔䚹
䞉┴䛷䝇䜽䝸䞊䝙䞁䜾䝅䝇䝔䝮ᑟධ䛧䛯䛣䛸䛻䜘䜛䚸⑊③⒪䛾ᡂᯝ䛿䛹 㻌 䛾䜘䛖䛺䜒䛾䛛䛸㉁ၥ䛒䜚䚹䠄ᚋ᪥㝖③⋡➼㈨ᩱᥦ౪䛩䜛ணᐃ䠅
ᖺᗘ䛾ィ⏬
䠍䠊ᆅᇦ䛜䜣デ⒪㐃ᦠᣐⅬ㝔䛻⦆䜿䜰ᥦ౪య 㻌 㻌 ไ䛾ホ౯䛸ᨵၿ䜢┠ᣦ䛧䛯ᐇែㄪᰝ
䠎䠊ᆅᇦ䛜䜣デ⒪㐃ᦠᣐⅬ㝔䛸ⱞ③䛾䝇䜽䝸䞊 㻌 㻌 䝙䞁䜾㢖ᗘ䜢༠㆟
䠏䠊ᅾᏯ䛾ⱞ③䛾䝇䜽䝸䞊䝙䞁䜾ᬑཬ䛻ྥ䛡䛯ゼ 㻌 㻌 ၥデ⒪་䚸ゼၥ┳ㆤ䝇䝔䞊䝅䝵䞁䜈䛾ᑟධ
㟷᳃┴❧୰ኸ㝔䛻䛚䛡䜛䛜䜣ᝈ⪅䛾䝇䜽 䝸䞊䝙䞁䜾ຠᯝ䛸ᆅᇦ䜈䛾ᬑཬຠᯝ
㟷᳃┴㝔ᒁ㻌
ᴗ⟶⌮⪅㻌 ྜྷ⏣㻌 ⱱ
䠏䠊ᅾᏯ䛾ⱞ③䛾䝇䜽䝸䞊䝙䞁䜾ᬑཬ䛻ྥ䛡䛯㻌 㻌 ゼၥデ⒪་䚸ゼၥ┳ㆤ䝇䝔䞊䝅䝵䞁䜈䛾ᑟධ㻌 㻌
㻌 ␊እ⛉⫶⭠⛉་㝔䛸䛒䜣䛥䜣ゼၥ┳ㆤ䝇䝔䞊䝅䝵 䞁䛻ᅾᏯ䛾ⱞ③䛾䝇䜽䝸䞊䝙䞁䜾ᑟධ䛻䛴䛔䛶౫㢗䚸 ᢎㅙ䜢ᚓ䛶䛔䜛䚹
␊እ⛉⫶⭠⛉་㝔䛾ᴫせ
㻌 ẕయ䛿␊እ⛉⫶⭠⛉་㝔䛷䚸䛭䛾ᅾᏯㆤᨭ䝉䞁䝍䞊 㻌 ㆤ⪁ேಖタ䛸䛧䛶⤌⧊䛥䜜䛶䜛䚹ㆤ⪁ேಖタ䚸 㻌 ᅾᏯ䚸ධ㝔䚸እ᮶䛾䝣䜱䞊䝹䝗䛜☜ಖ䛥䜜䚸ᖺ㛫䠄ϮϬϭϱᖺ 㻌 ᗘ䠅ᅾᏯ䛾䛜䜣ᝈ⪅ཷ䛡ධ䜜ேᩘ䛿ϰϬྡ䚸ᅾᏯ┳ྲྀ䜚௳ᩘ䛿 㻌Ϯϳྡ䛷䛒䜛䚹
䛒䜣䛥䜣ゼၥ┳ㆤ䝇䝔䞊䝅䝵䞁䛾ᴫせ
㻌 ⦆䜿䜰ㄆᐃ┳ㆤᖌ䛜ᡤ㛗䜢ᢸ䛔䚸䛜䜣ᝈ⪅䜢ከ䛟ཷ䛡ධ䜜 㻌 䛶䛔䜛䚹ᖺ㛫䠄ϮϬϭϱᖺᗘ䠅ᅾᏯ䛜䜣ᝈ⪅ཷ䛡ධ䜜ேᩘ䠄᪂つ䠅 㻌 䛿㻌ϭϬϵྡ䚸ᅾᏯ┳ྲྀ䜚௳ᩘ䛿ϱϳྡ䛷䛒䜛
ィ⏬䛾ᴫせ
䠎䠊ᆅᇦ䛜䜣デ⒪㐃ᦠᣐⅬ㝔䛸ⱞ③䛾䝇䜽䝸䞊 㻌 㻌 䝙䞁䜾㢖ᗘ䜢༠㆟
┠ⓗ㻌 ᆅᇦ䛜䜣デ⒪㐃ᦠᣐⅬ㝔䠎タ䠄ᙜ㝔䜢ྵ䜐䠅䛜 㻌 㻌 㻌 ᐃᮇⓗ䛻䚸䛭䛾ϰタ䛿䇾䛜䜣䛸デ᩿䛥䜜䛯䇿䛾 㻌 㻌 㻌 䜏䛻䝇䜽䝸䞊䝙䞁䜾䜢ᐇ䛧䛶䛔䜛䚹䛜䜣䛾≧䛿 㻌 㻌 㻌 ⥅⥆ⓗ䛻ኚ䛩䜛䛣䛸䛛䜙䚸⦆䜿䜰䝏䞊䝮ධ౫ 㻌 㻌 㻌 㢗ᝈ⪅䜢ᑐ㇟䛻③䜏䛾䝇䜽䝸䞊䝙䞁䜾䛾㢖ᗘ䜢᳨ウ ᪉ἲ䠖ᆅᇦ䛜䜣デ⒪㐃ᦠᣐⅬ㝔ϲタ䛻䚸ϮϬϭϱᖺϰ᭶ 㻌 㻌 㻌ϭ᪥䡚ϳ᭶ϯϭ᪥䛻⦆䜿䜰䝏䞊䝮䛻⑊③䝬䝛䝆䝯㻌 㻌 㻌 㻌 㻌 䞁䝖౫㢗䛷⤂䛥䜜䛯䛜䜣ᝈ⪅䛾ึᅇ䝇䜽䝸䞊䝙䞁 㻌 㻌 㻌 䜾⤖ᯝ䚸౫㢗䜎䛷䛾䝇䜽䝸䞊䝙䞁䜾ᅇᩘ➼䜢㞟ィ ༠㆟䠖㟷᳃┴䛜䜣デ⒪㐃ᦠ༠㆟⦆䜿䜰㒊ϲ᭶䛻༠㆟
㻌 㻌 㻌 ணᐃ
ィ⏬䛾ᴫせ
䠍䠊ᆅᇦ䛜䜣デ⒪㐃ᦠᣐⅬ㝔䛻⦆䜿䜰ᥦ౪యไ䛾ホ౯䛸ᨵ 㻌 㻌 ၿ䜢┠ᣦ䛧䛯ᐇែㄪᰝ
ϰ᭶Ϯϴ᪥
㻌 ┴ෆ䛷ᙜ㝔௨እ䛷䚸၏୍ᐃᮇⓗ䛺䝇䜽䝸䞊䝙䞁䜾䜢ᐇ䛧䛶䛔䜛༑⏣ᕷ
❧୰ኸ㝔䛷䚸ŝWĂĚ䜎䛯䛿ŝWŽĚƚŽƵĐŚ䜢ά⏝䛧䛯③䜏䛸䛴䜙䛥䛾䝇䜽䝸䞊䝙䞁 䜾䝅䝇䝔䝮䛾ヨ⾜ⓗᑟධ䛻䛴䛔䛶᳨ウ䜢౫㢗䛧䚸䝅䝇䝔䝮䛾ᴫせ䛸⦆䜿䜰 యไ䛻䛴䛔䛶ㄝ᫂䛧䛯䚹
㻌 ᅇ⟅
䞉┳ㆤ㒊䛛䜙㟁Ꮚ䜹䝹䝔䛾᳨ ⾲ෆᐜ䠄EZ^➼䠅䛸䚸ၥデ⤖ᯝ䛜ྠ䛻ぢ䜛 㻌 䛣䛸䛜䛷䛝䛺䛔䛾䛷䛒䜜䜀䜐䛧䜝䝇䝮䞊䝈䛻㐠䜀䛺䛔䚹
䞉┴䛷䝇䜽䝸䞊䝙䞁䜾䝅䝇䝔䝮ᑟධ䛧䛯䛣䛸䛻䜘䜛䚸⑊③⒪䛾ᡂᯝ䛿䛹 㻌 䛾䜘䛖䛺䜒䛾䛛䛸㉁ၥ䛒䜚䚹䠄ᚋ᪥㝖③⋡➼㈨ᩱᥦ౪䛩䜛ணᐃ䠅
ᖺᗘ䛾ィ⏬
䠍䠊ᆅᇦ䛜䜣デ⒪㐃ᦠᣐⅬ㝔䛻⦆䜿䜰ᥦ౪య 㻌 㻌 ไ䛾ホ౯䛸ᨵၿ䜢┠ᣦ䛧䛯ᐇែㄪᰝ
䠎䠊ᆅᇦ䛜䜣デ⒪㐃ᦠᣐⅬ㝔䛸ⱞ③䛾䝇䜽䝸䞊 㻌 㻌 䝙䞁䜾㢖ᗘ䜢༠㆟
䠏䠊ᅾᏯ䛾ⱞ③䛾䝇䜽䝸䞊䝙䞁䜾ᬑཬ䛻ྥ䛡䛯ゼ 㻌 㻌 ၥデ⒪་䚸ゼၥ┳ㆤ䝇䝔䞊䝅䝵䞁䜈䛾ᑟධ
㟷᳃┴❧୰ኸ㝔䛻䛚䛡䜛䛜䜣ᝈ⪅䛾䝇䜽 䝸䞊䝙䞁䜾ຠᯝ䛸ᆅᇦ䜈䛾ᬑཬຠᯝ
㟷᳃┴㝔ᒁ㻌
ᴗ⟶⌮⪅㻌 ྜྷ⏣㻌 ⱱ
ᒓᛶ䠎
ෆ⛉㻌 ϭϱϴ䠄ϳ͘Ϯ䠂䠅㻝㻟㻚㻟䠂㻌 Ͳ㻌
ᚠ⎔ჾ⛉㻌 Ϯ䠄Ϭ͘ϭ䠂䠅
Ϭ䠂 Ͳ㻌
እ⛉㻌 ϭϱϯϴ䠄ϳϬ͘ϱ䠂䠅
㻝㻡㻚㻜䠂㻌 Ϯϳϳϯ䠄Ϯϵ͘ϵ䠂䠅 㻟㻚㻟䠂㻌
⏘፬ே⛉㻌 Ϯϴϴ䠄ϭϯ͘Ϯ䠅
㻝㻜㻚㻠㻌 Ͳ㻌
ᨺᑕ⥺⛉㻌 ϭϵϱ䠄ϴ͘ϵ䠂䠅
㻞㻟㻚㻢㻌 Ͳ㻌
㯞㓉⛉㻌 ϭ䠄Ϭ͘ϭ䠂䠅
㻝㻜㻜䠂㻌 Ͳ㻌
ᾘჾෆ⛉㻌 Ͳ㻌 ϲϰϬϲ䠄ϲϵ͘ϭ䠂䠅 㻞㻚㻣䠂㻌
⦆䜿䜰⛉㻌 Ͳ㻌 ϵϴ䠄ϭ͘ϭ䠂䠅 㻟㻣㻚㻤䠂㻌
デ⒪⛉㻌 㮵ᒇ㻌 㟷᳃㻌
㼀㼛㼠㼍㼘㻌 㻞㻝㻤㻞䠄㻝㻜㻜䠂䠅㻌 㻝㻡㻚㻜䠂㻌
㻥㻞㻣㻣䠄㻝㻜㻜䠂䠅㻌 㻟㻚㻞䠂㻌
㻌ὀ 㻌 䛹 㻌 䛾 㻌 デ 㻌 ⒪ 㻌 ⛉ 㻌 䜒 㻌 ᐇ 㻌 㻌 ⋡ 㻌 䛜 㻌 ᮍ 㻌 ᐃ 㻌 䛷 㻌 䛒 㻌 䜛 㻌 䛣 㻌 䛸 㻌 䛻 㻌 ὀ 㻌 ព 㻌 䟿
㯮Ꮠ䠖䝇䜽䝸䞊䝙䞁䜾௳ᩘ䠄௳ᩘయ䛾ྛデ⒪⛉䛾༨䜑䜛ྜ䠅
㉥Ꮠ䠖③䜏䛷ฟ᮶䛺䛔䜔ᅔ䛳䛶䛔䜛䛣䛸䛜䛂䛒䜛䛃䛸ᅇ⟅䛧䛯ྜ䠄デ⒪⛉ẖ䠅 እ⛉䛾ᐇ⋡䛜
ⴭ䛧䛟ᝏ䛔䚹 䠄ᒣୗ䛥䜣ሗ䠅
