Tsunami inundation after the Great East Japan Earthquake and mortality of affected communities.

OBJECTIVE: To examine the relationship between mortality rate and tsunami inundation after the Great East Japan Earthquake (GEJE) in 2011. STUDY DESIGN: Cross-sectional study. METHODS: One hundred and fifty-five town or village sections in Ishinomaki, Myagi Prefecture, were included in this study. Three areas in the city were classified by characteristic landforms: plains area (n = 114), ria coastal area (n = 27) and Kitakami riverside (n = 14). The correlation coefficient between tsunami inundation depth and mortality rate was calculated for each area, and the differences between the areas were examined. Furthermore, multivariate analyses adjusted for the characteristics of the sections were conducted using census data taken before the GEJE. RESULTS: An association was found between inundation depth and mortality rate for Ishinomaki as a whole (r = 0.65, P < 0.001), Kitakami riverside (r = 0.85, P < 0.001) and the plains area (r = 0.75, P < 0.001) in separate analyses. However, no association was detected between inundation depth and mortality rate for the ria coastal area (r = 0.14, P = 0.47). CONCLUSION: The ria coastal area has good accessibility to the hills and tight bonding between members of the community. These factors seemed to play crucial roles in the lower mortality rate in this area despite the deep inundation.

Driver exposure to particulate matter in Bangkok.

The aims of this study were to determine the particulate matter with aerodynamic diameters > or = 2.5 microm (PM2.5) and 2.5-10 microm (PM10-2.5) exposure levels of drivers and to analyze the proportion of elemental carbon (EC) and organic carbon (OC) in PM2.5 in Bangkok, Thailand. Four bus routes were selected. Measurements were conducted over 10 days in August (rainy season) 2008 and 8 days in January (dry season) 2009. The mean PM2.5 exposure level of the Tuk-tuk drivers was 86 microg/m3 in August and 198 microg/m3 in January. The mean for the non-air-conditioned bus drivers was 63 microg/m3 in August and 125 microg/m3 in January. The PM2.5 and PM10-2.5 exposure levels of the drivers in January were approximately twice as high as those in August. The proportion of total carbon (TC) in PM2.5 to the PM2.5 level in August (0.97 +/- 0.28 microg/m3) was higher than in January (0.65 +/- 0.13 microg/m3). The proportion of OC in the TC of the PM2.5 in August (0.51 +/- 0.08 microg/m3) was similar to that in January (0.65 +/- 0.07 microg/m3). The TC exposure by PM25 in January (81 +/- 30 microg/m3) remained higher than in August (56-21 microg/m3). The mean level of OC in the PM2.5 was 29 +/- 13 microg/m3 in August and 50 +/- 24 microg/m3 in January. In conclusion, the PM exposure level in Bangkok drivers was higher than that in the general environment, which was already high, and it varied with the seasons and vehicle type. This study also demonstrated that the major component of the PM was carbon, likely derived from vehicles.

Cancer mortality among Chinese chrysotile asbestos textile workers.

To determine mortality associated with exposure to chrysotile asbestos, a cohort of asbestos workers from an asbestos textile factory in China was followed prospectively from 1972 to 2008. A total 577 workers were successfully followed, achieving a follow-up rate of 98.5% over 37 years. Employment data and smoking information were obtained from factory and individual workers. Vital status was ascertained from factory personnel records and the municipal death registry. Workers were categorized into high, medium and low exposure groups in terms of their job titles and workshops. Follow-up generated 17,508 person-years, with 259 deaths from all causes, 96 all cancers and 53 lung cancers and 2 mesotheliomas. The highest cancer mortality was observed in the high exposure group, with 1.5-fold age-adjusted mortality from all cancers and 2-fold from lung cancer compared to the low exposure group. Age and smoking adjusted hazard ratio in the high exposure group was 2.99 (95%CI, 1.30, 6.91) for lung cancer and 2.04 (1.12, 3.71) for all cancers. Both smokers and nonsmokers at the high exposure level had a high death risk of lung cancer, with a clearer exposure-response trend seen in smokers. This study confirmed increased mortality from lung cancer and all cancers in asbestos workers, and the cancer mortality was associated with exposure level.

