Assessing the validity of health impact assessment predictions regarding a Japanese city's transition to core city status: a monitoring review.

BACKGROUND: The validity of health impact assessment (HIA) predictions has not been accurately assessed to date. In recent years, legislative attempts to promote decentralization have been progressing in Japan, and Kurume was designated as a core city in April 2008. An HIA into the transition of Kurume to a core city was conducted before the event, but the recommendations were not accepted by city officials. OBJECTIVE: The aim of this study was to examine the validity of predictions made in the HIA on Kurume by conducting a monitoring review into the accuracy of the predictions. METHOD: Before Kurume was designated as a core city, the residents completed an online questionnaire and city officials were interviewed. The findings and recommendations were presented to the city administration. One year after the transition, a monitoring review was performed to clarify the accuracy of the HIA predictions by evaluating the correlation between the predictions and reality. RESULTS: Many of the HIA predictions were found to conflict with reality in Kurume. Prediction validity was evaluated for two groups: residents of Kurume and city officials. For the residents, 17% (2/12 items) of the predictions were found to be compatible, 58% (7/12) were incompatible and 25% (3/12) were difficult to evaluate. For city officials, the analysis was divided into those whose department was directly involved in tasks transferred to them (transfer tasks) and those whose department was not. For the city officials in departments responsible for conducting core city transfer tasks, 33% (3/9 items) of the predictions were found to be compatible, 33% (3/9) were incompatible and 33% (3/9) were difficult to evaluate. However, for the city officials whose responsibilities were unrelated to core city transfer tasks, 11% (1/9) of predictions were found to be compatible, 78% (7/9) were incompatible and 11% (1/9) were difficult to evaluate. CONCLUSION: Although it was possible to validate some of the HIA predictions, the results of this monitoring review found substantial discrepancies between the predictions and reality 1 year after the transition of Kurume to a core city. This suggests that the accuracy of HIA predictions may be called into question. However, it should be noted that the review was conducted very soon after the transition and the steering group was very small, which may explain why the HIA predictions were inaccurate. Further, long-term studies may be needed to assess the accuracy of HIA predictions in similar contexts.

Lens exposure during brain scans using multidetector row CT scanners: methods for estimation of lens dose.

BACKGROUND AND PURPOSE: Some recent studies on radiation lens injuries have indicated much lower dose thresholds than specified by the current radiation protection guidelines. The purpose of this research was to measure the lens dose during brain CT scans with multidetector row CT and to assess methods for estimating the lens dose. MATERIALS AND METHODS: With 8 types of multidetector row CT scanners, both axial and helical scans were obtained for the head part of a human-shaped phantom by using normal clinical settings with the orbitomeatal line as the baseline. We measured the doses on both eyelids by using an RPLGD during whole-brain scans including the orbit with the starting point at the level of the inferior orbital rim. To assess the effect of the starting points on the lens doses, we measured the lens doses by using 2 other starting points for scanning (the orbitomeatal line and the superior orbital rim). RESULTS: The CTDIvols and the lens doses during whole-brain CT including the orbit were 50.9-113.3 mGy and 42.6-103.5 mGy, respectively. The ratios of lens dose to CTDIvol were 80.6%-103.4%. The lens doses decreased as the starting points were set more superiorly. The lens doses during scans from the superior orbital rim were 11.8%-20.9% of the doses during the scans from the inferior orbital rim. CONCLUSIONS: CTDIvol can be used to estimate the lens dose during whole-brain CT when the orbit is included in the scanning range.

Health impact assessment of the transition to a core city in Japan.