⤖ᯝ䠄እ᮶䝕䞊䝍䠅
⤖ᯝ䠄እ᮶䝕䞊䝍䠅
ᖹᆒཷデ㛫㝸㻌
䠄ᖹᆒ㼼㻿㻰䠅㻌 Ϯϯ͘ϳ㼼ϮϮ͘ϭ᪥㻌 ϯϭ͘ϯ㼼ϯϰ͘ϱ᪥㻌
ཷデ㛫㝸䛜㻤㐌㛫௨ୖ㻌 ϭϱϳ௳䠄ϳ͘ϮϬй䠅㻌 ϭϮϰϮ௳䠄ϭϯ͘ϰ䠂䠅㻌 ᛶู䠄ዪᛶྜ䠅㻌 ϰϴ͘ϮϬй㻌 ϰϳ͘ϮϬй㻌 ᖺ㱋䠄ᖹᆒ㼼^䠅 ϲϴ͘ϱ㻌 㼼ϭϮ͘ϴṓ㻌 ϲϳ͘ϱ㼼ϭϬ͘ϵṓ㻌
㮵ᒇ㻌 㟷᳃㻌
┠ⓗ
ྛタ䛾䝕䞊䝍䛾ᴫせ䜢ᢕᥱ䛩䜛
䝕䞊䝍䛾ಙ㢗ᛶ䚸䛚䜘䜃䚸タ㛫䛾ẚ㍑ྍ⬟ᛶ䛻䛴䛔䛶
᳨ウ䛩䜛
᪉ἲ
ྛタ䛾㝖③ᑐ㇟⪅䛾ᇶᮏሗ䛾グ㏙⤫ィ㔞䜢⟬ฟ䚹
እ᮶䛿㟷᳃䛸㮵ᒇ䛾እ᮶䛻↔Ⅼ䛧䚸䠎タ㛫䛾ᒓᛶ䚸グ
㏙⤫ィ㔞䜢⟬ฟ䛩䜛䚹
௨ୖ⤖ᯝ䜢ᇶ䛻䝃䞁䝥䝸䞁䜾≧ἣ䛻䛴䛔䛶⪃ᐹ䛩䜛䚹
ᮇ㛫
⯪Ώ䠖ϮϬϭϱ͘ϭϬ͘ϯϭ䡚ϮϬϭϲͲϯ͘Ϯϴ
୕ḟ䠖ϮϬϭϱ͘ϭϬ͘ϭϳ䡚ϮϬϭϲ͘ϯ͘ϵ 㟷᳃䠖ϮϬϭϱ͘ϭ͘ϭ焍ϮϬϭϱ͘ϳ͘ϯϭ 㮵ᒇ䠖ϮϬϭϱ͘ϴ͘Ϯϵ䡚ϮϬϭϲ͘Ϯ͘ϭϮ
ཧ⪃㈨ᩱ
㝖③⋡䛿ᑐ㇟ᮇ㛫䛜␗䛺䜛䛰䛡䛷䛺䛟䚸 ௨ୗ䛾Ⅼ䛻䜒ὀព䛜ᚲせ䚹 䞉ᑐ㇟デ⒪⛉䠖タ䛻䜘䜚␗䛺䜛 䞉ᑐ㇟⪅ᩘ䠖タ䛻䜘䜚ᖜ䛻␗䛺䜛 䞉୕ḟ䛿䚸ϭϬ᪥┠䜎䛷䛾䝕䞊䝍䛜ᴟ➃䛻ᑡ䛺䛔
Ϭй ϮϬй ϰϬй ϲϬй ϴϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ
㝖③⋡
᪥
タู䛾ධ㝔㝖③⋡
⯪Ώ ୕ḟ 㟷᳃ 㮵ᒇ
䛿䛨䜑䛻
ከタ䛷䝕䞊䝍㞟䛜ጞ䜎䛳䛯䛜䚸ධ㝔㝖③⋡䚸እ᮶䛻
䛔䛶䛿䚸③䜏䛷ฟ᮶䛺䛔䜔ᅔ䛳䛶䛔䜛䛣䛸䛜᭷䜛ே㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 䠄௨ୗ䚸③ฟᅔ䠅䛾ྜ䛜␗䛺䜛䚹
≉䛻䚸ᑟධ䛧ጞ䜑䛯䜀䛛䜚䛾እ᮶䛻䛚䛔䛶䛿䛭䛾㐪䛔䛜 㢧ⴭ䛷䛒䜛䚹
ཧຍタ䛻䛚䛡䜛䝇䜽䝸䞊䝙䞁䜾䝕䞊䝍䛾ᴫせ䛸 䝕䞊䝍䛾㉁䛻䛴䛔䛶
ϮϬϭϲ͘ϱ͘ϮϬ
ⓗሙ⌜㆟㈨ᩱ
ᅜ❧䛜䜣◊✲䝉䞁䝍䞊 䛜䜣ᑐ⟇ሗ䝉䞁䝍䞊䛜䜣⮫ᗋሗ㒊
ᴬཎ┤႐㻌 ᮾᑦᘯ
⤖ㄽ
タ㛫䛷䝃䞁䝥䝸䞁䜾䛻೫䜚䠄䝕䞊䝍䛾ᛶ㉁䛸䛭䛾ศ ᕸ䛜␗䛺䜛䠅䛜䛒䜛䛾䛷䚸タ㛫䛷䛾ẚ㍑ྍ⬟ᛶ䛿
᫂䚹
デ⒪⛉ู䛻ぢ䜛ሙྜ䛷䜒ᐇ⋡䛸ే䛫䛶᳨ウ䛩䜛ᚲ せ䛜䛒䜛䚹䠄タ㛫䛷䛾③ฟᅔ䛾ྜ䛿䚸⌧ẁ㝵䛷ಙ 㢗ᛶ䛾䛒䜛್䛸䛿ゝ䛘䛺䛔䚹䠅㻌
⌧Ⅼ䛷䚸ྛタ䛾≉ᚩ䛸ධ䛩䜉䛝ᝈ⪅ീ䜢ᢕᥱ 䛩䜛䛿ᅔ㞴
䝕䞊䝍䛾㉁䜈䛾ᙳ㡪せᅉ䛿ከ᪉㠃䛛䜙⪃䛘䜙䜜䜛 䛜䚸䜎䛪䛿ᐇ⋡䛾ྥୖ䛸೫䜚䛾↓䛔䝃䞁䝥䝸䞁䜾䛜
᭱ඃඛㄢ㢟䚹
⪃ᐹ
እ᮶䛾③ฟᅔ䛾ྜ䛾㐪䛔
¾ཷデ㛫㝸
㻌 䛭䜜䜋䛹ኚ䜟䜚䛺䛔䚹эᙳ㡪䛧䛶䛔䜛䛸䛿⪃䛘䛻䛟䛔 ¾䝃䞁䝥䝸䞁䜾䛾ၥ㢟
ᑐ㇟デ⒪⛉䛜ᴟ➃䛻␗䛺䜛䠄デ⒪⛉䛾ᵓᡂ䜒ྵ䜑䠅
ධ㝔䛷䜒ྠᵝ䛾䛣䛸䛜ゝ䛘䜛ྍ⬟ᛶ䛜䛒䜛 㻌 㻌эᚲせ䛺䝕䞊䝍䜢ྲྀ䜜䛶䛔䛺䛔ྍ⬟ᛶ 㻌 㻌 䠄೫䛳䛯䝕䞊䝍䜢ྲྀ䛳䛶䛔䜛ྍ⬟ᛶ䠅
㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌ᐇ⋡䜢ྥୖ䛥䛫䛺䛡䜜䜀ṇ☜䛺䝕䞊䝍䛸䛺䜙䛺䛔䚹 ¾䛾ᒓᛶ䛾㐪䛔䛜ᙳ㡪䛧䛶䛔䜛ྍ⬟ᛶ
ᆅᇦ≉ᛶ
㝔䛾ᶵ⬟䛸ᙺ䠄ᛴᛶᮇ䞉៏ᛶᮇ䚸デ⒪⛉䛾⦅ᡂ䠅
③䜏䛾✀㢮
㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 䛺䛹 Ϭй
ϮϬй ϰϬй ϲϬй ϴϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ 㮵ᒇ
⏨ ዪ
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ 㮵ᒇ
㧗㱋⪅ ୍⯡ᡂே
㻼㻌㻩㻌㻜㻚㻞㻣 㻼㻌㻩㻌㻜㻚㻜㻞
⤖ᯝ䠄ධ㝔䠖㝖③⋡ᛶู䛸㧗㱋⪅୍ͬ⯡ᡂே
デ⒪⛉㻌 ⏨ 䠄㝖③⋡䠅㻌
ዪ 䠄㝖③⋡䠅㻌 ෆ⛉㻌 ϴϳ͘ϯй㻌 ϱϵ͘Ϯй㻌 ᚠ⎔ჾ⛉㻌 ϭϰ͘ϯй㻌 ϭϰ͘ϯй㻌 እ⛉㻌 ϱϮ͘Ϭй㻌 ϱϬ͘Ϭй㻌
⬻⚄⤒እ⛉㻌 㻌ϱϱ͘ϲй ϱϱ͘ϲй㻌
⏘፬ே⛉㻌 ϲϰ͘ϰй㻌 ᨺᑕ⥺⛉㻌 ϲϱ͘ϱй㻌 ϱϰ͘ϯй㻌 dŽƚĂů㻌 ϱϴ͘Ϭй㻌 ϱϯ͘ϱй㻌
ዪ䛾
ྜ㻌 ϰϬ͘ϰϵ㻌 Ϭ㻌 ϰϬ͘ϭϵ㻌 ϯϰ͘Ϯϵ㻌 ϵϵ͘ϲϴ㻌 Ϯϵ͘ϯϮ㻌 ϱϬ͘ϱϭ㻌
ϭϳϳϵ䠄ϱϳ͘Ϭ䠂䠅 ϲϭϳ䠄ϭϵ͘ϴ䠂䠅 ϯϮϲ䠄ϭϬ͘ϱ䠂䠅 ϯϬϳ䠄ϵ͘ϴ䠂䠅 ϵϭ㻌 䠄Ϯ͘ϵ䠂䠅 ϯϭϮϬ䠄ϭϬϬ䠂䠅 እ⛉
⏘፬ே⛉
ෆ⛉
ᨺᑕ⥺⛉
䛭䛾
dŽƚĂů
⤖ᯝ䠄ධ㝔䠖㝖③⋡ᛶู䛸㧗㱋⪅୍ͬ⯡ᡂே
