Mortality benefit of participation in BOOCS program: a follow-up study for 15 years in a Japanese working population.

OBJECTIVE: This study aims to demonstrate the protective effect on mortality among participants of a health education program, Brain-Oriented Obesity Control System (BOOCS). METHODS: A quasi-experimentally designed, 15-year (1993 to 2007) follow-up study was conducted with a total of 13,835 male and 7791 female Japanese workers. They were divided into three groups: participants in the program (1565 males and 742 females), nonparticipant comparative obese controls (1230 males and 605 females), and nonparticipant reference subjects (11,012 males and 6426 females). Hazard ratios were calculated with survival curves drawn to evaluate the mortality effects by the program participation. RESULTS: The male participants showed significantly lower mortality risk for all causes of death at hazard ratio = 0.54 (95% confidence interval: 0.31 to 0.94) with significantly different survival curves (P = 0.014 by log-rank test) than obese controls. CONCLUSIONS: The results support a protective effect on mortality by participating in BOOCS program.

Current smoking rate in patients with psychiatric disorders in Japan: questionnaire survey.

The association between smoking and psychiatric disorders (PD) has been known for many years. Support for smoking cessation among patients with PD is provided in advanced nations, but there is a little support for smoking cessation among patients with PD in Japan, where few studies have investigated the smoking rate. The aim of the present study is to determine the smoking rate and smoking habits of Japanese patients with PD. The subjects included outpatients who visited the outpatient psychiatric clinic at a University hospital between January and March of 2011. They answered a questionnaire consisting of questions about their sociodemographic background and smoking habits. In an analysis of 733 subjects, the overall smoking rate was 25.1%. The smoking rates among the patients with schizophrenia and depression were 17.3% and 23.9%, respectively, and these rates were lower than the results of previous studies. Among the current smokers, 43.4% had experienced smoking cessation, and only 26.1% were not interested in smoking cessation. Of the current smokers, 37.5% spent between US$128.88 and US$257 per month on cigarettes.

Nationwide survey of work environment, work-life balance and burnout among psychiatrists in Japan.

BACKGROUND: Psychiatry has been consistently shown to be a profession characterised by 'high-burnout'; however, no nationwide surveys on this topic have been conducted in Japan. AIMS: The objective of this study was to estimate the prevalence of burnout and to ascertain the relationship between work environment satisfaction, work-life balance satisfaction and burnout among psychiatrists working in medical schools in Japan. METHOD: We mailed anonymous questionnaires to all 80 psychiatry departments in medical schools throughout Japan. Work-life satisfaction, work-environment satisfaction and social support assessments, as well as the Maslach Burnout Inventory (MBI), were used. RESULTS: Sixty psychiatric departments (75.0%) responded, and 704 psychiatrists provided answers to the assessments and MBI. Half of the respondents (n = 311, 46.0%) experienced difficulty with their work-life balance. Based on the responses to the MBI, 21.0% of the respondents had a high level of emotional exhaustion, 12.0% had a high level of depersonalisation, and 72.0% had a low level of personal accomplishment. Receiving little support, experiencing difficulty with work-life balance, and having less work-environment satisfaction were significantly associated with higher emotional exhaustion. A higher number of nights worked per month was significantly associated with higher depersonalisation. CONCLUSIONS: A low level of personal accomplishment was quite prevalent among Japanese psychiatrists compared with the results of previous studies. Poor work-life balance was related to burnout, and social support was noted to mitigate the impact of burnout.

Variation in benchmark dose (BMD) and the 95% lower confidence limit of benchmark dose (BMDL) among general Japanese populations with no anthropogenic exposure to cadmium.