OBJECTIVE: To discover whether a health impact assessment (HIA) is applicable in Japan with respect to the transition to a core city. STUDY DESIGN: Ecological study. METHODS: A rapid HIA was applied based on typical HIA guidelines. A rapid HIA consists of screening, scoping and assessment. In the assessment or policy analyses, information on the official opinions of Kurume was compiled and interviews were undertaken in Nagasaki, which had already become a core city (hereinafter, 'predecessor core city'). For qualitative and quantitative data, a survey of the 35 predecessor core cities was performed, together with an online questionnaire for the cities of Kurume and Aomori. RESULTS: The construction of new public health centres with the transition to core cities held major significance. In an effort to promote advantages, regionally co-ordinated health activities were quickly introduced, systems whereby residents can voluntarily participate in health activities were strengthened, and facilities where government and residents came together were built. To minimize disadvantages, special features of districts with good health services were applied to other districts, the provision of conventional health services throughout the city was improved, and prefectural and national offices opened consultation corners regarding employee or budgetary shortages. CONCLUSION: This paper reports the first use of an HIA in Japan with respect to governmental policy. However, this HIA was not a pre-assessment in principle, but rather a concurrent HIA. In the future, HIAs should be performed in Japan to make suggestions to government decision makers whenever policy is being formulated or programmes are being changed.

Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital.

The epidemiology of needlestick and sharps injuries (NSIs) was investigated among a complete cross-section of 1,162 nurses from a large hospital in southern Japan (response rate 74.0%). Forty-six percent had experienced an NSI in the previous year. Most were caused by ampoules or vials, which injured 32.3% of all nurses and accounted for 42.9% of all NSI events. Twenty-two percent of all NSIs involved a device that had been used on a patient prior to the NSI (contaminated device), while the usage status of a further 2.8% of devices was unknown. Logistic regression indicated that nurses younger than 25 years of age were 2.18 times more likely to have sustained a single NSI in the past 12 months [odds ratio (OR) 2.18, 95% confidence intervals (CI) 1.15-4.17] and 2.39 times more likely to have sustained multiple NSIs (OR 2.39, 95% CI 1.08-5.34). Working mixed shifts (rotating day and night, as opposed to day shifts alone) was associated with a 1.67-fold increased risk of sustaining any NSI (OR 1.67, 95% CI 1.01-2.85) and a 2.72 times greater risk of sustaining an NSI from a contaminated device (OR 2.72, 95% CI 1.71-4.44). Nurses who reported significant fatigue after work were 1.87 times more likely to sustain multiple NSIs (OR 1.87, 95% CI 1.13-3.13) and 1.94 times more likely not to report their NSIs (OR 1.94, 95% CI 1.03-3.71). Perceived high mental pressure was associated with a 1.75-fold increased risk of sustaining an NSI from a contaminated device (OR 1.75, 95% CI 1.07-2.88). Nurses who reported suboptimal staffing levels in their wards were 2.21 times more likely not to report any NSIs they sustained in the previous year (OR 2.21, 95% CI 1.06-4.89). Overall, this study suggests that NSIs represent a complex and multi-faceted problem for Japanese nurses. Intervention strategies should consider the emerging complicity of psychosocial factors on NSI among hospital staff in Japan, as elsewhere.

Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus.

OBJECTIVE: We evaluated the usefulness of analyzing expired gas during exercise testing for the prediction of postoperative cardiopulmonary complications in patients with esophageal carcinoma. BACKGROUND DATA: Radical esophagectomy with 3-field lymphadenectomy is performed in patients with thoracic esophageal carcinoma but has a high risk of postoperative complications. To reduce the surgical risk, we performed preoperative risk analysis using 8 factors. Although hospital mortality was decreased when this risk analysis was used, severe cardiopulmonary complications still occurred. METHODS: The study group consisted of 91 patients who had undergone curative esophagectomy with 3-field lymphadenectomy. The maximum oxygen uptake, anaerobic threshold, vital capacity, percent vital capacity, forced expiratory volume in 1 second, percent forced expiratory volume, V.(25)/HT, forced expired flow at 75% of forced vital capacity to height ratio (FEF(75%)/HT), forced expired flow at 50% to 75% of forced vital capacity ratio (FEF(50%)/FEF(75%)), percent diffusion capacity for carbon monoxide, and arterial oxygen tension were measured. Patients were divided into 2 groups on the basis of the presence or absence of postoperative cardiopulmonary complications. RESULTS: Only the maximum oxygen uptake was significantly different between the 2 groups. All patients were grouped according to the value of the maximum oxygen uptake, and the occurrence of postoperative cardiopulmonary complications was calculated for each group. A cardiopulmonary complication rate of 86% was found for patients with a maximum oxygen uptake of less than 699 mL. min(-1). m(-2); for those with a value of 700 to 799 mL. min(-1). m(-2), the complication rate was 44%. CONCLUSIONS: The maximum oxygen uptake obtained by expired gas analysis during exercise testing correlates with the postoperative cardiopulmonary complication rate. On the basis of these results, esophagectomy with 3-field lymphadenectomy can be safely performed in patients with a maximum oxygen uptake of at least 800 mL. min(-1). m(-2).

