An effective quarantine measure reduced the total incidence of influenza A H1N1 in the workplace: another way to control the H1N1 flu pandemic.

OBJECTIVES: To evaluate the effectiveness of a non-vaccine quarantine measure against pandemic influenza A H1N1 in workplaces. METHODS: Design was quasi-cluster randomized controlled trial in two sibling companies (Cohort 1 n=6,634, Cohort 2 n=8,500). The follow-up period was from July 1st, 2009 to February 19th, 2010 (233 days). Intervention was voluntary waiting at home on full pay if the family became Influenza like Illness (ILI). The incidences of influenza A H1N1 and those of the subgroups whose families got ILI in both cohorts were compared by a Cox regression model and log-rank test. RESULTS: There were 189 and 270 workers who got H1N1 infection during the follow-up period in each cohort. In this period 317 workers in Cohort 1 were asked to wait at home for several days (100% obeyed). The intervention group (Cohort 1) showed a statistically significant lower risk (p for log-rank test=0.033) compared with the control (Cohort 2), and the hazard ratio of the intervention was 0.799 [0.658-0.970] after adjusting for age, sex, BMI and smoking status. The workers who were asked to wait at home showed H1N1 infection more frequently (49 out of 317) compared with the workers whose family got ILI but were not asked to wait and work regularly (77 out of 990, RR=2.17 [1.48-3.18]). CONCLUSIONS: The waiting on full pay policy in the workplace reduced the overall risk of influenza A H1N1 by about 20% in one flu season in Japan. This kind of non-vaccine measure will be a promising option in workplaces to control the next flu pandemic.

Change of components of the metabolic syndrome in a workers' health checkup after five years--relation with elevated liver enzymes, gene polymorphisms for ALDH 2, beta3-AR and lifestyle.

We previously reported that the prevalence of elevated alanine aminotransferase (ALT) increases with accumulation of metabolic syndrome components, and a greater degree of involvement of aldehyde dehydrogenase 2 (ALDH2) than beta3-adrenergic receptor gene (beta3-AR) polymorphisms. The present study was designed to clarify the effect of aging, lifestyle and the two gene polymorphisms on the relationship between 4 components of the metabolic syndrome (obesity, hypertension, dyslipidemia and impaired glucose tolerance) and elevated ALT values in a subset of 73 out of 148 male workers who were 35 years of age in the baseline study and 40 years old in the present study. Study subjects completed questionnaires about drinking and smoking habits, and underwent urinalysis, physical examination and peripheral blood tests, blood chemistry, electrocardiogram and chest X-rays each year as required by Japanese law. Information from the questionnaires and physical examinations, including liver function tests, were compared with previously reported ALDH2 and beta3-AR genotypes for the 73 workers. Of the 73 workers studied, 14 (19%) demonstrated decrease in metabolic syndrome components, 39 (53%) demonstrated no change, and 20 (27%) demonstrated an increase. Ten workers (14%) showed liver dysfunction at age 35 and 20 workers (27%) at age 40. Fourteen workers were newly diagnosed as having liver dysfunction at their 40-year checkup, thus being associated with the BMI and an active ALDH2 genotype. Accumulation of components of the metabolic syndrome were associated with the presence of liver dysfunction at 35 years. In conclusion, these findings indicate that ALDH2 genotyping as well as lifestyle habits may be important factors in causing metabolic syndrome with liver dysfunction.

Association of change in the type of job with prevalence of components of the metabolic syndrome-special reference to job stress.

OBJECTIVE: It is well established that job stress is a leading cause of cardiovascular disease. The relationship with the metabolic syndrome, however, has received only limited attention. The present study was designed to investigate associations between change of the type of job and the prevalence of metabolic syndrome components from the aspect of on-the-job stress and alteration in life style. METHODS: Thirty-six male workers of the manufacturing department were transferred to the carsales department at the same automobile company in 1992 to 1993. These same workers were transferred back to the manufacturing department after two years. We compared the first health-check data before the transfer in 1992 (Term A), a second set of data two years after transfer in 1994-95 (Term B) and a third set of data two years following transfer back to the manufacturing department in 1996-1998 (Term C). The workers were requested to provide information about drinking and smoking habits, and answer Karasek's questionnaire and a simple stress questionnaire in order to clarify the possibility of job stress in occurrence of the metabolic syndrome, defined in terms of obesity, hypertension, dyslipidemia, and impaired glucose tolerance as components. RESULTS: Five workers had two or more components of the metabolic syndrome before the transfer to the car-sales department (Group I). One demonstrated improvement, three no change, and one increase in symptoms from A to B. Seven workers had more than two components after the transfer to car-sales department (Group II), and six of them exhibited decrease two years following transfer back to the manufacturing department. Five of them also showed elevated liver enzymes in serum with the appearance of the components, and three of them demonstrated recover. Three workers had two components of the metabolic syndrome only at time point C (Group III), while the remaining 21 workers had 0 to one component throughout the observation period (Group IV). Amount of drinking and smoking increased significantly when working in the sales department but these items returned to the previous values after rejoining manufacturing, though differences were not observed between workers with (Group II) and without (Group IV) components of the metabolic syndrome. Body mass index (BMI) and alanine aminotransferase (ALT) increased significantly when workers moved to the sales department and that was significant in Group II as compared to Group IV. Three components of Karasek's JCQ changed significantly during job transfer, though differences were not observed between the workers with (Group II) and without (Group IV) components of the metabolic syndrome. Logistic regression analysis with age, lifestyle, Karasek's JCQ, and ALT revealed that elevation of ALT value was associated with having two or more components of metabolic syndrome, while hours of sleep demonstrated an inverse association. CONCLUSION: Elevated ALT and reduction of sleep hours may be associated with development of the metabolic syndrome in workers who change their type of job.

Aldehyde dehydrogenase 2 and beta3-adrenergic receptor gene polymorphisms: their association with elevated liver enzymes and metabolic syndrome.

Recent studies indicate that some patients with nonalcoholic fatty liver have ongoing liver injury that may progress from steatosis to steatohepatitis or fibrosis. The present study was designed to clarify the clinical features of liver dysfunction observed in the course of workplace physical check-ups in relation to multiple risk factor syndrome including obesity, hyperlipidemia, hypertension, and impaired glucose tolerance, and to clarify the involvement of aldehyde dehydrogenase 2 (ALDH2) and beta(3)-adrenergic receptor (beta3-AR) gene polymorphisms in elevation of liver enzymes. One hundred forty-eight male workers 35 years of age were enrolled. They were requested to answer questionnaires about drinking and smoking habits, and underwent urinalysis, physical and peripheral blood examinations, blood chemistry, electrocardiogram and chest x-rays. The genotypes of ALDH2 and beta3-AR were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The subjects were divided into active ALDH2 or inactive ALDH2 groups. They were also divided into 2 groups according to the beta3-AR genotype. The relationships between ALDH2 and beta3-AR gene polymorphism and the results of the physical examination including liver function tests were analyzed. The subjects were also divided according to the number of components of metabolic syndrome. The prevalence of elevated alanine aminotransferase (ALT) level increased with the accumulation of components of metabolic syndrome. Active ALDH2 was associated with elevated ALT level to a greater degree than beta3-AR polymorphism. Among those with normal body mass index (BMI), the genotypes of ALDH2 and beta3-AR were strongly associated with elevated ALT level. Logistic regression analysis revealed that BMI, triglyceride level, and ALDH2 genotype were associated with ALT elevation. In conclusion, evaluating the genotype of ALDH2 and beta3-AR may assist in predicting and preventing the development of fatty liver which may be related to multiple risk factor syndrome.