BACKGROUND: The use of benchmark dose (BMD) and the 95% lower confidence limit of benchmark dose (BMDL) have been gaining popularity not only in experimental studies but also in epidemiological studies including those on toxicology of cadmium (Cd), a ubiquitous hazardous element in the environment. However, the reproducibility of BMD and BMDL values has seldom been examined. OBJECTIVES: This study was initiated to determine whether consistent BMD and BMDL values are obtained for similar non-exposed populations, i.e., the populations with no anthropogenic exposure to Cd in a single nation of Japan. METHODS: Cd (an exposure marker), α(1)-microglobulin (α(1)-MG), ß(2)-microglobulin (ß(2)-MG) and N-acetyl-ß-D-glucosaminidase (NAG) (three effect markers of tubular dysfunction) levels in the urine of adult Japanese women from five previous publications of this study group were examined. Overall, data were available for 17,375 cases (in 16 prefectures) regarding Cd, α(1)-MG and ß(2)-MG, and 6,409 cases (in ten prefectures) regarding NAG. The data were used to calculate BMD and BMDL values taking advantage of the hybrid approach (Budtz-JÇ¿rgensen et al. in Biometrics 57:698-706, 2001). It was possible to calculate BMD and BMDL values for α(1)-MG and ß(2)-MG for all of the 16 prefectures with 17,375 cases, whereas the values for NAG were successfully calculated for nine prefectures with 5,843 cases. RESULTS: The application gave BMD values of 1.92, 2.46 and 2.32 µg Cd/g cr for α(1)-MG, ß(2)-MG and NAG, respectively, and BMDL values of 1.83, 2.32 and 2.09 µg Cd/g cr. Large inter-prefectural variations were observed in the BMD and BMDL; there was about fourfold difference both in BMD and in BMDL calculated for α(1)-MG and ß(2)-MG in 16 prefectures, and the variation was greater (i.e., by about sevenfold) in BMD and BMDL for NAG in nine prefectures. A survey of relevant literature revealed variation in BMD and BMDL values of similar folds as observed in the present analyses in five studies of Japanese populations. Multiple regression analyses taking BMD or BMDL as a dependent variable and age, CR concentration and Cd concentration as independent variables showed both BMD and BMDL were significantly influenced by Cd concentration in cases of α(1)-MG and ß(2)-MG, whereas BMD and BMDL for NAG was by CR. CONCLUSIONS: Even when the analysis was conducted in a single nation, both BMD and BMDL for the Cd effect markers varied by ca. fourfold when examining α(1)-MG or ß(2)-MG and the values varied by ca. sevenfold for NAG among Cd-non-exposed populations. The most influential factors in the study population may include urine density and Cd levels in the urine.

Global magnitude of reported and unreported mesothelioma.

BACKGROUND: Little is known about the global magnitude of mesothelioma. In particular, many developing countries, including some with extensive historical use of asbestos, do not report mesothelioma. OBJECTIVES: We estimated the global magnitude of mesothelioma accounting for reported and unreported cases. METHODS: For all countries with available data on mesothelioma frequency and asbestos use (n=56), we calculated the 15-year cumulative number of mesotheliomas during 1994-2008 from data available for fewer years and assessed its relationship with levels of cumulative asbestos use during 1920-1970. We used this relationship to predict the number of unreported mesotheliomas in countries for which no information on mesothelioma is available but which have recorded asbestos use (n=33). RESULTS: Within the group of 56 countries with data on mesothelioma occurrence and asbestos use, the 15-year cumulative number of mesothelioma was approximately 174,300. There was a statistically significant positive linear relation between the log-transformed national cumulative mesothelioma numbers and the log-transformed cumulative asbestos use (adjusted R(2)=0.83, p<0.0001). Extrapolated to the group of 33 countries without reported mesothelioma, a total of approximately 38,900 (95% confidence interval, 36,700-41,100) mesothelioma cases were estimated to have occurred in the 15-year period (1994-2008). CONCLUSIONS: We estimate conservatively that, globally, one mesothelioma case has been overlooked for every four to five reported cases. Because our estimation is based on asbestos use until 1970, the many countries that increased asbestos use since then should anticipate a higher disease burden in the immediate decades ahead.

Relationships between diabetes and medical and dental care costs: findings from a worksite cohort study in Japan.