Relationship between body mass index and infertility in healthy male Japanese workers: a pilot study.

Our aim was to evaluate the relationship between men's body mass index (BMI) and infertility and to examine the effects of factors related to metabolic syndrome such as hypertension, dyslipidaemia, and impaired glucose tolerance. Our sample comprised 74 healthy Japanese workers at a company who were married between 2003 and 2005. The outcome variable was whether a baby was born during the study period (median follow-up period, 20 months; range, 8-42 months). Data for BMI and other factors were obtained from the results of an annual health checkup in the year of each employee's marriage. Forty-seven men (64%) did not father a baby. Having a baby was significantly associated with a low BMI (21.4 versus 23.2 kg m(-2); P = 0.006). A Cox proportional hazard regression model was performed to assess the association of BMI with fathering a baby. Adjusting for age, systolic and diastolic blood pressure, low density lipoprotein cholesterol, triglycerides, and haemoglobin A(1C), higher BMI was significantly associated with not fathering a baby (hazard ratio, 0.80; 95% confidence interval, 0.67-0.95; P = 0012). High BMI in men was independently associated with an increased risk of not siring a child.

Association of metabolic syndrome with depression and anxiety in Japanese men.

AIM: The evidence is conflicting as to whether or not metabolic syndrome (MetS) is associated with depression and anxiety. For this reason, we have investigated the association of MetS with depression and anxiety in Japanese men. METHODS: MetS was defined as in the new (2006) criteria of the International Diabetes Federation (IDF), and depression and anxiety were assessed using the Profile of mood states (POMS), in 1215 male Japanese workers. The relationship between MetS and these mental conditions was assessed by logistic-regression analysis after controlling for age, gender, obesity, medical history (cardiovascular disease and diabetes), lifestyle habits (smoking, alcohol consumption, exercise and sleep) and work situation. Trend analyses for a positive association between MetS components and depression and anxiety were also performed. RESULTS: A total of 148 (12.2%), 92 (7.6%) and 170 (14.0%) patients were diagnosed with MetS, depression and anxiety, respectively. MetS was significantly related to depression, and waist circumference contributed significantly to the relationship. Trend analysis of the number of positive MetS components and depression showed a positive trend that was of borderline significance (P(trend)=0.06). No relationship was found between MetS and anxiety. Trend analysis of the number of positive MetS components and anxiety failed to show a clear trend (P(trend)=0.57). CONCLUSION: A positive relationship was found between MetS and depression, but not between MetS and anxiety, in male Japanese workers. The specific factors comprising MetS, such as waist circumference, may be a reflection of the depression.

Finding order in heterogeneity: types of quality-improvement intervention publications.

BACKGROUND: Stakeholders in quality improvement agree on the need for augmenting and synthesising the scientific literature supporting it. The diversity of perspectives, approaches, and contexts critical to advancing quality improvement science, however, creates challenges. The paper explores the heterogeneity in clinical quality improvement intervention (QII) publications. METHODS: A preliminary classification framework was developed for QII articles, aiming for categories homogeneous enough to support coherent scientific discussion on QII reporting standards and facilitate systematic review. QII experts were asked to identify articles important to QII science. The framework was tested and revised by applying it to the article set. The final framework screened articles into (1) empirical literature on development and testing of QIIs; (2) QII stories, theories, and frameworks; (3) QII literature syntheses and meta-analyses; or (4) development and testing of QII-related tools. To achieve homogeneity, category (1) required division into (1a) development of QIIs; 1(b) history, documentation, or description of QIIs; or (1c) success, effectiveness or impact of QIIs. RESULTS: By discussing unique issues and established standards relevant to each category, QII stakeholders can advance QII practice and science, including the scope and conduct of systematic literature reviews.

Prescription of benzodiazepines and antidepressants to outpatients attending a Japanese university hospital.