Ϭй ϱϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ ϭϲ
㝖③⋡
᪥
⯪Ώ
Ϭй ϱϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ
᪥
⯪Ώ
㻼㻌㻩㻌㻜㻚㻠㻟 㻼㻌㻩㻌㻜㻚㻝㻢
Ϭй ϱϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ
㝖③⋡
୕ḟ
Ϭй ϱϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ
୕ḟ
Ϭй ϱϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ
㍈䝷䝧䝹
㟷᳃
⏨ ዪ
Ϭй ϱϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ 㟷᳃
㧗㱋⪅ ୍⯡ᡂே
⤖ᯝ䠄ධ㝔䠅
㻼㻌㻩㻌㻜㻚㻠㻟 㻼㻌㻩㻌㻜㻚㻝㻢
㻌 ⯪Ώ ୕ḟ 㟷᳃ 㮵ᒇ
ࣱК=ڡࣱлӳ? ϰϭ͘Ϯй ϯϴ͘ϳй ϰϯ͘ϱй ϱϬ͘ϱй ᖺ㱋ᖹᆒ㼼^ ϳϮ͘ϱ㼼ϭϬ͘ϰ ϳϮ͘ϱ㼼ϭϮ͘ϲ ϲϲ͘Ϯ㼼ϭϭ͘ϯ ϳϬ͘Ϯ㼼ϭϮ͘Ϯ
ᚮၲᅹ⁍⊑≋≉≌⁏‒ 㻌㻌 㻌 㻌
እ⛉ ϭϬϲϮ䠄Ϯϳ͘ϴ䠂䠅 ϮϮϴ䠄ϯϲ͘ϳ䠂䠅 ϭϵϴϬ䠄Ϯϱ͘ϲ䠂䠅 ϭϳϳϵ䠄ϱϳ͘Ϭ䠂䠅
⏘፬ே⛉ ϮϵϮ㻌 䠄ϳ͘ϲ䠂䠅 ϱϱ㻌 䠄ϴ͘ϴ䠂䠅 ϴϭϱ䠄ϭϭ䠂䠅 ϲϭϳ䠄ϭϵ͘ϴ䠂䠅
ෆ⛉ ϲϲϱ䠄ϭϳ͘ϰ䠂䠅 ϮϬϱ䠄ϯϯ͘Ϭ䠂䠅 Ͳ ϯϮϲ䠄ϭϬ͘ϱ䠂䠅
Ἢᒀჾ⛉ ϲϱϳ䠄ϭϳ͘Ϯ䠂䠅 ϭϭϬ䠄ϭϳ͘ϳ䠂䠅 ϱϯϮ䠄ϲ͘ϵ䠂䠅 Ͳ
྾ჾ⛉ ϰϲϲ䠄ϭϮ͘Ϯ䠂䠅 Ͳ ϳϯϯ䠄ϵ͘ϱ䠂䠅 Ͳ ᾘჾ⛉ ϯ㻌 䠄Ϭ͘ϭ䠂䠅 Ͳ Ͳ Ͳ
ᾘჾෆ⛉ Ͳ Ͳ Ϯϭϭϰ䠄Ϯϳ͘ϯ䠂䠅 Ͳ
⪥㰯ဗႃ⛉ Ͳ ϭ㻌 䠄Ϭ͘Ϯ䠂䠅 ϰϳϯ䠄ϲ͘ϭ䠂䠅 Ͳ
⾑ᾮෆ⛉ ϱϭϴ䠄ϭϯ͘ϱ䠂䠅 Ͳ ϭϬϴϵ䠄ϭϰ͘ϭ䠂䠅 Ͳ
ᨺᑕ⥺⛉ Ͳ Ͳ Ͳ ϯϬϳ䠄ϵ͘ϴ䠂䠅
䛭䛾 ϭϲϯ䠄ϰ͘ϰ䠂䠅 Ϯϯ䠄ϯ͘ϳ䠂䠅 ϱ㻌 䠄Ϭ䠂䠅 ϵϭ㻌 䠄Ϯ͘ϵ䠂䠅 dŽƚĂů ϯϴϮϲ䠄ϭϬϬ䠂䠅 ϲϮϮ䠄ϭϬϬ䠂䠅 ϳϳϰϭ䠄ϭϬϬ䠂䠅 ϯϭϮϬ䠄ϭϬϬ䠂䠅
⤖ㄽ
タ㛫䛷䝃䞁䝥䝸䞁䜾䛻೫䜚䠄䝕䞊䝍䛾ᛶ㉁䛸䛭䛾ศ ᕸ䛜␗䛺䜛䠅䛜䛒䜛䛾䛷䚸タ㛫䛷䛾ẚ㍑ྍ⬟ᛶ䛿
᫂䚹
デ⒪⛉ู䛻ぢ䜛ሙྜ䛷䜒ᐇ⋡䛸ే䛫䛶᳨ウ䛩䜛ᚲ せ䛜䛒䜛䚹䠄タ㛫䛷䛾③ฟᅔ䛾ྜ䛿䚸⌧ẁ㝵䛷ಙ 㢗ᛶ䛾䛒䜛್䛸䛿ゝ䛘䛺䛔䚹䠅㻌
⌧Ⅼ䛷䚸ྛタ䛾≉ᚩ䛸ධ䛩䜉䛝ᝈ⪅ീ䜢ᢕᥱ 䛩䜛䛿ᅔ㞴
䝕䞊䝍䛾㉁䜈䛾ᙳ㡪せᅉ䛿ከ᪉㠃䛛䜙⪃䛘䜙䜜䜛 䛜䚸䜎䛪䛿ᐇ⋡䛾ྥୖ䛸೫䜚䛾↓䛔䝃䞁䝥䝸䞁䜾䛜
᭱ඃඛㄢ㢟䚹
⪃ᐹ
እ᮶䛾③ฟᅔ䛾ྜ䛾㐪䛔
¾ཷデ㛫㝸
㻌 䛭䜜䜋䛹ኚ䜟䜚䛺䛔䚹эᙳ㡪䛧䛶䛔䜛䛸䛿⪃䛘䛻䛟䛔 ¾䝃䞁䝥䝸䞁䜾䛾ၥ㢟
ᑐ㇟デ⒪⛉䛜ᴟ➃䛻␗䛺䜛䠄デ⒪⛉䛾ᵓᡂ䜒ྵ䜑䠅
ධ㝔䛷䜒ྠᵝ䛾䛣䛸䛜ゝ䛘䜛ྍ⬟ᛶ䛜䛒䜛 㻌 㻌эᚲせ䛺䝕䞊䝍䜢ྲྀ䜜䛶䛔䛺䛔ྍ⬟ᛶ 㻌 㻌 䠄೫䛳䛯䝕䞊䝍䜢ྲྀ䛳䛶䛔䜛ྍ⬟ᛶ䠅
㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌ᐇ⋡䜢ྥୖ䛥䛫䛺䛡䜜䜀ṇ☜䛺䝕䞊䝍䛸䛺䜙䛺䛔䚹 ¾䛾ᒓᛶ䛾㐪䛔䛜ᙳ㡪䛧䛶䛔䜛ྍ⬟ᛶ
ᆅᇦ≉ᛶ
㝔䛾ᶵ⬟䛸ᙺ䠄ᛴᛶᮇ䞉៏ᛶᮇ䚸デ⒪⛉䛾⦅ᡂ䠅
③䜏䛾✀㢮
㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 䛺䛹 Ϭй
ϮϬй ϰϬй ϲϬй ϴϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ 㮵ᒇ
⏨ ዪ
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ 㮵ᒇ
㧗㱋⪅ ୍⯡ᡂே
㻼㻌㻩㻌㻜㻚㻞㻣 㻼㻌㻩㻌㻜㻚㻜㻞
⤖ᯝ䠄ධ㝔䠖㝖③⋡ᛶู䛸㧗㱋⪅୍ͬ⯡ᡂே
デ⒪⛉㻌 ⏨ 䠄㝖③⋡䠅㻌
ዪ 䠄㝖③⋡䠅㻌 ෆ⛉㻌 ϴϳ͘ϯй㻌 ϱϵ͘Ϯй㻌 ᚠ⎔ჾ⛉㻌 ϭϰ͘ϯй㻌 ϭϰ͘ϯй㻌 እ⛉㻌 ϱϮ͘Ϭй㻌 ϱϬ͘Ϭй㻌
⬻⚄⤒እ⛉㻌 㻌ϱϱ͘ϲй ϱϱ͘ϲй㻌
⏘፬ே⛉㻌 ϲϰ͘ϰй㻌 ᨺᑕ⥺⛉㻌 ϲϱ͘ϱй㻌 ϱϰ͘ϯй㻌 dŽƚĂů㻌 ϱϴ͘Ϭй㻌 ϱϯ͘ϱй㻌
ዪ䛾