The purpose of this study was to evaluate the relationships between diabetes and medical and dental care costs from a 5-yr prospective observation of Japanese workers. The data were derived from health and dental examinations and health insurance claims of 4,086 workers aged 40-54 yr. At baseline, the subjects were assigned to four categories: known diabetes; undiagnosed diabetes; impaired fasting glucose (IFG); and non-diabetic. The differences in health care costs among the non-diabetics, IFG and undiagnosed diabetes groups were not seen at baseline, but the costs incurred by the subjects with undiagnosed diabetes substantially increased thereafter. Over 5 yr of the study period, compared with the non-diabetic group, subjects with known diabetes incurred 3.9- and 2.9-fold higher annual inpatient and outpatient costs, respectively, while subjects in the undiagnosed diabetes group incurred 3.0- and 1.6-fold higher costs, respectively. There were no significant associations between annual dental care costs and diabetic status. The excess costs of medical care among subjects with diabetes were attributable to diabetes itself, heart disease and cerebrovascular disease, but not cancer. Among middle-aged workers, diabetics incurred significantly greater medical care costs than non-diabetics, whereas IFG was not associated with higher costs.

[Issues and the current situation of the new compulsory residency training program in Japan: the results of an attitude survey for young career psychiatrists].

The new 2 year compulsory residency training program, which includes rotation to each department and requires 1 month of psychiatric training for all residents, started in April 2004 in Japan. In August to September belonging 2008, we conducted an attitude survey of psychiatrists with 10 or fewer years of experience to 15 institutions to clarify the problems and present condition of primary psychiatric training. Psychiatrists (92%) who experienced the new residency program were satisfied with it, and 41% decided to become a psychiatrist after the primary psychiatric training. We compared the training periods and training institutions. Psychiatrists who experienced training for 3 months or more rate themselves higher with regard to pharmacotherapy, and those who underwent training in private psychiatric hospitals rate themselves higher with regard to their understanding of psychiatric disorders. It was suggested that the introduction of primary psychiatric training has promoted motivation to become a psychiatrist and that the length of the training period and type of institution lead to differences in the acquisition of psychiatric skills. Psychiatrists who train residents thought that the skill that residents most needed to acquire was intervention for suicidal patients, but, for residents, this was the least useful item in their training. It was suggested that, in the current situation, there is an insufficient acquisition of learning items. In 2010, psychiatric rotation will change from a required to an elective subject, but residents will still have the opportunity to select it. We need to consider how to devise a short-term but effective primary psychiatric training program in which residents can acquire the basics of primary care psychiatry.

Varenicline does not increase serum BDNF levels in patients with nicotine dependence.

Varenicline, alpha4beta2 nicotinic acetylcholine receptor (nAChR) partial agonist, is a new class of medications for treating nicotine dependence. As an alpha4beta2 nAChR partial agonist, varenicline serves to reduce nicotine withdrawal symptoms, while high-affinity binding of the agonist mitigates the reinforcing effects of smoking. In the present study, we compared serum brain-derived neurotrophic factor (BDNF) levels of nicotine dependence and nonsmokers, and we investigated changes in serum BDNF levels after 8 weeks of treatment with varenicline. Patients met the DSM-IV criteria for nicotine dependence. Both the Fagerström test for nicotine dependence (FTND) and the Tobacco Dependence Screener (TDS) were used. Serum BDNF levels and breath carbon monoxide (CO) levels were measured before and 8 weeks after varenicline treatment. Fourteen of 16 subjects (87.5%) stopped smoking within 12 weeks of varenicline treatment. Thirteen healthy nonsmokers who never had previously smoked were randomly selected as a control group. Serum BDNF levels of patients before treatment (4.8 +/- 3.8 ng/ml) were significantly lower than those in the control group (12.4 +/- 6.13 ng/ml). Serum BDNF levels had not increased from baseline (4.8 +/- 3.8 ng/ml) to 8 weeks after varenicline treatment (3.0 +/- 1.1 ng/ml) of patients. These results suggest that smoking might decrease serum BDNF levels and that treatment with varenicline for 8 weeks, combined with 12 weeks of not smoking, does not increase serum BDNF levels in smokers.

National use of asbestos in relation to economic development.

