Quality of Life in Hand Eczema Questionnaire: Validation of the Japanese version of a disease-specific measure of quality of life for hand eczema patients.

Hand eczema (HE) is a common skin disease that impairs health-related quality of life (HRQOL). Impairments in HRQOL have already been reported in Japanese HE patients using the Skindex-16. Recently, an instrument to measure disease-specific HRQOL in HE patients was developed by an international expert group, consisting of domains for: (i) symptoms; (ii) emotions; (iii) functioning; and (iv) treatment and prevention. The objective of this study is to translate the English-language version of the Quality of Life Hand Eczema Questionnaire (QOLHEQ) to Japanese and then to validate the Japanese version. The Japanese version of the QOLHEQ, the Dermatological Life Quality Index (DLQI) and a questionnaire regarding basic demographic information, including patient ratings of HE severity, were distributed to Japanese HE patients. Additionally, a dermatologist evaluated patients' HE severity using the Physician Global Assessment. A total of 124 patients with a mean age of 43.7 years were included in the analysis, and 78% of the sample was female. Cronbach's alphas for the domains symptoms, emotions, functioning, and treatment and prevention were 0.76, 0.89, 0.88 and 0.81, respectively. The total QOLHEQ score showed a strong correlation with the DLQI, a moderate correlation with patient-rated severity and weak correlations with dermatologist-rated severity and the number of consultations. The Japanese version of the QOLHEQ showed excellent reliability and high validity. The Japanese version of the QOLHEQ is ready for use in epidemiological studies to evaluate HRQOL impairments in HE patients.

Cross-Cultural Validation of the Quality of Life in Hand Eczema Questionnaire (QOLHEQ).

The Quality of Life in Hand Eczema Questionnaire (QOLHEQ) is the only instrument assessing disease-specific health-related quality of life in patients with hand eczema. It is available in eight language versions. In this study we assessed if the items of different language versions of the QOLHEQ yield comparable values across countries. An international multicenter study was conducted with participating centers in Finland, Germany, Japan, The Netherlands, Sweden, and Turkey. Methods of item response theory were applied to each subscale to assess differential item functioning for items among countries. Overall, 662 hand eczema patients were recruited into the study. Single items were removed or split according to the item response theory model by country to resolve differential item functioning. After this adjustment, none of the four subscales of the QOLHEQ showed significant misfit to the item response theory model (P < 0.01), and a Person Separation Index of greater than 0.7 showed good internal consistency for each subscale. By adapting the scoring of the QOLHEQ using the methods of item response theory, it was possible to obtain QOLHEQ values that are comparable across countries. Cross-cultural variations in the interpretation of single items were resolved. The QOLHEQ is now ready to be used in international studies assessing the health-related quality of life impact of hand eczema.

Self-reported hand eczema among dental workers in Japan - a cross-sectional study.

BACKGROUND: Dental workers are considered to have a high risk of developing occupational hand eczema. OBJECTIVES: To estimate the prevalence of work-related hand eczema and associated risk factors in dental workers in Japan. METHODS: A self-administered questionnaire was sent by mail to all dental clinics of Kumamoto City, Japan. In addition, patch testing with 24 dentistry-related allergens was offered. RESULTS: In total, 46.4% of dental workers (n = 528: response 31.4%, based on 97 clinics) reported a lifetime history of chronic hand eczema. The 1-year prevalence was 36.2%. According to logistic regression analysis, the most important risk factors for the 1-year prevalence were a personal history of atopic dermatitis [odds ratio (OR) 4.7, 95% confidence interval (CI): 2.2-8.8], asthma and/or allergic rhinitis (OR 2.0, 95%CI: 1.3-3.0), dry skin (OR 1.7, 95%CI: 1.1-2.7), shorter duration of work (OR 2.0, 95%CI: 1.2-3.5 for up to 10 years versus >20 years), and washing hands >10 times per day (OR 1.6, 95%CI: 1.0-2.5). Fifty-four workers were patch tested. Rubber chemicals and acrylates were the most frequent occupationally relevant contact allergens. CONCLUSIONS: Dental workers in Japan have a high prevalence of hand eczema. Health education to prevent hand eczema and more frequent patch testing are needed.

Allergic contact dermatitis from two-component acrylic resin in a manicurist and a dental hygienist.