The mechanism of a human reaction to vibration stress by palmar sweating in relation to autonomic nerve tone.

OBJECTIVES: To clarify the mechanism of a human reaction to vibration stress by palmar sweating in relation to the autonomic nerve tone. METHODS: The autonomic nerve tone was divided into four types by using digital photoelectroplethysmography (PTG) with auditory stimuli: normal (N), hyperreactive (I and D), and hyporeactive (P) types. Palmar sweating and digital PTG were simultaneously measured on the right palm and middle finger, respectively, in 20 healthy men. The left hand gripping the handle with a grasp strength of 49 N was exposed to vibration at a frequency of 125 Hz and acceleration magnitudes of 0 m/s2 (as a control), 30 m/s2, or 50 m/s2 for 3 min. The volume of palmar sweating was recorded before, during, and 30 min after vibration load. Three kinds of drugs related to the autonomic nervous system were orally administered to the subjects. Then 80 min after administration, the experiments were repeated. RESULTS: Of 20 subjects, 17 showed normal autonomic nerve tone (N type), and 3 hyperreactive (I type). The palmar sweating reaction to vibration in I-type subjects was greater and lasted longer than that in N-type subjects. Vibration with an acceleration of 50 m/s2 produced the greatest reaction which was about 7 times larger than that at 0 m/s2 and 2.5 times that at 30 m/s2 (P < 0.01). Sulpiride decreased palmar sweating during vibration, while prazosin and scopolamine inhibited it. CONCLUSIONS: The palmar sweating reaction to vibration stress was related to the background level of the autonomic nerve tone. The sweating volume was in direct proportion to the acceleration magnitude of vibration. The reaction of palmar sweating to vibration stress may be mediated through both the adrenergic and cholinergic fibers of the autonomic nervous system.

Suppressive mechanism of gastric motility by whole-body vibration.

OBJECTIVE: To investigate the mechanism of gastric motility suppression by exposure to whole-body vibration (WBV). METHODS: The gastric motility was evaluated by electrogastrography (EGG) under food intake and autonomic nerve blocking agents in ten healthy volunteers. Sinusoidal vertical vibration with a frequency of 4 Hz (1.0 ms(-2) rms) was given to the subject for 10 min. RESULTS: The amplitude of EGG wave and the power spectrum corresponding to the slow wave component was remarkably decreased by vibration exposure. Food intake enhanced the gastric motility about 2.5-fold in the power spectral density. During and after vibration exposure, the response mode was similar to those at fasting states. Under the influence of anticholinergic (scopolamine) and alpha-adrenergic blocking agents (prazosin), the power spectra were decreased. A further decrease was observed during vibration exposure. A beta-adrenergic blocking agent (propranolol) led to a marked increase in the amplitude of EGG and its power spectrum. With pretreatment by a beta-adrenergic blocking agent, however, vibration exposure reduced both of them. CONCLUSIONS: These results suggest that short-term exposure to WBV can suppress the gastric myoelectric activity, the responses on which may be mediating by neurohumoral effects as well as the mechanical effect of WBV.

A strategy for health promotion among unemployed people in Japan.

OBJECTIVE: To describe the unemployment situations in Japan and to propose a strategy for promoting health among unemployed persons. METHODS: The published government reports and the actual circumstances were analyzed to make an action program on the basis of social and occupational situations in Japan. RESULTS: The unemployment rate was low as compared to that of other countries because of two major reasons. One was that the workers were absorbed in minor or family corporation despite unsatisfactory job. The other was based on the financial support system for adjusting employment by the government. In an action program for promoting health of the unemployed persons, the same health care system as workers should be applied to the unemployed in the regional center of occupational health.

Changes of visual performance induced by exposure to whole-body vibration.