OBJECTIVE: Excessive benzodiazepine use is a public health concern from clinical and economical perspectives. Although more benzodiazepines are prescribed in Japan than in any other country, no hospital-based report has documented this phenomenon. Therefore, this study compared the prescription frequency of benzodiazepines with that of selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and other antidepressants in a single Japanese hospital over 1 year. MATERIAL: The annual prescription of benzodiazepines was assessed with that of antidepressants using an electronic database of medical records for outpatients at a Japanese tertiary care hospital affiliated with a private university with approximately 600,000 outpatient visits annually. METHOD: Groups of departments were analyzed separately (i.e. internal medicine, surgery, neurology, psychiatry, and others). The ratio of the number of prescriptions of anxiolytic benzodiazepines to that of SSRI and SNRI was calculated among the department groups and used as one of indicators comparing the prescriptions of benzodiazepines with those of antidepressants. RESULTS: Of 644,444 hospital prescriptions, 6.1% were for anxiolytic benzodiazepines, and 5.8% were for hypnotic benzodiazepines. Regarding antidepressants, 1.6% of prescriptions were for SSRIs/SNRIs, 0.8% were for tricyclic antidepressants, and 1.5% were for other antidepressants. Of the benzodiazepine prescriptions, 26.8% were written by the internal medicine group. The ratio of the number of prescriptions for anxiolytic benzodiazepines to that for SSRI and SNRI was highest in the department of internal medicine (ratio = 13.0), followed by surgery (7.6), neurology (4.8), and psychiatry (2.5). With the department of psychiatry as the reference, the tendency to prescribe an anxiolytic benzodiazepine rather than an SSRI or SNRI was statistically significant in the remaining four department groups, after controlling for the effects of patient age and sex in a multiple logistic regression analysis. CONCLUSIONS: Benzodiazepine prescriptions in the Japanese hospital were far more common than prescriptions for antidepressants such as SSRIs and SNRIs, especially in internal medicine. Multi-institutional studies are needed to address this issue in Japanese hospitals, as well as in hospitals in other countries.

A comparative study of behavioural, physical and mental health status between term-limited and tenure-tracking employees in a population of Japanese male researchers.

OBJECTIVES: Traditional lifelong employment systems have been changing rapidly in Japan. The aim of this study was to assess the health impacts of term-limited employment systems that have recently been introduced into Japanese academic institutes. STUDY DESIGN: Cross-sectional. METHODS: A total of 514 male researchers (275 term limited and 239 tenure track) were compared in terms of behavioural, physical and mental status at annual health examinations. At these examinations, working hours and health-related lifestyles were examined using a self-completed questionnaire. Clinical structured interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were used to detect major depression. RESULTS: The term-limited researchers tended to work longer hours (P<0.001), drink alcohol more frequently (P<0.001) and eat breakfast less regularly (P<0.001) compared with the tenure-track researchers. Although the prevalence of DSM-IV major depression was comparable (P>0.05) between the two groups, fatigue was more prevalent (P=0.027) in the term-limited researchers than in the tenure-track researchers, adjusting for the effects of age. Compared with colleagues working in the same laboratories, the term-limited researchers worked longer hours, irrespective of fatigue, whereas only the fatigued tenure-track researchers worked longer hours. In the total sample, the fatigued researchers tended to belong to laboratories where their colleagues, on average, worked longer hours, compared with the non-fatigued researchers. CONCLUSIONS: These results imply that the term-limited researchers suffered more from fatigue, due to longer working hours, than their colleagues, and that organized, rather than personal, interventions with respect to the working environment may be effective in reducing overload in such workplaces.

Japanese spousal smoking study revisited: how a tobacco industry funded paper reached erroneous conclusions.