ྜ㻌 ϰϬ͘ϰϵ㻌 Ϭ㻌 ϰϬ͘ϭϵ㻌 ϯϰ͘Ϯϵ㻌 ϵϵ͘ϲϴ㻌 Ϯϵ͘ϯϮ㻌 ϱϬ͘ϱϭ㻌
ϭϳϳϵ䠄ϱϳ͘Ϭ䠂䠅 ϲϭϳ䠄ϭϵ͘ϴ䠂䠅 ϯϮϲ䠄ϭϬ͘ϱ䠂䠅 ϯϬϳ䠄ϵ͘ϴ䠂䠅 ϵϭ㻌 䠄Ϯ͘ϵ䠂䠅 ϯϭϮϬ䠄ϭϬϬ䠂䠅 እ⛉
⏘፬ே⛉
ෆ⛉
ᨺᑕ⥺⛉
䛭䛾
dŽƚĂů
⤖ᯝ䠄ධ㝔䠖㝖③⋡ᛶู䛸㧗㱋⪅୍ͬ⯡ᡂே
Ϭй ϱϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ ϭϲ
㝖③⋡
᪥
⯪Ώ
Ϭй ϱϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ
᪥
⯪Ώ
㻼㻌㻩㻌㻜㻚㻠㻟 㻼㻌㻩㻌㻜㻚㻝㻢
Ϭй ϱϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ
㝖③⋡
୕ḟ
Ϭй ϱϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ
୕ḟ
Ϭй ϱϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ
㍈䝷䝧䝹
㟷᳃
⏨ ዪ
Ϭй ϱϬй ϭϬϬй
ϭ Ϯ ϯ ϰ ϱ ϲ ϳ ϴ ϵ ϭϬ ϭϭ ϭϮ ϭϯ ϭϰ ϭϱ 㟷᳃
㧗㱋⪅ ୍⯡ᡂே
⤖ᯝ䠄ධ㝔䠅
㻼㻌㻩㻌㻜㻚㻠㻟 㻼㻌㻩㻌㻜㻚㻝㻢
㻌 ⯪Ώ ୕ḟ 㟷᳃ 㮵ᒇ
ࣱК=ڡࣱлӳ? ϰϭ͘Ϯй ϯϴ͘ϳй ϰϯ͘ϱй ϱϬ͘ϱй ᖺ㱋ᖹᆒ㼼^ ϳϮ͘ϱ㼼ϭϬ͘ϰ ϳϮ͘ϱ㼼ϭϮ͘ϲ ϲϲ͘Ϯ㼼ϭϭ͘ϯ ϳϬ͘Ϯ㼼ϭϮ͘Ϯ
ᚮၲᅹ⁍⊑≋≉≌⁏‒ 㻌㻌 㻌 㻌
እ⛉ ϭϬϲϮ䠄Ϯϳ͘ϴ䠂䠅 ϮϮϴ䠄ϯϲ͘ϳ䠂䠅 ϭϵϴϬ䠄Ϯϱ͘ϲ䠂䠅 ϭϳϳϵ䠄ϱϳ͘Ϭ䠂䠅
⏘፬ே⛉ ϮϵϮ㻌 䠄ϳ͘ϲ䠂䠅 ϱϱ㻌 䠄ϴ͘ϴ䠂䠅 ϴϭϱ䠄ϭϭ䠂䠅 ϲϭϳ䠄ϭϵ͘ϴ䠂䠅
ෆ⛉ ϲϲϱ䠄ϭϳ͘ϰ䠂䠅 ϮϬϱ䠄ϯϯ͘Ϭ䠂䠅 Ͳ ϯϮϲ䠄ϭϬ͘ϱ䠂䠅
Ἢᒀჾ⛉ ϲϱϳ䠄ϭϳ͘Ϯ䠂䠅 ϭϭϬ䠄ϭϳ͘ϳ䠂䠅 ϱϯϮ䠄ϲ͘ϵ䠂䠅 Ͳ
྾ჾ⛉ ϰϲϲ䠄ϭϮ͘Ϯ䠂䠅 Ͳ ϳϯϯ䠄ϵ͘ϱ䠂䠅 Ͳ ᾘჾ⛉ ϯ㻌 䠄Ϭ͘ϭ䠂䠅 Ͳ Ͳ Ͳ
ᾘჾෆ⛉ Ͳ Ͳ Ϯϭϭϰ䠄Ϯϳ͘ϯ䠂䠅 Ͳ
⪥㰯ဗႃ⛉ Ͳ ϭ㻌 䠄Ϭ͘Ϯ䠂䠅 ϰϳϯ䠄ϲ͘ϭ䠂䠅 Ͳ
⾑ᾮෆ⛉ ϱϭϴ䠄ϭϯ͘ϱ䠂䠅 Ͳ ϭϬϴϵ䠄ϭϰ͘ϭ䠂䠅 Ͳ
ᨺᑕ⥺⛉ Ͳ Ͳ Ͳ ϯϬϳ䠄ϵ͘ϴ䠂䠅
䛭䛾 ϭϲϯ䠄ϰ͘ϰ䠂䠅 Ϯϯ䠄ϯ͘ϳ䠂䠅 ϱ㻌 䠄Ϭ䠂䠅 ϵϭ㻌 䠄Ϯ͘ϵ䠂䠅 dŽƚĂů ϯϴϮϲ䠄ϭϬϬ䠂䠅 ϲϮϮ䠄ϭϬϬ䠂䠅 ϳϳϰϭ䠄ϭϬϬ䠂䠅 ϯϭϮϬ䠄ϭϬϬ䠂䠅
๓ᖺ䠄2015䠅䛾ᡂ⦼
䜰䜴䝖䜹䝮䝔䞊䝤䝹
᭱⤊ᮇᴗ⦼ணᐃ䐟㻌 㻌
㻿㻼㻭㻾㻯㻿㝖③䝙䞊䝈᭱䠬䡐䜈䛾᥎ዡᡂ⦼䠄ணഛ◊✲ᢞ✏䠅㻌
⪃ᐹ
㻌 ๓ᖺ䠄᩿⥆ⓗ䛺䜿䞊䝇䝅䝸䞊䝈䠅䛛䜙ᨵၿ䛧䛯⌮⏤䛿䠛㻌
㻌 䞉㻌 ་䜈䛾ሗබ㛤䠄䜹䞁䝣䜰䝺䞁䝇䛸㆟䝥䝺䝊䞁䝔䞊䝅䝵䞁䠅䛸⩏ᅇ⟅
э䛂ᢎ䛧䛶䛛䜙䛾᥎ዡ䛃䛰䛛䜙䜰䜽䝉䝥䝖⋡㧗䛔䛾䛿ᙜ↛䛛䠛 э㻌 䛂㏱᫂ᛶ㻌 Transparency䛃䜢䛸䛔䛖⒪་䝸䜽䜶䝇䝖
䛻ᑐᛂ䛧䛶᪉ἲㄝ᫂䞉ᝈ⪅䞉ᐙ᪘䜈䛾䝫䝇䝍䞊ᥦ♧䛺䛹䚸䜢ᐇ䛧䛶䛛 䜙
㻌 䞉㻌 䝇䜽䝸䞊䝙䞁䜾䛛䜙䛾≧䝖䝸䜰䞊䝆䛷䠄䛒䜛⛬ᗘSystematic䛻䠅䛜䜣㝖③ຠᯝ 䜢♧䛧䛘䛯䛂䛿䛨䜑䛶䛾䝺䝫䞊䝖䛃
㻌
⤖ᯝ-2㻌 䠄䝥䝻䝉䝇ホ౯䠅
䐟㻌 䠳䠤䠫䜺䜲䝗䝷䜲䞁 (䠝䠨䠬䠤䠝䝥䝻䝖䝁䝹) 䠑ཎ๎䛻䜘䜛᥎ዡෆᐜศ㢮䠄㔜」䛒䜚䠅 㻌 㻌Dose Escalation via “For the Individual”:㻌 䠍8㻌recommendedэ䠍6㻌accepted㻌 Analgesics Class Step-up via “By the Ladder”:㻌 䠑recommendedэ䠐accepted Treatment to improve Adverse Effect㻌via “Attention to Detail”:㻌9 recommended э 7 accepted
Prescription Schedule adjustment via “By the Clock”:㻌 䠍 recommended э䠍accepted Optimization of the route (Switching the Route) via “By Mouth”:㻌 䠎 recommended э䠎 accepted
