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.

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.

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.

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.

[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.

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.

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.

Inequality in the health status of workers in small-scale enterprises.

BACKGROUND: Small-scale enterprises (SSEs) usually share poorer resources for promoting occupational health. AIM: To investigate inequality of health status among SSEs in Japan. METHOD: A cross-sectional, multiple-centred study was carried out using the periodical health check-up data for the fiscal year 2000 to compare the age-adjusted proportions of workers with hypertension (HT), hyperlipidaemia, impaired glucose tolerance (IGT) and obesity and of current smokers by size of enterprise, i.e. or=1000 employees in Japan. RESULTS: From five leading occupational health organizations, data were collected for 9833 enterprises with a total of 436 729 subjects, 302 383 males and 134 346 females. The proportions of workers in SSEs with or=50 male employees. The prevalence of smokers in SSEs with or=50 male employees. These proportions showed a significantly increasing tendency with decreasing size of male workforce. CONCLUSION: Despite the cross-sectional design and only adjusting age as a potential confounder, higher proportions of HT, IGT, obesity and smoking in male workers were found in SSEs compared to larger organizations.

A retrospective cohort study among iron-steel workers in Anshan, China: exposure assessment.

Although adequate assessment of exposure is needed in epidemiological studies among foundry workers, previous studies are often lacking in this aspect. We conducted a retrospective cohort study of a Chinese iron and steel company with a 14-yr follow up during 1980-1993. Exposure assessment was performed for a single job, i.e., the current job for the active worker and the longest job for the retired or deceased worker as of the end of the follow-up, which was allocated as the surrogate of lifetime job and was applied to a job-exposure matrix. Of the 147,062 cohort members, 52,394 males (43%) and 5,291 females (21%) were exposed to any of 15 hazardous factors such as dust, silica, PAHs (polycyclic aromatic hydrocarbons), CO (carbon monoxide) and heat. In 2,104 randomly selected samples, the exposure assessment of exposed workers based on a single job was found to be 12-14% lower than the real situation. This study suggests that the exposure assessment is valuable in evaluating the health effects among the foundry workers, despite some limitations such as underestimation of exposure assessment and the lack of data regarding smoking and drinking habits.

[Overwork and its health effects--current status and future approach regarding Karoshi].

The word karoshi, i.e. death due to overwork, is not defined for medical diagnosis, but in Japan it means cases of compensation awarded by reason of fatal occupational diseases, particularly ischemic heart diseases and cerebrovascular diseases which are recognized as caused by a heavy workload. Current studies have shown that 1) almost definitely there is evidence of an association between overwork and cardiovascular diseases and the risk factors were found, 2) no reports have been published on evidence of a causal relationship between overwork and fatal effects even though the possibility remains, and 3) the adverse health effects can vary according to workers' characteristics such as gender, age, stress coping and perception. Recently there has been an increase in the proportion of compensated cases versus claims from 3.1% in the 1988 fiscal year to 20.7% in the 2001 fiscal year. This may be related to the deregulation of criteria for compensation, or nintei-kijun. The period of determination of overwork for victims has been extended to a maximum of six months in the newest criteria set in 2001, up from only one week in the criteria set in 1987. According to sociological analysis, long working hours in Japan are related not only to the structure of the working-time system but also the sociocultural background of labor. In 2002, the Japanese government provided the first countermeasures for the prevention of karoshi for all employees stating that they should not work more than 45 h overtime per month and that government intervention in the form of administrative guidance to employees and their employers should be conducted if overtime exceeds 100 h per month. It is a population strategy targeting all workers equally, not just a high-risk strategy targeting only those with some risk factors, and is expected to provide more fruitful results with flexibility, i.e. differentially reinforced management for older workers and those working under highly stressful conditions with harmonization of the production cycle in the workplace. Occupational health professionals such as occupational health physicians and nurses will play a key role in making break-throughs to solve various problems related to karoshi, which may then result in further investigations to provide scientific evidence for policy making.