BACKGROUNDS: Two-component acrylic resin used in nail art and dentistry can cause allergic contact dermatitis (ACD), but only a few reports from Japan have been published. CASES: A 35-year-old female manicurist (case 1) and 30-year-old female dental hygienist (case 2) were diagnosed with ACD caused by ethyl methacrylate and methyl methacrylate in a liquid monomer of two-component acrylic resin respectively. Case 1 was sensitized from direct skin contact with nail art acrylic products, which could have been avoided, and gave up both being a manicurist and a user. Onset in case 2 occurred when she started to work as an apprentice. She had believed that the cause of her symptoms was use of disposable natural rubber gloves, not a liquid monomer penetrating through her gloves, until she was patch tested positive to (meth)acrylates and liquid monomer. CONCLUSIONS: To prevent sensitization, it should be emphasized in occupational training in both specialties that there should be no direct contact with acrylic products and that disposable gloves do not have sufficient protecting properties.

Relationship between lifestyle and lifestyle-related factors in a rural-urban population of Japan.

OBJECTIVE: To clarify the actual state of residents' lifestyle in a mixed rural-urban area in Japan, and to investigate the relationship between residents' lifestyle and lifestyle-related factors. METHODS: The Japanese version of Health Promoting Lifestyle Profile-II (HPLP-II), lifestyle-related factors developed through group work with residents of Town A, and demographic variables were used to evaluate 1176 community residents' lifestyles and associated factors. RESULTS: Factor analysis revealed that there were 4 factors related to healthy lifestyle. Nonparametric analysis revealed that female and elderly groups showed higher overall HPLP-II score than male and young groups. A significant correlation coefficient was seen between scores of overall HPLP-II and lifestyle-related factors (r = 0.611, p < 0.001). Multiple linear regression analysis demonstrated that HPLP-II was significantly associated with each lifestyle-related factor, showing a similar order in both gender and age groups. Finally, covariance structure analysis demonstrated that the score of health cognition and regional factors increased the score of HPLP-II, which then increased the score of self-rated health. CONCLUSIONS: The present research clarified the actual state of residents' lifestyles by age and gender in a mixed rural-urban area in Japan, demonstrating a vector model from health cognition and regional factors to self-rated health, via residents' lifestyle.

Assessment of health-promoting lifestyle profile in Japanese university students.

OBJECTIVES: This descriptive study of 314 students was conducted to determine whether there were any relationships of their demographic variables with a health-promoting lifestyle profile. METHODS: The Japanese version of the Health Promoting Lifestyle Profile II (HPLP-II) questionnaire was used to investigate students' lifestyles. One-way analysis of variance (ANOVA) and multiple comparison procedures using the Scheffe test were conducted to identify significant differences among university year (first, second, etc.) groups. The t-test independent participants was utilized to compare the HPLP-II scores according to gender and living with family (yes/no). Multiple regression analysis was used to analyze the effects of various demographics on the overall HPLP-II score and the six health-promoting lifestyle subscales. RESULTS: The whole cohort of participants had an overall HPLP-II mean score of 2.50 (SD = 0.29), with the highest mean score being for interpersonal relations (3.05 ± 0.44), and the lowest mean score being for health responsibility (2.01 ± 0.53). The overall HPLP-II score of the students during the first university year was 2.59 (SD = 0.29), and this score progressively declined in their second year (2.49 ± 0.29), third year (2.47 ± 0.28), and fourth year (2.45 ± 0.30). Female students practiced significantly better health responsibility, interpersonal relations, and nutrition than males, and male students practiced significantly better physical activity than females. The students who were living with family had significantly higher nutrition scores than those not living with family. CONCLUSIONS: These significant findings linking the HPLP-II, university year level, and living with family (yes/no) in university students will enable healthcare providers to develop interventions to assist students in improving their health lifestyles in the university environment and will help in devising suitable education programs.

A comparative study of health-promoting lifestyles in agricultural and non-agricultural workers in Japan.

OBJECTIVES: To clarify the difference in health-promoting lifestyles between agricultural and non-agricultural workers in Japan, a cross-sectional study was conducted on 627 residents living in a town with a mixed rural-urban population. METHODS: The subjects were divided into 8 groups by job (agricultural and non-agricultural), age (young and old), and gender (male and female). To evaluate the subjects' lifestyles, the Health Promoting Lifestyle Profile II (HPLP-II) was applied. The Bartlett test and the Kendall rank test were performed for statistical analysis. RESULTS: There was no significant difference in the overall score of the HPLP-II between the two job groups. However, for the HPLP-II subscales, a significantly higher score for "spiritual growth" and a significantly lower score for "physical activity" were seen in the agricultural group than in the non-agricultural group. In general, the old and female groups showed higher scores than the corresponding groups, regardless of job type. CONCLUSIONS: It was determined that the major countermeasures to maintain a healthy lifestyle in agricultural workers should be associated with how to introduce daily activities that maintain and enhance "spiritual growth" and improve "physical activity".