䐠㻌 䠝䠨䠬䠤䠝䜰䝹䝂䝸䝈䝮䠄䠀䠍䡚䠒䠅䛻䜘䜛᥎ዡศ㢮䠖㻌 㔜」䛒䜚45᥎ዡ 䠀䠍:㻌 䛺䛧㻌
䠀䠎:㻌 䠑 䠀䠏:㻌 䠒
䠀䠐䠖㻌 䠎䠏㻌 䠄䠓䠕㻌 䠂䠬䡐䠅 䠀䠑㻌 䠍
䠀䠒䠖㻌 䛺䛧
᭱⤊ᮇᴗ⦼ணᐃ䐟㻌 㻌
㻿㻼㻭㻾㻯㻿㝖③䝙䞊䝈᭱䠬䡐䜈䛾᥎ዡᡂ⦼䠄ணഛ◊✲ᢞ✏䠅㻌
ᮇ㛫㻌 䠎䠌䠍䠒ᖺ㻌 䠍᭶䠎䠕᪥䛛䜙䠐᭶䠎䠔᪥䜎䛷䠏䛛᭶䠄㐃⥆䠅
ᝈ⪅㻌 㠀㝖③䝇䜽䝸䞊䝙䞁䜾э䠟䠪䝷䜴䞁䝗ᑐᛂ䛷་ྠពэ䠰䠲㆟᥎ዡ䠄䠝䠨䠬䠤䠝䠅 ᪉ἲ㻌 ከ⫋✀」ᩘྡ䛾ྜ㆟䛻䜘䜛᥎ዡ䛸⤖ᯝุᐃ
⤖ᯝ-1㻌 䠄䜰䜴䝖䜹䝮ホ౯䠅
䛾䜉䠎䠕௳䠄⏨ᛶ䠎䠍௳䠅䚸ᐇᩘ䠍䠕
䠬䠯䠖㻌 䠌䠙䛺䛧䚸䠬䠯䠍䠙䠕䚸䠬䠯䠎䠙䠕㻌 䠬䠯䠏䠙11䚸䠬䠯䠐䠙䠍 ᖺ㱋䠄ᐇᩘ䛷䜹䜴䞁䝖䠅䠖㻌 䠒䠍䠊䠌㼼䠍䠌䠊䠔ṓ䠄䠏䠐䡚䠓䠐䚸୰ኸ್䠒䠍ṓ䠅 ཎⓎᕢ㻌 䠄ᐇᩘ䠅㻌 㢌㢕㒊㻌 䠎䚸ୗ㒊ᾘ⟶䠎䚸⫢⫹⮅䠎䚸Ẽ⟶ᨭ䠏 㦵⤖ྜ⤌⧊䠍䚸ୖ㒊ᾘ⟶7䚸Ἢᒀ⏕Ṫჾ䠎
ᨵၿ ᨵၿ
䛺䛧
᫂ ྜィ௳ᩘ
᥎ዡ ᥇⏝
䠎䠎 䠏 0 25
䠄86.2䠂䠅
㠀᥇⏝ 䠌 䠏 䠍䠆 䠐
䠄13.8䠂䠅 䠆㻌 ᥎ዡ⩣᪥䚸ཎᝈ䛾ቑ ᝏ䛻䜘䜛ᛴኚ䠄᫃╧䠅
᭱⤊ᮇᴗ⦼ணᐃ䐟㻌 㻌
㻿㻼㻭㻾㻯㻿㝖③䝙䞊䝈᭱䠬䡐䜈䛾᥎ዡᡂ⦼䠄ணഛ◊✲ᢞ✏䠅㻌
᥎ዡ᥇⏝⋡86.2䠂 㻌 ᥇⏝䛾ᨵၿ⋡88.0䠂 㻌 㠀᥇⏝䝸䝇䜽ẚ㻌5.5 㻌Chi-square test P value < 0.0004
㻌
Study Background of Our Group
z ࡀࢇᑐ⟇᥎㐍ᇶᮏィ⏬ 㸦㹆ᖺᨵゞ㹼㸧
⦆ࢣࠊࡀࢇデ᩿ࡉࢀࡓࡽᥦ౪"
ࡀࢇデ⒪㐃ᦠᣐⅬ㝔ࡢㄆᐃせ௳
z Trained Nursesࠕ⪺ࡁྲྀࡾ࡛ࠖ✺◚ᮇᚅࡍࡿࣂࣜ
⮬Ⓨⓗッ࠼࡞࠸㸦ᑜࡡ࡚ࡋ࠸㸧᪥ᮏேᚰ⌮㸨
ࡀࢇ⒪་㸦┤᥋㸧ⱞ③ࢆッ࠼ࡿࡇࡢᜍᛧ
z Unknowns: ᪥ᮏᘧSymptom Triageࡢ᪉ἲࠊධ⤖ᯝ
⟶⌮ࣇ࣮ࣟᝈ⪅ᐙ᪘ࡶྵࡴබ㛤ࡀᚲ㡲͊
Largest Unmet Needsࢆᣢࡘࡢᩆ῭ࡀ࢝ࢠ
䠆㻌Fujimori䜙䚸2007㻌 㻌†㻌Mtchell AJ䜙㻌2013
ᖹᡂ㻞㻢ᖺ㻝᭶䚸䛜䜣デ⒪㐃ᦠᣐⅬ㝔䛾ᣦᐃせ௳㻌 䖃㻌 ⣔⤫ⓗ䛺ⱞ③䛾䝇䜽䝸䞊䝙䞁䜾㻌
㻌
䖃㻌 ึᮇ≧ᑐᛂ䞉䝏䞊䝮౫㢗䛾㝔ෆ䝹䞊䝹䜢᫂☜㻌 㻌
䖃㻌 䝏䞊䝮䠄䝉䞁䝍䞊䠅┳ㆤᖌ䛾䝇䜽䝸䞊䝙䞁䜾ᨭ䜔䚸㻌 㻌 㻌 㻌 ᝈ⪅䜈䛾䜹䜴䞁䝉䝸䞁䜾㻌
㻌 㻌 㻌 䋻䝏䞊䝮䛾㐃ᦠ䜢☜ಖ䛧䚸㎿㏿䛻ᑐᛂ㻌 ᖹᡂᖺᗘ➨ᅇⓗሙ⌜㆟ᖹᡂᖺ᭶᪥㸦㔠㸧
㸸㹼㸸
ሙ㸸᪥ᮏ㉥༑Ꮠ♫་⒪ࢭࣥࢱ࣮
㸡㸱 ࢱࢺࣝ
ಶࠎࡢタ࡛ࡢᑐᛂᅔ㞴࡞㧗ᗘ࡞ⱞ③ࡢホ౯
⒪ᨭࡢࡓࡵࡢࢸࣞࣅ㆟➼ࡼࡿᨭࢩࢫࢸ࣒
㸦③ࡳ࣭ᝏᚰྤ࣭྾ᅔ㞴࣭ࡏࢇዶཱྀ࣭Ῥ࣭ᛰ ឤ࡞㸧
ࣉࣞࢮࣥࢱ࣮㸸 ୰ி㝔 ྜྷᮏ
◊✲༠ຊ⪅ 㛗ᓮᏛ 㱟ࠊ⪷㞔ᯇ ሷᕝ
ධ㝔䛜䜣ᝈ⪅䛾Severe Symptom Prevalence䛿䠛
୰ி㝔䠬䠟䠰䝁䞁䝃䝹䝖
䠎䠌䠌䠏ᖺ䠑᭶䡚䠎䠌䠍䠍ᖺ䠎᭶㻌 1271 referrals (700 cases) 11 classed NRS䛷㻌 䠪䠮䠯䠓௨ୖ䜢㔜䛸ᐃ⩏䛧䚸 䝁䞁䝃䝹䝖䠄䝏䞊䝮⒪㛤ጞ๓䛾≧ែ䠅᭷⋡㻌
྾ᅔ㞴㻌 22.3% ref㻌 䠄28㻌 21䠅 7.7% referral Total Limited in Severe
ᝏᚰྤ㻌15.4% re䡂㻌 䠄32㻌 4䠍䠅 3.1% referral
ᛰឤ㻌32.8% ref㻌 䠄50㻌 nd䠅㻌 㻌 10.2% referral
⭡㒊⭾‶㻌18.4% ref㻌 䠄21 nd䠅 3.0% referral
๓ᖺ㼀㼂㆟䛾ẕ㞟ᅋ㻌 䠄䠪䠙䠓㻡㻞䠅䜈䛾ほᐹ◊✲㻌
㻌
䐟 ୰➼ᗘ௨ୖ䛾䛂䛴䜙䛥䛃䛾㢖ᗘ㻌
㻌 㻌 㻌 ᛰឤ䠙㻝㻟㻚㻢䠂䚸㣗ᛮ䠙㻞㻡㻚㻣䠂㻌 㻌 㻌 㻌 ᝏᚰ䞉ྤ䠙㻢㻚㻤䠂䚸㻌 ཱྀῬ㻌 䠙㻝㻜㻚㻞䠂㻌 㻌 㻌 㻌 ౽⛎㻌 䠙㻝㻝㻚㻜䠂䚸྾ᅔ㞴䠙㻜㻚㻤䠂㻌 㻌 㻌 㻌 ╧╀㞀ᐖ䠙㻟㻢㻚䠎䠂㻌 䠄୰㏵ぬ㓰䛜᭱ከ䠅㻌 㻌
䐠㻌 㙠③⸆௨እ䛾䛂ᑐᛂ䛃㻌
㻌 㻌 㻌 ⏬ീ᳨ᰝ䛾㏣ຍ㻌 䠐㻌 㐃ᦠᐊ↷㻌 䠎㻌 㻌 㻌 㻌 ཱྀ⭍䜿䜰ᙉ㻌 䠍䠌㻌 㝖③䛾ᨺᑕ⥺㻌 䠐㻌
㻌 㻌㠀㝖③ᝈ⪅䛾③䜏௨እ䛾≧ゎᯒ㻌
1998ᖺ Cancer Pain Relief䛻⥆䛔䛶
③䜏௨እ䛾≧䛾䠳䠤䠫䜺䜲䝗䝷䜲䞁ฟ∧
䜰䝉䝇䝯䞁䝖䛷᭱ඃඛ䛥䜜䜛䜉䛝䛿㻌
ッ䛸᭱䛾ᠱᛕ䛾ྠᐃ䛷䛒䜛㻌
≧ᙉᗘ䛸ᛶ㉁㻌 䜢䝹䞊䝏䞁ホ౯㻌 㻌
䖃㻌 ⏕άᙳ㡪㻌 䖃㻌 䠝䠠䠨㞀ᐖ㻌