To clarify the effects of whole-body vibration (WBV) on visual performance, visual acuity and a self-rated assessment of difficulties in visible perception were determined after various frequencies of vibration in six healthy males. Two different sitting postures, an erect posture and a muscle-relaxed posture, were used. Sinusoidal vertical vibrations at ten frequencies (8, 10, 12.5, 16, 20, 25, 31.5, 40, 63.5 and 80 Hz) were applied to the seated subjects for 20 sec. The magnitude of acceleration at each vibration frequency was maintained at 2.5 msec-2 (r.m.s.). The visual performance was evaluated by a standard visual acuity test and a self-rated assessment for difficulties in visible perception. The disturbances of visual performance were dependent on the vibration frequency (p < 0.01, ANOVA) with a maximum reduction of visual acuity at a frequency of 12.5 Hz. The disruption of the visual performance was more severe with the erect posture than with the muscle-relaxed posture. In conclusion, short-term WBV exposure can affect visual performance, depending on the vibration frequency and the sitting posture. The visual acuity and self-rated assessment of disturbances of vision may be influenced by the resonance frequency of the eyeball.

Whole-body vibration suppresses gastric motility in healthy men.

The influence of whole-body vibration on gastric motility was investigated by using an electrogastrography (EGG) in seven healthy men. The EGG is usually referred to as a noninvasive technique of recording gastric myoelectrical activity by means of placing electrodes on the abdominal surface. Sinusoidal vertical vibration at each of 3 different frequencies (10 Hz, 20 Hz, 40 Hz) were randomly given to the subject seated on a platform of vibrator for 5 min. The vibration magnitude was kept at a constant of 2.0 msec-2 (r.m.s.) during operation. The mean dominant frequency of EGG at control period was prior to operation 3.3 cycles per min (cpm). During vibration exposure at 10 Hz, the peak of dominant frequency increased to 3.9 cpm, and the relative power of slow wave showed the statistically significant decrease (45.8%, p < 0.05). The mean relative power of slow wave which is composed of frequencies ranged from 2.0 to 5.0 cpm was 56.6% at control period. On the contrary the mean relative power of frequencies ranging from 5.0 to 9.0 cpm, tachygastria increased from 29.5% to 39.1%. These results suggest that the short-term exposure to whole-body vibration effects on the gastric myoelectrical activity.

A revised cold water immersion test for assessing peripheral circulatory function.

To improve the conventional cold water immersion test for assessing peripheral circulatory function, the immersed area of the hand was changed in this study. Twenty-seven healthy medical students with a mean age of 24 years participated in the study. The cold water immersion tests were carried out using two methods (in 5 degree C water for 1 min), in which the immersed area was up to the metacarpophalangeal (MP) joints (hereafter, MP-method) which is a new method, or to the wrist (hereafter, W-method) which is a conventional method. The recovery of skin temperature, vibratory perception threshold and complaints of finger pain were determined during cold immersion tests with the two methods. The mean skin temperature for the MP-method after immersion recovered more quickly than that for the W-method. However, the time courses of recovering were parallel for the two methods. Significant differences were noted at 3 min, 5 min and 10 min after cessation of immersion. There was a significant positive correlation in the recovery rates at 5 min after immersion between the two methods (correlation coefficient = 0.65, p < 0.01). The mean vibratory thresholds for the W-method were higher than those for the MP-method, and the difference was significant (p < 0.01). All subjects preferred the MP-method to the W-method because there was less finger pain. These results indicate that the MP-method, immersion up to the MP joint of a hand, for assessing peripheral circulatory function is better than the W-method.

Application of Stockholm criteria to patients with hand-arm vibration syndrome in a follow-up study.