Policy framework for formulating environmental management strategy for sustainable development of tanneries in India.

OBJECTIVES: The leather industry is one of the main examples of industries which play an important role in the Indian economy in terms of exports and employment opportunities, while being blamed for environmental pollution. The objective of this study was to find the advances or improvements in the Japanese leather industry which are not found in typical leather industries in developing countries. We examined the Japanese leather industry in this context because Japan is a developed country in which tanning processes have been a traditional business from ancient times, and also the leather industry has played an important role in the process of economic development of Japan. METHODS: The study was based both on information collected from various areas related to the leather industry or leather industry stakeholders, and also on a review of published information. Information was collected through site visits, interviews, questionnaires, and detailed discussions with these stakeholders, as well as from their websites. RESULTS: The framework of a typical leather industry is discussed in three sections: pollution prevention, pollution control, and pollution mitigation related to sources, processes, and impact possibilities, respectively. Eleven basic differences were noted between the Japanese and Indian leather industries. The availability of melting centers is the main important feature of the Japanese leather sector. CONCLUSION: Guidelines are suggested which focus on some changes that are expected to lead to both environmental and economic benefits, with better pollution management, which should lead to continuous improvement of the environmental performance of the industry, and, finally, sustainable development.

Applying the social cognitive perspective to volunteer intention in China: the mediating roles of self-efficacy and motivation.

When predicting volunteer intention, much attention is paid to the volunteer organization environment (VOE). Given that self-efficacy and motivation have emerged as important predictors of volunteer intention, we adopted a combination of ideas of Bandura's social cognitive theory and Ajzen's theory of planned behavior integrating VOE, self-efficacy and motivation to examine their effects on volunteer intention and to determine whether self-efficacy and motivation mediate the relationship between VOE and volunteer intention. The subjects of this study consisted of 198 community health volunteers in Shanghai city, China. Exploratory factor analysis was performed to identify the factor structure using standard principal component analysis. Six new factors were revealed, including two VOE factors, relation with organization and support from government; two motivation factors, personal attitude and social recognition; self-efficacy and volunteer intention. The results of a hierarchical regression analysis indicated that relation with organization accounted for 14.8% of the variance in volunteer intention, and support from government failed to add significantly to variance in volunteer intention; self-efficacy and personal attitude motivation partially mediated the effects of relation with organization on volunteer intention; social recognition motivation did not mediate the relationship between relation with organization and volunteer intention; and relation with organization, self-efficacy and personal attitude motivation accounted for 33.7% of the variance in volunteer intention. These results provide support for self-efficacy and personal attitude motivation as mediators and provide preliminary insight into the potential mechanisms for predicting volunteer intention and improving volunteering by integrating VOE, self-efficacy and motivation factors.

Quality of life associated with perceived stigma and discrimination among the floating population in Shanghai, China: a qualitative study.

The floating population refers to the large and increasing number of migrants without local household registration status and has become a new demographic phenomenon in China. Most of these migrants move from the rural areas of the central and western parts of China to the eastern and coastal metropolitan areas in pursuit of a better life. The floating population of China was composed of 121 million people in 2000, and this number was expected to increase to 300 million by 2010. Quality of life (QOL) studies of the floating population could provide a critical starting point for recognizing the potential of regions, cities and local communities to improve QOL. This study explored the construct of QOL of the floating population in Shanghai, China. We conducted eight focus groups with 58 members of the floating population (24 males and 34 females) and then performed a qualitative thematic analysis of the interviews. The following five QOL domains were identified from the analysis: personal development, jobs and career, family life, social relationships and social security. The results indicated that stigma and discrimination permeate these life domains and influence the framing of life expectations. Proposals were made for reducing stigma and discrimination against the floating population to improve the QOL of this population.

[Skin sensitizers in cosmetics and skin care products].