≧䝖䝸䜰䞊䝆䛾䛂㡯┠䠄ෆᐜ䠅䛃䛿ఱ䛜ጇᙜ䠛㻌 䋻㒊䜢ẖ᪥㻌 ⧞䜚㏉䛧⪺䛝ྲྀ䜛䠛㻌
᭱⤊ᮇᴗ⦼ணᐃ䐡㻌 㻌
㻌 ⑊③䜢ྵ䜐≧䝖䝸䜰䞊䝆䚸㼃㼑㼎㆟᥎ዡ䛻䜘䜛ᨵၿ䠖㻌 ከタ◊✲㻌 㻙㻻㼚㼑㻌㼛㼒㻌㼠㼔㼑㻌㼁㼘㼠㼕㼙㼍㼠㼑㻌㻼㼡㼞㼜㼛㼟㼑㼟㻌㼕㼚㻌㻿㻼㻭㻾㻯㻿㻌
Ჷ䠪䠯䛾䝇䜽䝸䞊䝙䞁䜾䛷㻌 ᚰ㌟䛾㞀ᐖ䛜≧䛷㉳䛝䛶䛔 䜛䠬䡐㻌 㻔㼕㼚㻌㼠㼔㼑㻌㻵㼙㼜㼍㼕㼞㼑㼐㻌㻸㼕㼒㼑㻕䛾ᝈ⪅⩌䜢㐃᪥䜴䜸䝑䝏䛩䜛㻌 䋻ᙉᗘ≧㻌㼛㼞㻌୰➼ᗘ䛜㻟᪥௨ୖᣢ⥆䜢ᑓᚑ䠪䡏䛜㻌 㻌 䛂≧䝖䝸䜰䞊䝆䛃䛧䛶䠍ḟᑐᛂ㻌
㻌 䝏䞊䝮䠪䡏ᑟ䚸䜸䞊䝥䞁ሗ䛷་䛸ᨵၿ᳨ウ㻌 㻌
䋻་䛾ᕼᮃ䛷䚸┤᥋䜎䛯䛿䠎ḟᑐᛂ䛸䛧䛶㻌
㻌 㻌 እ㒊ᑓ㛛ᐙ䛸䝏䞊䝮䛾䠰䠲㆟䛷་䜈㻲㼑㼑㼐㼎㼍㼏㼗㻌 㻌
䋻䝥䝻䝉䝇䛸䜰䜴䝖䜹䝮ホ౯䜢㻭㼡㼐㼕㼠䛧䛶ᡂ⦼䝺䝫䞊䝖㻌
᭱⤊ᮇᴗ⦼ணᐃ䐠㻌 㻌
㻌 䜸䝢䜸䜲䝗䝺䝡䝳䞊䠄䠯䠟䠫䠬䠡䠅㻌
Rationale 䠄◊✲䛾ᚲせᛶ䠅
㻌 䛛䛳䛶䛿Ḣ⡿䛷䜒㝖③⒪䛾᭱䝞䝸䜰䛿䚸་ᖌ䛾䜰䜽䝅䝵䞁䛷䛒䜛䛸䛥䜜䠄Von Roenn䚸1993䠅䚸᪥ᮏ䜢㝖䛟䜰䝆䜰䛷䜒ྠᵝ䛾▱ぢ䛜ሗ࿌䛥䜜䛶䛔䜛䚹
᪥ᮏ䛷䛾䠬䠟䠰ඛ⾜◊✲䠄䠝䠨䠬䠤䠝㻌2014䠅䛷䚸䛿་ᖌฎ᪉䚸≉䛻䜸䝢䜸䜲䝗䛷䛒䜛ྍ
⬟ᛶ䛜♧၀䛥䜜䛯䛜䚸㠀䝁䞁䝃䝹䝔䞊䝅䝵䞁䛾ฎ᪉䜢䠳䠤䠫䜺䜲䝗䝷䜲䞁㑂Ᏺ䛸䛔 䛖どⅬ䛷䝃䞊䝧䜲䛧䚸᥎ዡෆᐜ䛸䜰䜴䝖䜹䝮䜢ゎᯒ䛩䜛䛣䛸䛿ᅜෆᡂ⦼ᨵၿ䛻᭷⏝䚹 ᝈ⪅䛸᪉ἲ䐟
㻌 䠎䠌䠍䠏ᖺ䛛䜙䛾䠎ᖺ䠝䡑䡀䡅䡐䚸୰ி㝔䛷䝥䝻䝉䝇ホ౯䛸䜰䜴䝖䜹䝮ホ౯䠄ከ⫋✀
㻌 ྜ㆟䠅䚸Default Data 䠄2㻌months 㽢䠎䠅䚸ィ⏬᭩ᥦฟ䛧䠥䠮䠞ㄆྍ䛒䜚㻌
⤖ᯝ䐟
㻌 䠳䠤䠫䠑ཎ๎䛾ฎ᪉䝞䝸䜰䛜䚸㠀䝁䞁䝃䝹䝖䛷䜒䜋䜌ྠᵝ䛷䚸᥎ዡཷㅙ䛻䜘䜛 㻌 䜰䜴䝖䜹䝮ᨵၿ䛜☜ㄆ䛷䛝䛯䚹㻌э㻌 䠝䠦䠤䠬䠩䜈ᢞ✏䠛
ᝈ⪅䛸᪉ἲ䐠
㻌 㐣ཤ䠑ᖺ䛾ᅜෆከタ䜸䝢䜸䜲䝗䝺䝡䝳䞊ሗ࿌䛾ᡂຌᅉᏊ䛸ኻᩋᅉᏊ䜢᥈⣴䛩䜛 㻌 䜰䞁䜿䞊䝖◊✲㻌 䠄ኻᩋ୰Ṇタ4䚸ᡂຌሗ࿌9䠅㻌
㻌э㻌 䛜䜣䛸Ꮫ⒪ἲ䛻ᢞ✏䠛
ධ㝔䛜䜣ᝈ⪅䛾Severe Symptom Prevalence䛿䠛
୰ி㝔䠬䠟䠰䝁䞁䝃䝹䝖
䠎䠌䠌䠏ᖺ䠑᭶䡚䠎䠌䠍䠍ᖺ䠎᭶㻌 1271 referrals (700 cases) 11 classed NRS䛷㻌 䠪䠮䠯䠓௨ୖ䜢㔜䛸ᐃ⩏䛧䚸 䝁䞁䝃䝹䝖䠄䝏䞊䝮⒪㛤ጞ๓䛾≧ែ䠅᭷⋡㻌
྾ᅔ㞴㻌22.3% ref㻌 䠄28㻌 21䠅 7.7% referral Total Limited in Severe
ᝏᚰྤ㻌 15.4% re䡂㻌 䠄32㻌 4䠍䠅 3.1% referral
ᛰឤ㻌32.8% ref㻌 䠄50㻌 nd䠅㻌 㻌 10.2% referral
⭡㒊⭾‶㻌 18.4% ref㻌 䠄21 nd䠅 3.0% referral
๓ᖺ㼀㼂㆟䛾ẕ㞟ᅋ㻌 䠄䠪䠙䠓㻡㻞䠅䜈䛾ほᐹ◊✲㻌
㻌
䐟 ୰➼ᗘ௨ୖ䛾䛂䛴䜙䛥䛃䛾㢖ᗘ㻌
㻌 㻌 㻌 ᛰឤ䠙㻝㻟㻚㻢䠂䚸㣗ᛮ䠙㻞㻡㻚㻣䠂㻌 㻌 㻌 㻌 ᝏᚰ䞉ྤ䠙㻢㻚㻤䠂䚸㻌 ཱྀῬ㻌 䠙㻝㻜㻚㻞䠂㻌 㻌 㻌 㻌 ౽⛎㻌 䠙㻝㻝㻚㻜䠂䚸྾ᅔ㞴䠙㻜㻚㻤䠂㻌 㻌 㻌 㻌 ╧╀㞀ᐖ䠙㻟㻢㻚䠎䠂㻌 䠄୰㏵ぬ㓰䛜᭱ከ䠅㻌 㻌
䐠㻌 㙠③⸆௨እ䛾䛂ᑐᛂ䛃㻌
㻌 㻌 㻌 ⏬ീ᳨ᰝ䛾㏣ຍ㻌 䠐㻌 㐃ᦠᐊ↷㻌 䠎㻌 㻌 㻌 㻌 ཱྀ⭍䜿䜰ᙉ㻌 䠍䠌㻌 㝖③䛾ᨺᑕ⥺㻌 䠐㻌
㻌 㻌㠀㝖③ᝈ⪅䛾③䜏௨እ䛾≧ゎᯒ㻌
1998ᖺ Cancer Pain Relief䛻⥆䛔䛶
③䜏௨እ䛾≧䛾䠳䠤䠫䜺䜲䝗䝷䜲䞁ฟ∧
䜰䝉䝇䝯䞁䝖䛷᭱ඃඛ䛥䜜䜛䜉䛝䛿㻌
ッ䛸᭱䛾ᠱᛕ䛾ྠᐃ䛷䛒䜛㻌
≧ᙉᗘ䛸ᛶ㉁㻌 䜢䝹䞊䝏䞁ホ౯㻌 㻌
䖃㻌 ⏕άᙳ㡪㻌 䖃㻌 䠝䠠䠨㞀ᐖ㻌
≧䝖䝸䜰䞊䝆䛾䛂㡯┠䠄ෆᐜ䠅䛃䛿ఱ䛜ጇᙜ䠛㻌 䋻㒊䜢ẖ᪥㻌 ⧞䜚㏉䛧⪺䛝ྲྀ䜛䠛㻌
᭱⤊ᮇᴗ⦼ணᐃ䐡㻌 㻌
㻌 ⑊③䜢ྵ䜐≧䝖䝸䜰䞊䝆䚸㼃㼑㼎㆟᥎ዡ䛻䜘䜛ᨵၿ䠖㻌 ከタ◊✲㻌 㻙㻻㼚㼑㻌㼛㼒㻌㼠㼔㼑㻌㼁㼘㼠㼕㼙㼍㼠㼑㻌㻼㼡㼞㼜㼛㼟㼑㼟㻌㼕㼚㻌㻿㻼㻭㻾㻯㻿㻌
Ჷ䠪䠯䛾䝇䜽䝸䞊䝙䞁䜾䛷㻌 ᚰ㌟䛾㞀ᐖ䛜≧䛷㉳䛝䛶䛔 䜛䠬䡐㻌 㻔㼕㼚㻌㼠㼔㼑㻌㻵㼙㼜㼍㼕㼞㼑㼐㻌㻸㼕㼒㼑㻕䛾ᝈ⪅⩌䜢㐃᪥䜴䜸䝑䝏䛩䜛㻌 䋻ᙉᗘ≧㻌㼛㼞㻌୰➼ᗘ䛜㻟᪥௨ୖᣢ⥆䜢ᑓᚑ䠪䡏䛜㻌 㻌 䛂≧䝖䝸䜰䞊䝆䛃䛧䛶䠍ḟᑐᛂ㻌
㻌 䝏䞊䝮䠪䡏ᑟ䚸䜸䞊䝥䞁ሗ䛷་䛸ᨵၿ᳨ウ㻌 㻌
䋻་䛾ᕼᮃ䛷䚸┤᥋䜎䛯䛿䠎ḟᑐᛂ䛸䛧䛶㻌
㻌 㻌 እ㒊ᑓ㛛ᐙ䛸䝏䞊䝮䛾䠰䠲㆟䛷་䜈㻲㼑㼑㼐㼎㼍㼏㼗㻌 㻌