BACKGROUND: National disparities in asbestos use will likely lead to an unequal burden of asbestos diseases. OBJECTIVES: As economic status may be linked to asbestos use, we assessed, globally, the relationship between indicators of national economic development and asbestos use. METHODS: For the 135 countries that have ever used asbestos, per capita asbestos use (kilograms per capita per year) was compared with per capita gross domestic product (GDP) in 1990 Geary-Khamis dollars (GKD) for the period 1920-2003. Countries were grouped into three income levels (high, middle, and low) that were adapted from the 2003 World Bank categories. RESULTS: The historical pattern of asbestos use followed the environmental Kuznets curve in which use by high-income countries peaked when incomes attained 10,000-15,000 GKD and essentially ceased at income levels over 20,000 GKD. Currently, middle- and low-income countries are increasing their use of asbestos, closely following the paths once traced by higher income countries. CONCLUSIONS: Developing countries have the opportunity to eliminate asbestos use sooner than high-income countries and thus reduce the future burden of asbestos diseases.

Plasma levels of brain-derived neurotrophic factor and interleukin-6 in patients with dysthymic disorder: comparison with age- and sex-matched major depressed patients and healthy controls.

In the present study, we investigated the serum BDNF levels and plasma IL-6 levels in patients with dysthymic disorder, major depressive disorder and control subjects. Eighteen patients who met the DSM-IV criteria (American Psychiatric Association, 1994) for dysthymic disorder (male/female: 5/13; age: 36 ± 9 year) and 20 patients (male/female: 7/13; age: 38 ± 10 year) who met the criteria for major depressive disorder were enrolled. The serum BDNF levels in patients with dysthymic and major depressive disorder were significantly lower than those in the control subjects. However, no difference was found between the dysthymic group and major depression group. The plasma IL-6 levels in the dysthymic group and major depression group were significantly higher than those in the control group. No difference was observed in the plasma IL-6 levels between the dysthymic group and major depression group. These results suggest that the pathophysiology of dysthymic disorder and major depression might be similar in terms of the blood levels of BDNF and IL-6.

Cancer risk among Japanese chromium platers, 1976-2003.

OBJECTIVE: The aim of our prospective cohort study was to assess cancer mortality risks among chromium platers. METHODS: The cohort comprised 1193 male platers (626 with exposure to chromium, the remainder with no exposure) with a follow-up period of 27 years (1 October 1976 to 31 December 2003). Mortality risk was assessed by the standardized mortality rate (SMR) with reference to the national population. RESULTS: Lung cancer mortality was elevated only in the chromium plater subgroup, with borderline statistical significance [SMR=1.46, observations (Obs)=28, 95% confidence interval (95% CI) 0.98-2.04]. The chromium plater subgroup also showed elevated mortality risks for brain tumor (SMR=9.14, Obs=3, 95% CI 1.81-22.09) and malignant lymphoma (SMR=2.84, Obs=6, 95% CI 1.05-5.51). Risks were particularly elevated for lung cancer (SMR=1.59, Obs=23, 95% CI 1.01-2.38) and malignant lymphoma (SMR=3.80, Obs=6, 95% CI 1.39-8.29) among those with initial chromium exposure prior to 1970. CONCLUSIONS: In Japan, occupational exposure to chromium through work as a chromium plater is a risk factor for lung cancer, especially for platers working prior to 1970. Occupational chromium exposure may also increase the risk of brain tumor and malignant lymphoma.

Clinical factors predictive of encephalitis caused by Angiostrongylus cantonensis.

Angiostrongylus cantonensis is mainly caused eosinophilic meningitis in humans, whereas a minority of patients develop encephalitic angiostrongyliasis (EA). EA is an extremely fatal condition, and the clinical factors predictive of EA have never been reported. A comparison study was conducted in a hospital situated in an endemic area of Thailand. We enrolled 14 and 80 angiostrongyliasis patients who developed encephalitis and meningitis, respectively. Logistic regression analysis was used to assess the clinical variables predictive of encephalitis. Age (adjusted odds ratio [OR], 1.22; 95% confidence interval [CI], 1.05-1.42), duration of headache (adjusted OR, 1.26; 95% CI, 1.03-1.55), and fever > 38.0 degrees C (adjusted OR, 37.05; 95% CI, 1.59-862.35) were identified as statistically significant factors for EA prediction. Elderly patients with angiostrongyliasis experiencing fever and prolonged headaches were at the highest risk of developing EA.