Cosmetics are defined as "articles with mild action on the human body, which are intended to be applied to the human body through rubbing, sprinkling or other methods, aiming to clean, beautify and increase the attractiveness, alter the appearance or to keep the skin or hair in good condition (The Pharmaceutical Affairs Law: Article 2)." Consequently, they include personal hygiene products such as shampoos, soaps and toothpaste. In Europe, 1% of the population is estimated to be allergic to fragrances and 2-3% to ingredients of cosmetics; 10% of outpatients patch-tested for cosmetics allergy were found to be positive. Allergenic ingredients of cosmetics can be fragrances, hair dye, preservatives, antioxidants, emollients, surfactants, UV absorbers, pigments or resins used in nail cosmetics. Among standard allergen series, eight substances are related to cosmetics; in Japan in 2003, p-phenylenediamine (hair dyes) induced allergic reactions with the highest rate of 7.9% in outpatients patch-tested (n=805), followed by fragrance mix No. 1 (4.0%, mixture of eight fragrances frequently used), colophony (3.2%, main contents of pine resin), lanolin alcohol (2.7%,emollients), and formaldehyde, parabens, Kathon CG (2.7% ,1.9% and 1.0%, respectively; preservatives). Cosmetic allergy symptoms tend to be mild except those caused by hair dye. However, the population exposed to cosmetics is huge and the number of ingredients used in cosmetics increased up to more than 6000. Here, major cosmetic ingredient allergens, mainly reported in Japan, are reviewed and discussed.

Description of environmental determinants of quality of life in children with intellectual disability in Japan using the Delphi technique.

OBJECTIVES: The present study aimed to define the framework of an environment conducive to the well-being of children with intellectually disability (CID). METHODS: A questionnaire composed of 31 items was developed through literature review. Then a 2-round Delphi survey was conducted with 3 different panels: health professionals (HPs), parents of CID, and teachers. The participants were asked to rate each item, select and rank the 10 most important items, and suggest additional ones. RESULTS: A total of 71 participants responded to the first round: 24 HPs, 22 parents, and 25 teachers. In the second round the overall response rate was 83%. At the end of the exercise, 12 items reached global consensus, i.e., in all groups. Only 5 items were ranked as most important by all groups: attitudes of family members at home; attitudes of HPs and teachers; support from family members at home; support at school (classmates and teachers); and government policies. Nevertheless, the panelists' views diverged on the remaining items. Several additional elements were suggested. CONCLUSIONS: The views of HPs, teachers, and parents are complementary for the improvement of quality of life (QOL) of CID. The present findings will be used as a basis for the development of an instrument to assess the living environment of CID.

Development of an assessment sheet for fall prediction in stroke inpatients in convalescent rehabilitation wards in Japan.

OBJECTIVE: We conducted a study to develop an assessment sheet for fall prediction in stroke inpatients that is handy and reliable to help ward staff to devise a fall prevention strategy for each inpatient immediately upon admission. METHODS: The study consisted of three steps: (1) developing a data sampling form to record variables related to risk of falls in stroke inpatients and conducting a follow-up survey for stroke inpatients from their admission to discharge by using the form; (2) carrying out analyses of characteristics of the present subjects and selecting variables showing a high hazard ratio (HR) for falls using the Cox regression analysis; (3) developing an assessment sheet for fall prediction involving variables giving the integral coefficient for each variable in accordance with the HR determined in the second step. RESULTS AND DISCUSSION: (1) Subjects of the present survey were 704 inpatients from 17 hospitals including 270 fallers. (2) We selected seven variables as predictors of the first fall: central paralysis, history of previous falls, use of psychotropic medicines, visual impairment, urinary incontinence, mode of locomotion and cognitive impairment. (3) We made 960 trial models in combination with possible coefficients for each variable, and among them we finally selected the most suitable model giving coefficient number 1 to each variable except mode of locomotion, which was given 1 or 2. The area under the ROC curve of the selected model was 0.73, and sensitivity and specificity were 0.70 and 0.69, respectively (4/5 at the cut-off point). Scores calculated from the assessment sheets of the present subjects by adding coefficients of each variable showed normal distribution and a significantly higher mean score in fallers (4.94 +/- 1.29) than in non-fallers (3.65 +/- 1.58) (P = 0.001). The value of the Barthel Index as the index of ADL of each subject was indicated to be in proportion to the assessment score of each subject. CONCLUSION: We developed an assessment sheet for fall prediction in stroke inpatients that was shown to be available and valid to screen inpatients with risk of falls immediately upon admission.

Toxicity study of the volatile constituents of Myoga utilizing acute dermal irritation assays and the Guinea-pig Maximization test.