We applied Stockholm criterion to patients with hand-arm vibration syndrome (HAVS) for assessing the therapeutic effects in comparison with the criterion of the Ministry of Labour in Japan (MLJ). Forty male patients recognized as an occupational disease were examined in two times (mean interval periods 3.0 years). The subjects were free from vibratory tasks during the mean period of 8.3 years. The clinical examinations and some laboratory tests were conducted with the same procedures by the two same occupational physicians. The criterion of MLJ was graded more severe than Stockholm one for the vascular component at the first examination. According to Stockholm criterion, 16 patients (40%) were classified into stage 0 in the vascular component, 11 (70%) of which complained of coldness in the fingers. At the second examination, 9 of 16 patients in stage 0 had Raynaud's phenomenon (RP). On the other hand, the criterion of MLJ could reflect an improvement of symptoms, for example, coldness. The findings may indicate that Stockholm criterion for vascular component is not enough to assess the clinical changes for light stages according to the severity of RP alone. For the sensorineural (SN) component, both criteria were almost compatible. From the viewpoint of preventive medicine, it was concluded that Stockholm criterion was not suitable for evaluating their clinical severity in the early stage of HAVS.

A new criterion proposed for the diagnosis of hand-arm vibration syndrome.

To propose a new criterion for the diagnosis of hand-arm vibration syndrome (HAVS), we evaluated the severity of the patients in comparison with the criterion of the Ministry of Labour in Japan (MLJ) and the Stockholm criterion. The characteristics of the Stockholm criterion was to classify severe cases with vascular disorders, because of evaluation due to the frequency of Raynaud's phenomenon alone. The Stockholm criterion diagnosed the HAVS separately in vascular and sensorineural disorders. The MLJ criterion was able to subdivide light stages. In vascular disorders, the MLJ criterion made serious consideration about cold sensation which appeared long before the occurrence of Raynaud's phenomenon. The MLJ criterion diagnosed the patients with vascular, sensorineural and motor (musculoskeletal) system disorders comprehensively. A new criterion which we proposed includes sensorineural, vascular and motor system disorders, the grade of which is evaluated in each system. The diagnosis might be done comprehensively.

[Perceived health of persons and their practice of health promoting activities].

The perceived health of persons and their practice of health promoting activities were surveyed using a self-rating questionnaire with 49 items assessing level of health, practice of health promoting activities, life styles, health education, and participation in health screening for general health conditions and cancers. The questionnaires were mailed to 2,500 residents of a city, aged from 30 to 69 years old, randomly selected according to the composition ratios of the populations in the city. Persons from 2,333 subjects (1,057 male and 1,276 female) were effectively collected, representing about 1% of the city's population. General health was good in about 85% of the subjects, with decreases observed with age. Practice of activities for health promotion was wide-spread among the subjects. These activities included regularity, diet, nutrition, smoking and drinking control, physical exercise, sleep, and rest. The subjects expressed strong fear of cancers and concerns about deterioration in physical fitness. Their target life style was one with adequate sleep and rest, regularity in eating, good nutrition, and avoidance of overwork. Health screening participation rates were low at approximately 28% because of their perceived good health, and busy daily life and work. It appears that the perceived health of citizens may not always correlated with the practice of health promoting activities.

[Difference in perceived health between blue- and white-collar workers of a manufacturing factory by a self-administered questionnaire].

In order to examine the differences in which blue- and white-collar workers perceive their own health status, a survey using self-administered questionnaire was conducted. The subjects were 1,428 male workers in a tire manufacturing factory, consisting of 1,185 blue-collar workers and 243 white-collar workers. Most of the blue-collar workers were engaged in shift work consisting of three shifts/d. The questionnaire included 32 items concerning health habits, life and job satisfaction, mental stress, and type A behavior. The following findings were obtained. Good daily health habits were related to age. Older workers had better health habits than the younger ones both in white- and blue-collar workers. The white-collar workers were more satisfied with their life and jobs, and also showed type A behaviors at a higher rate. As for fatigue and dissatisfaction association with shift work, the workers' complaints increased in the order of day shift, evening shift and midnight shift. The older workers had fewer complaints than the younger ones. These results suggested that health management and education will be more effective if the working conditions and the background of each worker are taken into consideration.

[A 4 degrees C-1 min method of cold water immersion test for peripheral circulatory function in fingers].