Recent mortality from pleural mesothelioma, historical patterns of asbestos use, and adoption of bans: a global assessment.

BACKGROUND: In response to the health risks posed by asbestos exposure, some countries have imposed strict regulations and adopted bans, whereas other countries have intervened less and continue to use varying quantities of asbestos. OBJECTIVES: This study was designed to assess, on a global scale, national experiences of recent mortality from pleural mesothelioma, historical trends in asbestos use, adoption of bans, and their possible interrelationships. METHODS: For 31 countries with available data, we analyzed recent pleural mesothelioma (International Classification of Diseases, 10th Revision) mortality rates (MRs) using age-adjusted period MRs (deaths/million/year) from 1996 to 2005. We calculated annual percent changes (APCs) in age-adjusted MRs to characterize trends during the period. We characterized historical patterns of asbestos use by per capita asbestos use (kilograms per capita/year) and the status of national bans. RESULTS: Period MRs increased with statistical significance in five countries, with marginal significance in two countries, and were equivocal in 24 countries (five countries in Northern and Western Europe recorded negative APC values). Countries adopting asbestos bans reduced use rates about twice as fast as those not adopting bans. Turning points in use preceded bans. Change in asbestos use during 1970-1985 was a significant predictor of APC in mortality for pleural mesothelioma, with an adjusted R(2) value of 0.47 (p < 0.0001). CONCLUSIONS: The observed disparities in global mesothelioma trends likely relate to country-to-country disparities in asbestos use trends.

Vancomycin-resistant enterococci (VRE) outbreak at a university hospital in Kitakyushu, Japan: case-control studies.

At a university hospital in Japan, a total of 15 patients (14 adults and 1 newborn baby) with vancomycinresistant enterococci (VRE) infection or colonization (inf/col) were identified via routine clinical examinations and two nonroutine examinations from January to April 2007. Two case-control studies were conducted to identify the factors related to VRE inf/col. In study 1, the patients with VRE inf/col from ward A (n = 8) were compared with all of the patients without VRE isolates in the same ward, i.e., the controls (n = 26). In study 2, all adult patients with VRE inf/col throughout the hospital (n = 14) were compared with controls randomly selected from among all patients without VRE isolates (n = 45). All the subject cases were found to be infected or colonized with Enterococcus faecium, vanB. All but two of the isolated strains were completely identical according to pulsed field gel electrophoresis. Univariate analysis in study 2 showed several factors, including the isolation of methicillin-resistant Staphylococcus aureus (MRSA) (odds ratio [OR], 8.6; 95% confidence interval [CI], 1.3-53.7) and the use of antibiotics other than anti-MRSA drugs (OR, 33.0; 95% CI, 1.8-587.6) to be risk factors for VRE inf/col. Multivariate logistic regression analysis in study 2 demonstrated associations with VRE inf/col in the use of an ultrasound nebulizer (OR, 5.9; 95% CI, 1.5-22.8) and extended bed rest (OR, 3.8; 95% CI, 1.02-24.5). Although severe infection with VRE did not occur, to avoid the spread of VRE in hospital wards, further staff education should be implemented in regard to the usual standard and contact precautions, and the appropriate selection of antibiotics.

[Asbestos clinics and asbestos health examinations--findings from a questionnaire survey of implementing organizations].