䋻䝥䝻䝉䝇䛸䜰䜴䝖䜹䝮ホ౯䜢㻭㼡㼐㼕㼠䛧䛶ᡂ⦼䝺䝫䞊䝖㻌
᭱⤊ᮇᴗ⦼ணᐃ䐠㻌 㻌
㻌 䜸䝢䜸䜲䝗䝺䝡䝳䞊䠄䠯䠟䠫䠬䠡䠅㻌
Rationale 䠄◊✲䛾ᚲせᛶ䠅
㻌 䛛䛳䛶䛿Ḣ⡿䛷䜒㝖③⒪䛾᭱䝞䝸䜰䛿䚸་ᖌ䛾䜰䜽䝅䝵䞁䛷䛒䜛䛸䛥䜜䠄Von Roenn䚸1993䠅䚸᪥ᮏ䜢㝖䛟䜰䝆䜰䛷䜒ྠᵝ䛾▱ぢ䛜ሗ࿌䛥䜜䛶䛔䜛䚹
᪥ᮏ䛷䛾䠬䠟䠰ඛ⾜◊✲䠄䠝䠨䠬䠤䠝㻌2014䠅䛷䚸䛿་ᖌฎ᪉䚸≉䛻䜸䝢䜸䜲䝗䛷䛒䜛ྍ
⬟ᛶ䛜♧၀䛥䜜䛯䛜䚸㠀䝁䞁䝃䝹䝔䞊䝅䝵䞁䛾ฎ᪉䜢䠳䠤䠫䜺䜲䝗䝷䜲䞁㑂Ᏺ䛸䛔 䛖どⅬ䛷䝃䞊䝧䜲䛧䚸᥎ዡෆᐜ䛸䜰䜴䝖䜹䝮䜢ゎᯒ䛩䜛䛣䛸䛿ᅜෆᡂ⦼ᨵၿ䛻᭷⏝䚹 ᝈ⪅䛸᪉ἲ䐟
㻌 䠎䠌䠍䠏ᖺ䛛䜙䛾䠎ᖺ䠝䡑䡀䡅䡐䚸୰ி㝔䛷䝥䝻䝉䝇ホ౯䛸䜰䜴䝖䜹䝮ホ౯䠄ከ⫋✀
㻌 ྜ㆟䠅䚸Default Data 䠄2㻌months 㽢䠎䠅䚸ィ⏬᭩ᥦฟ䛧䠥䠮䠞ㄆྍ䛒䜚㻌
⤖ᯝ䐟
㻌 䠳䠤䠫䠑ཎ๎䛾ฎ᪉䝞䝸䜰䛜䚸㠀䝁䞁䝃䝹䝖䛷䜒䜋䜌ྠᵝ䛷䚸᥎ዡཷㅙ䛻䜘䜛 㻌 䜰䜴䝖䜹䝮ᨵၿ䛜☜ㄆ䛷䛝䛯䚹㻌э㻌 䠝䠦䠤䠬䠩䜈ᢞ✏䠛
ᝈ⪅䛸᪉ἲ䐠
㻌 㐣ཤ䠑ᖺ䛾ᅜෆከタ䜸䝢䜸䜲䝗䝺䝡䝳䞊ሗ࿌䛾ᡂຌᅉᏊ䛸ኻᩋᅉᏊ䜢᥈⣴䛩䜛 㻌 䜰䞁䜿䞊䝖◊✲㻌 䠄ኻᩋ୰Ṇタ4䚸ᡂຌሗ࿌9䠅㻌
㻌э㻌 䛜䜣䛸Ꮫ⒪ἲ䛻ᢞ✏䠛
ၘỚở˂ỉၐཞỉẶẟỂẆỂẨễẟʙởẾềẟỦʙ ửᴾ ၏ჃᜱࠖầଐấݮỈẲộẴẇᴾ ႸႎỊᴾ ếỤẟၐཞử᠉ẪẴỦၲửእଔẪ੩̓ẴỦẺỜỂẴᴾ
ྤ䛝Ẽ䜔౽⛎
䛚ཱྀ䛾䝖䝷䝤䝹䛷 㣗䜉䜜䛺䛔
㌟య䛜䛰䜛䛔
ᜥⱞ䛧䛔㻌 䝉䜻䛜⥆䛟
③䜏௨እ䛾≧䛻䛴䛔䛶䛾⪺䛝ྲྀ䜚䠄䝥䝷䞁䠟䠅
䝫䜲䞁䝖䠖㻌
䐟㻌 ᇶᮏ䝁䞁䝉䝥䝖䠄ᝈ⪅䛾⏕άどⅬ䛷⒪┠ᶆタᐃ䠅䜢
⑊③䛸≧䛷⤫୍䛩䜛
䐠㻌 ୍␒ᅔ䛳䛶䛔䜛≧䠄ッ䚸᭱㛵ᚰ䠅䜢ᝈ⪅⮬㌟
㻌 㻌 㻌 䛜䝸䝇䝖䛛ᅗ⾲䛛䜙㑅ᢥ
䐡㻌 ③䜏௨እ䛾≧䜢䛂⣔⤫ⓗ䛻䛃䛂⏕άどⅬ䛷䛃 㻌 㻌 㑅䜆䝸䝇䝖䜢ᝈ⪅䛻ᥦ♧эヰ䛧ྜ䛔䝒䞊䝹䛷䜒䛒䜛 㻌 㻌 䚸㻌 ᄟୗ䞉㣗䞉ἥ;㻌 ᐷ䜜䛺䛔ヰ䜔ㄞ᭩⬟
㻌 㻌 㻌 䠄ྤ䛝Ẽ㻌 ⱞ䛧䛥䚸䝉䜻䚸䛚䛺䛛䛾䛿䜚䠅 㻌 㻌
③䜏௨እ䛾≧䜢䝸䝇䝖䛩䜛᪉ἲ㻌 䐠㻌
③䜏௨እ䛾≧䜢䝸䝇䝖䛩䜛᪉ἲ㻌 䐟㻌
≧䝖䝸䜰䞊䝆䛾䛂ඃඛ㡰䛃䜢䛹䛖䛩䜛䠛㻌 䋻≧䛾ᩘ䠛ᮇ㛫䠛ᙉ䛥䠛㻌
③
③
ྤ
ᛰ
ྤ
ⱞ
ᛰ ᛰᝎ
ᝎཱྀ
ཱྀ䠄 Fechner’s law 䠅 䠪䠮䠯
่⃭ධຊ 䛾ᙉ䛥 Screening 㻌 䠄䠰䡎䡅䠽䡃䡁䠅䛾⥙
䜢㏻䛩䜉䛝䛷䛺䛔䛾䛿䛹䛳䛱䠛
㣗ḧ㻌21.9% referral㻌 䠄84 nd䠅 3.2% referral Total Limited in Severe
╀㻌9.5% ref 㻌 䠄 80 㻌31䠅 0.0% referral
Ᏻ䞉↔⇱㻌5.1% ref 0.4% referral
⑊③㻌86.8% referral㻌 䠄90 92䠅 32.6% referral 㻌 1271 referrals (700 cases) to Chukyo PCT㻌 䠄䛴䛵䛝䠅
౽⛎㻌 30.1㻌 㻌(19㻌 27)㻌 % referral
ධ㝔䛜䜣ᝈ⪅䛾Severe Symptom Prevalence䛿䠛
୰ி ᳃⏣ Radbrach
㻲㼞㼛㼚㼠㼘㼕㼚㼑㻌㻿㼠㼡㼒㼒㻌䠄ㄆᐃ䠪䡏䠅ᑟ䝖䝸䜰䞊䝆㻌 䠙䜰䝅䝇䝖䛩䜛ᢏ⾡䛸ᑐᛂሗ䜢ᥦ౪䛩䜉䛝㻌
䝇䜽䝸䞊䝙䞁䜾䛛䜙䝖䝸䜰䞊䝆◊✲䛿䚸䜹䝘䝎䜔䜸䞊䝇䝖䝷䝸䜰㻌 䛜ඛ⾜䛧䛶䛔䜛䠙䝰䝕䝹䛸䛧䛶ᚋά⏝䛧䛯䛔㻌
㻌
䝇䜽䝸䞊䝙䞁䜾䝥䝻䜾䝷䝮䜢ᥦ౪䛩䜛䝣䝻䞁䝖䝷䜲䞁䞉䝇䝍䝑䝣䜈䛾㻌 カ⦎䛜ᚲ㡲䛷䛒䜛㻌
Training frontline staff to deliver screening programs is crucial, Carlson LE. J Clin Oncol 2012
≧䝖䝸䜰䞊䝆䜢ᡂຌ䛥䛫䚸᰿䛛䛫䜛䛯䜑䛻 䠖㻌 䛂㏱᫂ᛶ㻌Transparency䛃䜢䛸䛔䛖ᇶᮏ䝁䞁䝉䝥䝖 ᚲ㡲㡯┠䠖㻌
䕕㻌 㝔⟶⌮⪅䞉┳ㆤᒁ䞉⒪་䛾ពᛮỴᐃ⪅䞉㆟䛾 ᢎㅙ䛸䜰䝅䝇䝖䛸䜚䛴䛡---≉䛻ᑓᚑ䠪䡏䜈䛾⿵ൾ 䕕㻌 ་ᖌ䞉┳ㆤᖌ䜈䛾䠢䠝䠭సᡂ
䕕㻌 ᝈ⪅ᐙ᪘䛻䜒䚸ᐇ䛥䜜䛶䛔䜛䜰䜽䝅䝵䞁䜢ゎㄝ 䕕㻌 ⒪᪉㔪䜢་⒪⪅య䛻බ㛤䛩䜛䠄䠝䠨䠬䠤䠝᪥ᮏㄒ
≧䛾䜰䝹䝂䝸䝈䝮䠅
䕕㻌 ᐃᮇⓗ䛻⒪ᡂ⦼䜢་⒪⪅䛻බ㛤䛩䜛
䕕㻌 ᭱๓⥺䛛䛴᭱᪂䛾䚸་⒪ሗ䜢ᑓᚑ䠪䠯䛻ᥦ౪䛩䜛 䝅䝇䝔䝮---䠳䡁䠾䝉䝭䝘䞊䚸䝬䝙䝳䜰䝹㓄ᕸ䛺䛹㻌 㻌
㻲㼞㼛㼚㼠㼘㼕㼚㼑㻌㻿㼠㼡㼒㼒㻌䠄ㄆᐃ䠪䡏䠅ᑟ䝖䝸䜰䞊䝆㻌 䠙䜰䝅䝇䝖䛩䜛ᢏ⾡䛸ᑐᛂሗ䜢ᥦ౪䛩䜉䛝㻌