To assess the validity of a new simplified cold water immersion test (4 degrees C-1 min method) for peripheral circulatory function, comparison was made with the conventional method (10 degrees C-10 min method). These two different methods of cold immersion test were applied to 23 patients with vibration disease and 24 healthy men. Observation was made on finger skin temperature by a thermistor and complaints in the hand by a 5-step self-reported scale method every minute during the test. The patterns of recovery of skin temperature after cold immersion in each group were similar in both methods. Pain in the hand in the 4 degrees C-1 min method was less than that in the 10 degrees C-10 min method. The recovery rate at 5 min in the patients with Raynaud's phenomenon was lower than that in those without Raynaud's phenomenon in the 4 degrees C-1 min method (p < 0.01). However, no significant differences were noted in 10 degrees C-10 min method. The results suggest that the new method is feasible in detecting the response of vasodilation after immersion. In the recovery rate at 5 min after immersion, near values of the sensitivity and specificity were observed between 50% cut-off values in the 4 degrees C-1 min method and 30% value in the 10 degrees C-10 min method. Thus, the 4 degrees C-1 min method is considered to be more useful to evaluate the physiological response after cold immersion than the 10 degrees C-10 min method.

Hemodynamic changes in skin microcirculation induced by vibration stress in the conscious rabbit.

Cutaneous microcirculatory responses to vibration stress were observed by microphotoelectric plethysmography in a transparent round window installed in the ears of conscious rabbits. Vertical vibrations at frequencies ranging from 8 to 250 Hz were applied to the abdomen of the rabbits for 5 min. The vibrations produced an increase in heart rate and the index of discomfort, and a decrease in blood flow in the skin microcirculation. The maximum response was observed at 63 Hz. Rhythmic fluctuations in microcirculation were associated with two components: component A had a small amplitude and high frequency, and component B had a large amplitude and low frequency. Vibration exposure led to a large increase in component B and a smaller increase in component A. During vibration exposure, component A was suppressed by treatment with diltiazem, a calcium channel blocker, and was not affected by bunazosin, an alpha-1 adrenoceptor antagonist. The opposite changes were observed for component B. This indicates that components A and B of the rhythmic fluctuations are regulated by myogenic and neurogenic activities, respectively. Thus, the hemodynamic changes of skin microcirculation induced by vibration may actually be due to a neurogenic factor, especially sympathetic nerve activity. The responses appear to depend on the frequency of the vibrations.

Cardiovascular reflexes during vibration stress.

Vibration disease due to hand-held vibratory tools has various symptoms and signs which can be characterized by the severity. They include disorders of the central and autonomic nervous systems, as well as peripheral system disorders. The mechanism of Raynaud's phenomenon in vibration disease is proposed to be: Vibration and cold affect the local vessels and nerves directly, leading to enhanced release of chemical vasoconstrictors. Vibration, noise, cold, ergonomic and biodynamic conditions, and emotional stress during work result in disorders of the central and autonomic nervous systems. In the early stages, the autonomic nervous system may be stimulated, and in the later stages it is suppressed. When local vessel injuries and disorders of the central and local autonomic nervous mechanisms controlling the vessels occur, vasospasms in the fingers develop when the whole body is exposed to cold. The cardiovascular system, other than the peripheral circulatory system, may adapt to vibration stress. The adaptation subsides 7 to 8 years after discontinuation of the use of hand-held vibratory tools.

Frequency dependence of the suppressive effects of vibration on atherosclerosis in the rabbit.

Whole-body vibration suppresses the development of atherosclerosis in the rabbit (Oki and Matoba, 1987). The present study was designed to clarify whether the effect of vibration on atherosclerosis depends on the frequency of vibration. Longitudinal vibrations at a frequency of 30 or 60 Hz was applied to 12 New Zealand white rabbits for 12 weeks. The gradual decrease in body weight and blood hematocrit in the vibration groups with time were parallel to the changes in the controls. The rate of increase in serum lipid concentrations induced by a cholesterol-rich diet was significantly suppressed in the vibration groups, as compared to the controls. This may be due to the vibration and not the diet. The aortic wall was thinner at 60 Hz than at 30 Hz, whereas the ratios of trace metals (Ca/Mg and Zn/Cu) in the aortic tissues were smaller at 30 Hz. The area of plaque formation in the intima was smaller at 60 Hz than at 30 Hz (p less than 0.05). Thus, the suppressive effect of vibration on the development of atherosclerosis in the aorta may be greater at a frequency of 60 Hz than at 30 Hz. Vibration may play an important role in lipid metabolism.