OBJECTIVES: To provide a participant's account of the development of a paper commissioned by the tobacco industry examining the reliability of self reported smoking status; to redress the distorted report of this Japanese spousal smoking study which evaluated the reliability and validity of self reported smoking status, and estimated confounding by diet and lifestyle factors. DESIGN: Repeated interviews on smoking status and its verification by environmental and biological markers for environmental tobacco smoke (ETS) exposure. SETTING: Urban wives in Osaka City and Sizuoka City, Japan PARTICIPANTS: Semi-random sampling of 200 wives in each city. From the Osaka subjects, 100 non-smoking wives were selected for the validity study. MAIN OUTCOME MEASURES: Kappa coefficient for reliability of self reported smoking status. Correlation coefficients between environmental nicotine concentration, cotinine in saliva and urine, and self reported smoking status. RESULTS: The kappa coefficient for the repeated interview was high suggesting sufficient reliability of the response. The proportion of self reported current smokers misclassified as non-smokers was equivalent to the misclassified self reported non-smokers. Ambient concentration of nicotine and personal exposure to nicotine correlated with each other and also with salivary cotinine and self reported ETS exposure but not with urinary cotinine/creatinine ratio (CCR). There was no major difference in diet and lifestyle related to husband's smoking status. CONCLUSION: Self reported smoking status by Japanese wives shows high reliability. It also shows high validity when verified by both nicotine exposure and salivary cotinine, but not by CCR. A previous report questioning the credibility of self reported smoking status, based on questionable CCR, could thus be of dubious validity. In addition, possible dietary and lifestyle confounding factors associated with smoking husbands were not demonstrable, a finding not reported previously. Using all the data from this project changes the conclusion of the previous published report. In addition to the distortion of scientific findings by a tobacco industry affiliated researcher, anti-smoking campaigners made attempts to intimidate and suppress scientific activities. These distortions of science should be counteracted.

Blood lead and erythrocyte protoporphyrin levels in association with smoking and personal hygienic behaviour among lead exposed workers.

AIMS: To investigate the effects of smoking and personal hygienic behaviour on blood lead (BPb) and free erythrocyte protoporphyrin levels (FEP) in lead exposed workers. METHODS: Subjects were 105 lead exposed male workers in a battery recycling plant during the years 2000-03. BPb and FEP were measured as part of the ongoing occupational surveillance. Each worker completed a questionnaire for assessment of smoking and four measures of personal hygienic behaviour (glove and mask use, hand and face washing before meals during working hours). RESULTS: Statistically significant decreases in mean BPb and FEP occurred during the three years. The proportion of BPb reduction in the non-smoking workers was significantly higher (mean 24.3%) than in the smoking workers (15.3%). When the workers were classified into three groups (excellent, good, and poor) based on the four personal hygienic behavioural indicators, the greatest decreases of BPb and FEP were observed in the non-smoking workers of the excellent group. CONCLUSIONS: The consistent use of protection devices and cleanliness at work appeared to contribute to the lowering of BPb and FEP. Cessation of smoking in the workplace was also of importance.

Relationship between shunt-dependent hydrocephalus after subarachnoid haemorrhage and duration of cerebrospinal fluid drainage.

Subarachnoid haemorrhage (SAH) patients in Fisher group 3 have a high risk of vasospasm and chronic hydrocephalus. We have provided cisternal irrigation combined with a head-shaking method for preventing vasospasm in SAH patients. We investigated 76 SAH patients in Fisher group 3 who received cisternal irrigation with head-shaking to evaluate the relationship between the occurrence of hydrocephalus and various clinical factors, including duration of cerebrospinal fluid (CSF) drainage. Chronic hydrocephalus occurred in 25 patients (33%). The occurrence of hydrocephalus was associated with longer duration of CSF drainage (median, 13 days versus 9 days). By logistic regression analysis using significant factors, including age, preoperative neurological grade and Glasgow Outcome Scale, only the duration of drainage was independently associated with the occurrence of hydrocephalus (Odds ratio = 1.18 per day; 95% confidence interval, 1.02- 1.36). These results indicate that long duration of CSF drainage for preventing vasospasm may increase the occurrence of hydrocephalus.

Cancer mortality among workers exposed to amphibole-free chrysotile asbestos.

The issue of whether exposure to chrysotile asbestos alone, without contamination from amphibole asbestos, causes lung cancer and mesothelioma was investigated in a 25-year longitudinal study (1972-1996) in Chongqin, China. The study cohort comprised 515 male asbestos plant workers exposed to chrysotile only; the control cohort included 650 non-dust-exposed workers. The results of analysis in which the proportional hazards model was used indicated that mortality due to all causes, all cancers, and lung cancer was related to asbestos exposure; the relative risks, adjusted for age and smoking, were 2.9, 4.3, and 6.6, respectively. Fiber concentrations in the raw material section and the textile section of the plant were 7.6 and 4.5 fibers/ml, respectively. Because of differences between the study and control plants, the authors also compared various sections of the asbestos plant that had different levels of dust exposure. The adjusted relative risk of lung cancer was 8.1 for workers exposed to high versus low levels of asbestos. Two cases of malignant mesothelioma, one pleural and the other peritoneal, were found in the asbestos cohort. These results suggest that heavy exposure to pure chrysotile asbestos alone, with negligible amphibole contamination, can cause lung cancer and malignant mesothelioma in exposed workers.