In June 2005 the press reported that many former employees of a company which used asbestos, and individuals who lived near the company's factory, had been diagnosed with mesothelioma. This finding triggered concern and alarm in Japan. In response, many "asbestos clinics" were formed, and recognized medical institutions began to implement asbestos-related health examinations. We conducted a nationwide questionnaire survey to evaluate the activities in, and the challenges for, these medical institutions. We received 137 valid responses, more than half of which were from clinics and hospital-based "asbestos clinics" instigated after the "Kubota shock." Among the asbestos exposure history interviewing practices, job histories of the interviewee were prioritized, over place of residence, and possible exposure of family members. Standard questionnaires were utilized by over 70% of respondents. The practitioners reported problems with lack of manpower and evaluation of asbestos exposure. Examinees consulted attending physicians on a wide range of matters including asbestos-related diseases, asbestos exposure, and financial compensation. It is predicted that asbestos-related diseases in general, and mesothelioma in particular, will increase in the future. Accordingly, early detection and treatment should be accorded high priority. The organizations we surveyed have important roles to play. Although resources are limited, effective diagnosis and treatment are essential, and a system assisting organizations to make accurate and efficient identification of asbestos exposure hazards is imperative.

Respiratory symptoms among residents of a heavy-industry province in China: prevalence and risk factors.

OBJECTIVE: In China, significant levels of environmental pollution, substandard worksite quality and high rates of smoking predispose the population to potentially high risks of respiratory illnesses and other diseases. We assessed the prevalence of respiratory symptoms and their risks in relation to personal, occupational and environmental risk factors in a heavy-industry province of northeastern China. METHODS: Lifestyle, health, residential and occupational data were obtained in 2002 from 31,704 adults of six cities in Liaoning, China, using self-assessment questionnaires. General linear and multi-level models were used to evaluate prevalence rates and risks of respiratory symptoms, related to both individual and combined exposures to environmental and occupational risk factors. RESULTS: The crude prevalence rates (PRs) for persistent cough, persistent phlegm, wheeze and asthma were 2.3, 3.8, 2.1 and 1.0%, respectively. The odds ratios (ORs) of all four respiratory symptoms examined were increased by: smoking (ORs from 2.06 to 5.02), occupational dust (ORs from 1.35 to 1.72), occupational gas (ORs from 1.48 to 1.72) and presence of irritating smoke during cooking (ORs from 1.54 to 2.22). An index combining proximity of residence to road, factory or chimney, indoor coal use and presence of irritating smoke during cooking was associated with up to 3.9-fold increased risks of all symptoms. Increasing values of each risk factor were generally associated with dose-response trends in prevalence rates and risks (all p for trend <0.01). CONCLUSION: The crude PRs of symptoms were lower than those reported by European and American studies but closer to those of previous Chinese studies. The risks of respiratory symptoms in this population were increased by smoking, occupational exposures to dust and gas, and combined residence-related exposures such as living close to a main road, factory or chimney, indoor coal use and the presence of irritating smoke during cooking, among other risk factors.

Perception in relation to a potential influenza pandemic among healthcare workers in Japan: implications for preparedness.

Due to the potential for an influenza pandemic, preparedness for infection control in healthcare settings is essential from the standpoint of occupational health for healthcare workers. We conducted questionnaire surveys among Japanese hospitals to assess preparedness at the individual and institutional levels and their inter-relationship. Questionnaires were administered at 7 tertiary hospitals in Japan during the spring of 2006. We analyzed 7,378 individual responses of the 10,746 questionnaires administered and all seven institutional responses by hospital infection control committees. Healthcare workers assigned low importance to personal protective equipment and showed mixed attitudes (anxious but accepting) to the potential risk. Institutional gaps existed in preparedness across hospitals and most hospitals lacked the specificity to cope with a pandemic. A higher level of institutional preparedness, as determined by expertise as well as general and specific countermeasures, was an important predictor of individual recognition of preventive measures, perception of institutional measures, and attitude toward coping with risk. A higher level of institutional preparedness stood out to be an important predictor of individual preparedness. Considering the risk of a future influenza pandemic, hospitals should improve preparedness at all levels.

The effect of periodontal disease on medical and dental costs in a middle-aged Japanese population: a longitudinal worksite study.