Myoga is a fragrant plant which is the special product of Japan and is cultivated throughout Japan. According to our earlier investigation (unpublished data) of myoga cultivators in Japan, 8 of 35 cultivators experienced contact dermatitis in the harvest season. The purpose of this study was to assess the allergenicity of myoga and its major volatile components. The volatile components of myoga were analyzed by gas chromatograph (GC). They included a-pinene, beta-pinene and R-(+)-limonene. We performed a toxicity study of each of the major fragrant components of myoga using acute dermal irritation assays and the Guinea-Pig Maximization test (GPMT) in order to probe the mechanism of allergic contact dermatitis. In acute dermal irritation assays, alpha-pinene, beta-pinene and limonene showed positive responses at concentrations of 4%; limonene oxide at 20% and myoga showed a positive response at concentrations of 100%. From the results of the GPMT, according to Kligman scores, limonene oxide was identified as an extreme skin sensitizer and myoga as a mild skin sensitizer. The results of the present study show that R-(+)-limonene is the most important allergen amongst the chemical components of myoga, and we consider it to be the reason why myoga cultivators experience allergic contact dermatitis.

Arsenic-contaminated water and extent of acute childhood malnutrition (wasting) in rural Bangladesh.

To investigate whether children's nutritional status, especially the extent of wasting [acute malnutrition as measured by weight-for-height Z (WHZ) score] is associated with arsenic contamination of drinking water, a survey was carried out in two discrete rural areas located less than 30 km southeast and northeast of Dhaka, the capital of Bangladesh. 761 children between 7 and 14 years of age were randomly selected, one child per household. The arsenic concentration in the tube well water used by each child and the prevalence and intensity of infection of three geo-helminths [Ascaris lumbricoides, Trichuris trichiura and hookworm (Ancylostoma duodenale or Necator americanus)] were determined. Each child had their height and weight measured and WHZ score determined using the World Health Organization (WHO) reference values. Basic socio-demographic data and knowledge of arsenic poisoning were collected using a questionnaire. 62.2% of the households studied were using well water with arsenic concentrations above the 0.01 mg/L WHO guideline (i.e. arsenic-contaminated households). The mean WHZ score of all the 761 children was -0.843 (sd 1.227) but children living in contaminated households were significantly more wasted than children living in noncontaminated households (mean difference = -0.361, p 0.001). When the effects of the differences in socio-economic status and prevalence of geo-helminths were also taken into account, the difference in means remained highly significant (-0.330, p = 0.006). This study suggests that arsenic contamination has a negative impact on children's acute nutritional status.

Occupational dermatoses among fibreglass-reinforced plastics factory workers.

Fibreglass-reinforced plastics (FRP) factory workers are at high risk of developing occupational dermatoses because of their exposure to many chemicals used in the manufacture of plastics as well as to glass fibre or dust. Patch tests were carried out on 29 workers involved in FRP manufacturing processes where unsaturated polyester (UP) resin was used, to investigate the causes of their skin problems. Of the 22 workers who reported experiencing skin problems, 16 showed positive results to at least 1 chemical, including 6 cases of multiple sensitivity. 2 showed positive reactions to UP base resin, 6 to cobalt chloride, 5 to benzoyl peroxide (BPO), 4 to methyl ethyl ketone peroxide (MEKPO), 2 to para-tertiary butyl catechol (PTBC), 1 to styrene and 1 to formaldehyde. After taking into account their exposures and reported causes by questionnaires and their patch test results, 7 cases were diagnosed as allergic contact dermatitis (ACD) due to chemicals, 3 as irritant contact dermatitis (ICD) due to chemicals, and 3 as dermatitis due to mechanical irritation (MI) from glass fibre or dust, as well as 9 as ACD and/or MI. 18 of the total of 29 subjects (62.1%), including 2 workers without a history of skin problems, were sensitized to at least 1 chemical. Cobalt, peroxides, PTBC and UP base resin were the common causes of ACD.

Skin problems among fiber-glass reinforced plastics factory workers in Japan.

Two surveys, one in winter the other in summer time, examined the skin problems of the entire manual workers (N=148) from 11 small-to-medium sized fiber-glass reinforced plastics (FRP) factories located in Kyushu, Japan. The workers were exposed to unsaturated polyester resin, including styrene and auxiliary agents such as cobalt naphthenate, hardeners such as methyl ethyl ketone peroxides, glass fiber and dust including shortened glass fiber and plastic particles. Eighty-seven workers (58.8%) reported having skin problems (mainly itching or dermatitis) since they started to work in FRP manufacturing and 25 workers had consulted a physician because of their skin problems; one worker was forced to take sick leave because of his severe dermatitis. History of allergic diseases and shorter occupational period (duration of employment) in a FRP factory were associated with greater probability of having a history of work-related skin symptoms. Workers in factories where dust-generating and lamination sites were located in different buildings were significantly less likely to have a history of skin problems than those in factories where the two sites were located in the same building. Of the 67 workers examined in both seasons closed to double the prevalence of dermatitis was found in summer (23.3%) than winter (13.4%).