Intervention for prevention of low back pain in Japanese forklift workers.

BACKGROUND: The effectiveness of two different approaches for the prevention of low back pain (LBP) was compared in forklift workers. The first approach (personal) consisted of providing lumbar support, arctic jacket and physical exercise, and the second (facility approach) included the improvement of forklift seats and tires. METHODS: The self-reported prevalence of LBP was surveyed three times before and after the two forms of interventions, in 260 male blue-collar workers including 27 forklift workers, and 55 male white-collar workers of a copper smelter. RESULTS: The initial prevalence of LBP was 63% in the forklift workers, which was significantly higher than that found in the other blue-collar workers (32%) and in the white-collar workers (22%). One year after the first intervention (personal approach) to the forklift workers, the prevalence of LBP fell to 56%. The second intervention (facility approach), which was mainly comprised of a reduction in whole body vibration, was subsequently added, and 9 months later the prevalence of LBP in the forklift workers further decreased to 33%. The reduction of the prevalence from the initial survey was significant (P = 0.008), and that from the second survey was nearly significant (P = 0.070). CONCLUSIONS: These findings suggest that the facility approach is more effective for a reduction of LBP than the personal approach.

Test validity of periodic liver function tests in a population of Japanese male bank employees.

The validity (sensitivity and specificity) of annual liver function tests, determined by assaying blood levels of aspartate aminotransferase, alanine aminotransferase and gammaglutamyl transpeptidase, was evaluated using the results of health checkups of male bank workers. The specificity of each liver function test to detect persons with fatty liver, excess alcohol users, and hepatic virus carriers, diagnosed respectively by ultrasound, detailed inquiry, and virus marker tests, was always higher than 80%, except for alanine aminotransferase in excess alcohol users (63.5%). However, the highest sensitivity to detect virus carriers was alanine aminotransferase to detect HCV antibody-positive workers, but it was only 45.5%. The highest sensitivity of the liver function tests to detect excess alcohol users in obese subjects was only 33.3%. The highest sensitivity by liver function tests to detect fatty liver was 35.7% which was inferior to that of the body mass index. These results indicate that the liver function tests mandated in the workplace periodic health checkups in Japan exhibit very low sensitivity for the detection of any of the proposed target clinical conditions.

Pulmonary function in long-term asbestos workers in China.

The relationship of pulmonary function to exposure to asbestos and radiographic abnormalities has been controversial, especially when smoking is present as a confounder. The aim of the study was to provide further understanding on the radiographic-physiologic associations in nonsmoking and smoking asbestos workers. Radiographic asbestosis, pleural lesion, and pulmonary function were studied in 269 Chinese asbestos workers, with average exposure years of 23 for male workers and 18 for female workers. Their functional data were compared with those of 274 controls without exposure to dust. Although most of the male workers were smokers, none of the female workers smoked. In comparison with controls, asbestos workers had significantly lower lung volume and diffusing capacity, irrespective of gender. Female workers and smoking male workers had lower measurements of forced expiratory volume in 1 second and instantaneous forced expiratory flow at 50% and 25% of forced vital capacity. After adjustment for relevant covariates, asbestos exposure, asbestosis, and pleural abnormalities were associated with decreased parameters of pulmonary function, including lung volume, diffusing capacity, and airway flow. These data indicate that asbestos-related functional defects manifested by lung restriction and mild airway obstruction correlate with exposure to asbestos and with parenchymal and pleural abnormalities, independent of smoking.

Respiratory symptoms and pulmonary function among traffic police in Bangkok, Thailand.