BACKGROUND: Although periodontal disease is one of the most common chronic diseases, it is not clear whether periodontal disease is associated with increased health care costs. The authors examined the effect of periodontal disease on medical and dental costs and use for 3.5 years prospectively. METHODS: The data were derived from health and dental examinations and health insurance claims of 4,285 Japanese civil officers aged 40 to 59 years. The subjects were divided into three categories: no pathological pocket, moderate periodontitis, and severe periodontitis. Age, gender, smoking, body mass index, and hypertension were adjusted in a multivariate analysis after excluding subjects with any history of liver disease, heart disease, or diabetes mellitus. RESULTS: The cumulative cost for subjects with severe periodontitis was approximately 21% higher than for subjects with no pathological pocket, and the hospital admission rates of subjects with severe periodontitis were highest (male: odds ratio [OR]=.34; 95% confidence interval [CI]: 1.00 to 1.80; female: OR=1.29; 95% CI: 0.75 to 2.20). In males, the annual hospital costs of subjects with severe periodontitis were 75% higher than for subjects with no pathological pocket. There was no clear trend identified for outpatient care. The annual dental visit rates and costs for subjects with severe periodontitis were highest in both genders. Periodontal disease might increase the medical care costs for diabetes mellitus, digestive disease, and liver disease. CONCLUSION: Periodontal disease may have played an important role in the cumulative health care cost increases in middle-aged adults over a period of only a few years.

Ecological association between asbestos-related diseases and historical asbestos consumption: an international analysis.

BACKGROUND: The potential for a global epidemic of asbestos-related diseases is a growing concern. Our aim was to assess the ecological association between national death rates from diseases associated with asbestos and historical consumption of asbestos. METHODS: We calculated, for all countries with data, yearly age-adjusted mortality rates by sex (deaths per million population per year) for each disease associated with asbestos (pleural, peritoneal, and all mesothelioma, and asbestosis) in 2000-04 and mean per head asbestos consumption (kg per person per year) in 1960-69. We regressed death rates for the specified diseases against historical asbestos consumption, weighted by the size of sex-specific national populations. FINDINGS: Historical asbestos consumption was a significant predictor of death for all mesothelioma in both sexes (adjusted R2=0.74, p<0.0001, 2.4-fold [95% CI 2.0-2.9] mortality increase was predicted per unit consumption increase for men; 0.58, p<0.0001, and 1.6-fold [1.4-1.9] mortality increase was predicted for women); for pleural mesothelioma in men (0.29, p=0.0015, 1.8-fold [1.3-2.5]); for peritoneal mesothelioma in both sexes (0.54, p<0.0001, 2.2-fold [1.6-2.9] for men, 0.35, p=0.0008, and 1.4-fold for women [1.2-1.6]); and for asbestosis in men (0.79, p<0.0001, 2.7-fold [2.2-3.4]). Linear regression lines consistently had intercepts near zero. INTERPRETATION: Within the constraints of an ecological study, clear and plausible associations were shown between deaths from the studied diseases and historical asbestos consumption, especially for all mesothelioma in both sexes and asbestosis in men. Our data strongly support the recommendation that all countries should move towards eliminating use of asbestos.

The ratification status of ILO conventions related to occupational safety and health and its relationship with reported occupational fatality rates.

The aim of this study was to assess the relationship between the ratification status of occupational safety and health (OSH)-related ILO conventions and reported occupational fatality rates of ILO member countries, while controlling for possible confounding factors. ILO member states were divided into 4 levels of income status, based on the gross national income per capita. Seventeen conventions designated as OSH-related were examined. Reported country occupational fatality rates were compared according to the ratification status of these 17 conventions and multiple regression analyses were conducted to assess the relationship between the fatality rates, ratification status, income level and length of ILO membership. Fatality rates were inversely and significantly related to income levels. In general, non-ratifying countries had higher work-related fatality rates than ratifying countries. A statistical model for identifying predictors of fatal injury rates showed that a larger number of conventions ratified was significantly associated with lower fatality rates. The fact that non-ratifying countries generally have higher fatality rates than ratifying ones supports the notion that all countries should promote ratification of ILO conventions aimed at improving OSH conditions.