䝇䜽䝸䞊䝙䞁䜾䛛䜙䝖䝸䜰䞊䝆◊✲䛿䚸䜹䝘䝎䜔䜸䞊䝇䝖䝷䝸䜰㻌 䛜ඛ⾜䛧䛶䛔䜛䠙䝰䝕䝹䛸䛧䛶ᚋά⏝䛧䛯䛔㻌
㻌
䝇䜽䝸䞊䝙䞁䜾䝥䝻䜾䝷䝮䜢ᥦ౪䛩䜛䝣䝻䞁䝖䝷䜲䞁䞉䝇䝍䝑䝣䜈䛾㻌 カ⦎䛜ᚲ㡲䛷䛒䜛㻌
Training frontline staff to deliver screening programs is crucial, Carlson LE. J Clin Oncol 2012
≧䝖䝸䜰䞊䝆䜢ᡂຌ䛥䛫䚸᰿䛛䛫䜛䛯䜑䛻 䠖㻌 䛂㏱᫂ᛶ㻌Transparency䛃䜢䛸䛔䛖ᇶᮏ䝁䞁䝉䝥䝖 ᚲ㡲㡯┠䠖㻌
䕕㻌 㝔⟶⌮⪅䞉┳ㆤᒁ䞉⒪་䛾ពᛮỴᐃ⪅䞉㆟䛾 ᢎㅙ䛸䜰䝅䝇䝖䛸䜚䛴䛡---≉䛻ᑓᚑ䠪䡏䜈䛾⿵ൾ 䕕㻌 ་ᖌ䞉┳ㆤᖌ䜈䛾䠢䠝䠭సᡂ
䕕㻌 ᝈ⪅ᐙ᪘䛻䜒䚸ᐇ䛥䜜䛶䛔䜛䜰䜽䝅䝵䞁䜢ゎㄝ 䕕㻌 ⒪᪉㔪䜢་⒪⪅య䛻බ㛤䛩䜛䠄䠝䠨䠬䠤䠝᪥ᮏㄒ
≧䛾䜰䝹䝂䝸䝈䝮䠅
䕕㻌 ᐃᮇⓗ䛻⒪ᡂ⦼䜢་⒪⪅䛻බ㛤䛩䜛
䕕㻌 ᭱๓⥺䛛䛴᭱᪂䛾䚸་⒪ሗ䜢ᑓᚑ䠪䠯䛻ᥦ౪䛩䜛 䝅䝇䝔䝮---䠳䡁䠾䝉䝭䝘䞊䚸䝬䝙䝳䜰䝹㓄ᕸ䛺䛹㻌 㻌
䝔䝺䝡㆟䛷䛾⸆≀⒪ἲᨭ䙷
䠄ᚲせ䛻䛺䛳䛯⸆Ꮫⓗ▱㆑䠖㻌 䜸䝢䜸䜲䝗䠅 1.䜸䝢䜸䜲䝗䝇䜲䝑䝏䞁䜾᪉ἲ䚸ຊ౯⟬
2.䜸䝢䜸䜲䝗䝍䜲䝖䝺䞊䝅䝵䞁
3.䝺䝇䜻䝳䞊⸆䛻䛴䛔䛶䠄ຠᯝุᐃ䚸タᐃ᪉ἲ䠅 4.⸆≀䛾యෆືែ䛾▱㆑
5.⸆≀䛾〇Ꮫⓗ䛺▱㆑
6.స⏝㛵㐃㡯䛸ᑐ⟇䛻㛵䛩䜛▱㆑
㻌 䠄╀Ẽ䚸䛫䜣ዶ䚸ᝏᚰ䞉ྤ䚸౽⛎䠅
5
䝔䝺䝡㆟䛷䛾⸆≀⒪ἲᨭ䐠 䠄ከ䛛䛳䛯㡯┠㡰䠅
1.ຠᯝ
䠄䜸䝢䜸䜲䝗䚸䝺䝇䜻䝳䞊⸆䚸㠀䜸䝢䜸䜲䝗㙠③⸆䚸䜸䜽䝖䝺䜸䝏䝗䚸 㙠③⿵ຓ⸆㻌 ➼䠅
2.స⏝
䠄䜸䝢䜸䜲䝗䚸㠀䜸䝢䜸䜲䝗㙠③⸆䚸ᢠ䛜䜣䚸㙠③⿵ຓ⸆䠅 3.స⏝ᑐ⟇
䠄౽⛎䚸ᝏᚰ䞉ྤ䚸㠀䜸䝢䜸䜲䝗䠅
4.᭹⸆䜰䝗䝠䜰䝷䞁䝇䚸⸆≀┦స⏝䚸㓄ྜኚ
4
䝔䝺䝡㆟䛷䛾⸆≀⒪ἲᨭ䐟
ᖹᡂ 28 ᖺ 1 ᭶䡚 4 ᭶䛾 4 䛛᭶䠄 15 ᅇ㻌 䛾䜉 48 ௳䠅
⸆ᖌ䛾どⅬ䛛䜙䛾⸆≀⒪䜈䛾ពぢ
䠄ከ䛛䛳䛯⸆㡰䠅1.䜸䝢䜸䜲䝗㛵㐃
䠄䝍䝨䞁䝍䝗䞊䝹䚸䜸䜻䝅䝁䝗䞁䚸䝣䜵䞁䝍䝙䝹䚸䝰䝹䝠䝛➼䠅 2.㠀䜸䝢䜸䜲䝗㛵㐃
䠄䝻䝢䜸䞁ὀ䚸䝆䜽䝻䝣䜵䝘䜽ᆘ䚸䝉䝺䝁䝑䜽䝇㻌 ➼䠅
3.㙠③⿵ຓ⸆㛵㐃䠄䝥䝺䜺䝞䝸䞁䚸䝸䝗䜹䜲䞁䚸䜿䝍䝭䞁➼䠅 4.䛭䛾
䠄ᢠ䛜䜣䚸䜸䜽䝖䝺䜸䝏䝗䚸䜿䝍䝭䞁䚸ୗ䚸ไྤ䚸₎᪉㻌 ➼䠅
3
䝔䝺䝡㆟䛾䠬䠟⏬㠃䠄䠖㛗ᓮ䛷䛾⏬㠃䠅
2 㟁Ꮚ䜹䝹䝔⏬㠃
䠄㟷᳃┴❧୰ኸ㝔䠅
䝏䝱䝑䝖䠖䜹䞁䝣䜯䝷䞁䝇グ㘓 䕿䕿䕿䕿 䕿䕿䕿䕿䕿䕿䕿䕿 㻌 㻌 㻌 㻌 䕿䕿䕿䕿
ྜྷᮏඛ⏕䠄ྡྂᒇ䠅
⦆㻌 ᑓ㛛་
㱟㻌 䠄㛗ᓮ䠅
⦆⸆≀⒪ἲㄆᐃ
⸆ᖌ
1
㻌 ᥎ዡ䠖䕿䕿䕿䕿䕿䕿䕿䕿䕿䕿䕿䕿
2
㻌 ᥎ዡ䠖䕿䕿䕿䕿䕿䕿䕿䕿䕿䕿䕿䕿
䝔䝺䝡㆟㻌 㻌 㟷᳃䞊ྡྂᒇ䞊㛗ᓮ
䞉ᖹᡂ 27 ᖺᗘ䜘䜚⦆⸆≀⒪ἲㄆᐃ⸆ᖌ䛸䛧 䛶⣙ 40 ᅇ䛾䝔䝺䝡㆟䛻ཧຍ䛧䛯
䞉ᖹᡂ 28 ᖺ 1 ᭶䛛䜙 4 ᭶䜎䛷䛾 4 䛛᭶㛫 㻌 15 ᅇ䛾䝔䝺䝡㆟䛷䚸䛾䜉 48 ௳
㻌 䠄䜚㏉䜚୍㒊ྵ䜐䠅䛾᳨ウ䜢⾜䛳䛯䚹
1
⦆⸆≀⒪ἲㄆᐃ⸆ᖌ䛻䜘䜛 䝔䝺䝡㆟䜢㏻䛨䛯⸆≀⒪ἲᨭ㻌
㛗ᓮᏛ㝔㻌 㻌
⸆㒊㻌 䞉㻌 ⦆䜿䜰䝏䞊䝮㻌 㱟㻌 ᜨ⨾㻌 㻌 㻌 㻌
㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌 䝮
㻌㻌㻌㻌㻌㻌㻌㻌㻌 ᖹᡂ㻞㻤ᖺᗘཌ⏕ປാ┬⛉Ꮫ◊✲㻌 䛜䜣ᑐ⟇᥎㐍⥲ྜ◊✲ᴗ㻌
➨୍ᅇⓗሙ⌜㆟㻌 㻞㻜㻝㻢㻚㻡㻚㻞㻜㻌 㻌 㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌㻌
䝔䝺䝡㆟䛷䛾⸆≀⒪ἲᨭ䐢 䠄䛭䛾䛾ලయ䠅
䞉䠬䠟䠝䛻䛴䛔䛶㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 䞉䜸䜻䝅䝁䞁䝏䞁䛾䝂䞊䝇䝖䝢䝹 䞉䜸䝢䜸䜲䝗䛾ᆒ➼ᢞ㻌 㻌 㻌 㻌 㻌 䞉䜲䝺䜴䝇䛻ᑐ䛩䜛⸆≀⒪ἲ 䞉ᨺᑕ⥺㣗㐨⅖䛾③䜏䛾⸆≀⒪ἲ 䞉྾ᅔ㞴ឤ䛾⸆≀⒪ἲ 䞉䝰䝹䝠䝛䛻䜘䜛③ぬ㐣ᩄ 䞉᳨ᰝ䛾㙠③䚸㙠㟼㻌 䞉Ꮫ⒪ἲ䛾స⏝䠄⿵ຓ⒪ἲྵ䜐䠅
䞉ᒁ㯞䛾᭷⏝䛺⏝᪉ἲ䠄䝸䝗䜹䜲䞁〇䛾䛔ศ䛡䠅 䞉ᑠ⭠ษ㝖䛷䛾྾Ⰻ䛜༴䛥䜜䜛ሙྜ䛾⸆≀⒪ἲ 䞉䝉䝺䝛䞊䝇ὀ䛾ᢞ᪉ἲ䛻䛴䛔䛶
䞉⫈ぬ㞀ᐖ⪅䛾᭹⸆䜰䝗䝠䜰䝷䞁䝇䜢ྥୖ䛥䛫䜛䛻䛿 䞉ෆ᭹ྍ䛾㙠③⿵ຓ⸆
䞉╀Ẽ䜢㉳䛣䛩⸆≀䛸㐠㌿
䞉౽⛎䛻ᑐ䛧䛶䛾䝃䜲䝖䝔䝑䜽䞉䜶䝸䝇䝻䝬䜲䝅䞁䛾⏝
6