The authors undertook a cross-sectional study of the potential adverse health effects of air pollution in Bangkok, Thailand. During 1998 and 1999, the authors administered lung function spirometry tests and a Thai version of the American Thoracic Society's Division of Lung Diseases (ATS-DLD) respiratory questionnaire to 78 male traffic police and 60 male nontraffic police in Bangkok, as well as to 68 male general police in Ayutthaya province, a rural area in Thailand. No consistent trend of decreased pulmonary function was observed in traffic police. The authors controlled for age, height, and smoking index, after which mean levels of forced expiratory volume in 1 sec and maximal expiratory flow rate in 25% of vital capacity (V25) were significantly lower in Bangkok police than in Ayutthaya police. The prevalence of respiratory symptoms among Bangkok police was slightly higher than among Ayutthaya police. Multiple regression analysis identified age and workplace as statistically significant factors that contributed to the values of forced expiratory volume in 1 sec and V25. This study provided some evidence of an increase in prevalence of obstructive changes in the peripheral airways among traffic police in Bangkok.

From understanding health care provider behavior to improving health care: the QUERI framework for quality improvement. Quality Enhancement Research Initiative.

Basic science and health care research provide the evidence base for the scientific practice of medicine. Over the past 2 decades, as increasingly refined tools for improving health and health care have been developed, the health care community has attempted to bridge the gap between available tools and actual health care practices. This gap can be bridged only by influencing health care provider behavior. The VA Quality Enhancement Research Initiative (QUERI) is a program designed to systematically translate research findings into better health care practices, and thus better health outcomes for enrolled veterans. Integrating provider behavior research considerations and findings into each step of the QUERI process will enhance the effectiveness of the initiative. This article presents a provider behavior research framework for planning, implementing, and evaluating quality improvement interventions within QUERI.

[A comparison between three methods to investigate falls among the elderly living in the community].

PURPOSE: Interview survey is the often selected method to investigate falls among the elderly. However, the reliability of data obtained by that method has not be confirmed. The aim of this study is to clarify the number of intervals of recollection that should be specified to ensure accurate data when we investigate falls by using interview surveys among the elderly. METHODS: We carried out a total health survey among the elderly in Shigenobu town, and reported about the frequency of falls and its relating factors. Sex, age, walking ability over a distance of 1 km and hospitalization experience for past 1 year were related to falls significantly. In this study, we set 3 groups matching for the above factors in addition to history of falls during the preceding a year, and for one year we asked about falls every month for the first group (116 participants), every 3 months for the second group (116 participants) respectively. The third group (118 participants) was asked once at the end of this study. These three groups totaled 350 persons who were participants of physical fitness measurements that we carried out in Shigenobu town. The existence of falls was investigated by mail, and the nonrespondents were questioned by direct telephone calls. RESULTS: For reasons such as death, moving out, hospitalization and answer denial, persons whose answer was not obtained were excluded from the analysis. Finally, 87.1% in the 1st group, and 89.7% in the 2nd group and 96.6% in the 3rd group were analyzed. Statistically significant difference for the above factors related to falls did not exist among the 3 groups. Annual incidence for falls tended to be more frequent in the 1st group that in the 3rd group (20.5% in the 1st group, 15.9% in the 2nd group and 6.4% in the 3rd group) in males. In females, such a difference was not observed. (26.3% in the 1st group, 18.3% in the 2nd group and 20.9% in the 3rd group). CONCLUSIONS: There were no significant differences for the factors related to falls in 3 groups, therefore, the groups had almost similar backgrounds. In men, the difference of annual reported incidence between the 1st group and the 3rd group may be due to differences in the method of recollection.

Blood lead levels in copper smelter workers in Japan.

Lead exposure of workers in a Japanese copper smelter was assessed by determining lead levels in blood, air and flue cinder at the copper smelting processes. All the samples were analyzed for lead by atomic absorption spectrometry. Mean lead levels of air were highest at the anode department followed by the converter, smelter and blend departments. The mean level of blood lead of the workers in the anode department was also the highest among the four smelting departments. The mean blood lead levels of the workers in each department were positively correlated with their air lead levels (r = 0.99, p < 0.01). This study indicates therefore that workers in copper smelters have been exposed to lead in their workplace. Though this finding has already been reported in preceding studies, the Ordinance on Prevention of Lead Poisoning in Japan has not included copper smelter into its target job categories if their lead concentration in the raw material is less than 3%. The limitation of the present Ordinance which defines the targets by the types of job and not by the actual exposure, is discussed.