Exploring factors associated with deterioration in mental health among foreign technical intern trainees: a 6-month follow-up study.

To investigate factors contributing to the mental health of Vietnamese technical intern trainees in the food manufacturing industry, a questionnaire survey was conducted twice with a six-month interval. A total of 111 technical trainees who participated in two surveys were included in the analysis. We used a mixed-effects model, where items with statistically significant associations in the univariate analysis were fixed effects, factories were random effects, and the outcome was defined as the K6 score at follow-up. The mean K6 score increased from 3.13 (SD 3.5) at baseline to 3.86 (SD 4.1) at follow-up, with 26.1% and 34.2% exhibiting poor mental health (K6≥5) at baseline and follow-up, respectively. Insomnia and years of training experience were significantly associated with the K6 score at follow-up. Those with insomnia had significantly higher K6 score at follow-up. Compared to the first year of training, K6 score at follow-up increased significantly for training in their third year or more. It is important to understand the sleeping conditions of trainees and support them based on their years of training experience.

Sarcopenia and excess visceral fat accumulation negatively affect early urinary function after I-125 low-dose-rate brachytherapy for localized prostate cancer.

OBJECTIVES: To evaluate the effects of sarcopenia and excess visceral fat accumulation on early urinary function after I-125 low-dose-rate brachytherapy for prostate cancer. METHODS: We retrospectively reviewed consecutive patients who underwent brachytherapy for prostate cancer. Pre-treatment computed tomography was used to measure skeletal muscle index at the L3 level to assess sarcopenia and visceral fat area at the umbilical level. The International Prostate Symptom Score and the University of California Los Angeles Prostate Cancer Index were used to assess quality of life during the 24 months after brachytherapy. Logistic regression analysis was used to examine whether sarcopenia and excess visceral fat accumulation had clinically significant effects on post-treatment quality of life. RESULTS: Among 246 patients, 92 (37.4%) were stratified into the sarcopenia group and 141 (57.3%) into the excess visceral fat accumulation group. The sarcopenia group had significantly lower University of California Los Angeles Prostate Cancer Index urinary function than the non-sarcopenia group 24 months post-brachytherapy. The excess visceral fat accumulation group had significantly poorer International Prostate Symptom Score total, storage, and voiding scores than the non-excess accumulation group 12 months post-brachytherapy. In the multivariate analysis, sarcopenia had a clinically significant adverse effect on the University of California Los Angeles Prostate Cancer Index urinary function at 12 months. Excess visceral fat accumulation had a clinically significant adverse effect on the International Prostate Symptom Score voiding and storage scores at 12 months. CONCLUSIONS: Sarcopenia and excess visceral fat accumulation negatively affect urinary function early after I-125 low-dose-rate brachytherapy for prostate cancer.

[The Japanese Law Regulating Underwater and Caisson Work: Current Issues and Future Developments].

The Japan "Ordinance on Safety and Health of Work under High Pressure", which is the law regulating health conditions for workers under high pressure environments, was amended in 2014. The revised regulations have highlighted other difficulties and new problems, but they have not yet written an appropriate amendment based on the aspect of occupational and environmental health. Health management for occupational divers and caisson workers in accordance with the new regulations has not determined the best approach to reducing related disorders and will cause other legal problems. This paper presents some issues in the new regulations for hyperbaric workers, which directly or indirectly involve occupational health physicians. Health checkups and work limitations should be done in consideration of the occupational characteristics of the undersea and hyperbaric environment. Regular examinations using specific studies are useful to diagnose the early stages of chronic conditions for workers, and are also useful for determining the hiring suitability for hyperbaric workers. Work limitations should be decided by the conditions that induce serious accidents or disorders that result from exposure to hyperbaric environments, and depend on the obstacles for work due to sequelae of decompression sickness. The new regulations need to be properly revised, based on scientific evidence, to include health management for workers in undersea and hyperbaric environments.

Clinical outcomes of iodine-125 low-dose-rate brachytherapy for localized prostate cancer: a single-institution review in Japan.

Purpose: To evaluate the oncological outcomes and genitourinary and gastrointestinal adverse events in acute and late-phases of iodine-125 low-dose-rate brachytherapy for localized prostate cancer. Material and methods: We retrospectively evaluated 334 patients treated for localized prostate cancer with low-dose-rate brachytherapy. Bio-chemical relapse-free survival, cause-specific survival, and overall survival were evaluated using Kaplan-Meier method and log-rank test. Incidence of adverse events was calculated using National Cancer Institute common terminology criteria for adverse events, version 5. Logistic regression was used to identify independent predictors of acute and late-phase genitourinary and gastrointestinal adverse events. Results: National Comprehensive Cancer Network's low-, intermediate-, and high-risk groups included 133 (39.8%), 163 (48.8%), and 38 (11.3%) patients, respectively. The 5-year cause-specific survival rate was 100%. The 5-year bio-chemical relapse-free survival rates for the low-, intermediate-, and high-risk groups were 98.3%, 95.8%, and 100%, respectively. One patient had a ≥ grade 3 acute adverse event. The 5-year cumulative ≥ grade 1, ≥ grade 2, and ≥ grade 3 genitourinary adverse event rates were 27.9%, 14.4%, and 0.5%, respectively. The 5-year cumulative ≥ grade 1, ≥ grade 2, and ≥ grade 3 gastrointestinal adverse event rates were 3.1%, 1.5%, and 0.5%, respectively. A high pre-treatment international prostate symptom score and non-use of α1-blockers were associated with an increased risk of acute genitourinary adverse events. Conclusions: Low-dose-rate brachytherapy had good oncological outcomes, with acceptable adverse event rates. Pre-treatment urinary function and use of α1-blockers may be useful in predicting and preventing acute genitourinary adverse events.

Severe immersion pulmonary edema in a novice elderly scuba diver after heavy alcohol intake.

BACKGROUND: There are no reports of immersion pulmonary edema induced by excessive alcohol intake. We describe the case of a novice scuba diver who developed apnea due to immersion pulmonary edema during scuba diving after heavy alcohol intake. CASE PRESENTATION: A 71-year-old hypertensive man, without regular antihypertensive therapy, performed diving after excessive alcohol intake (total amount, approximately 253 g) until the night before. When swimming at a depth of 12 m, the patient experienced chest discomfort and ascended immediately but became unconscious. Respiratory arrest was confirmed, and he spat pink foamy sputum. On hospital admission, hypoxemia was confirmed, and chest radiography revealed butterfly-shaped shadows. Therefore, mechanical ventilation was initiated. The next day, his blood oxygenation level improved, and the radiographic shadows disappeared. He was discharged on day 7 of hospitalization without sequelae. CONCLUSION: A scuba diver with untreated hypertension might develop immersion pulmonary edema during diving after heavy alcohol intake.

Decompression Illness in Repetitive Breath-Hold Diving: Why Ischemic Lesions Involve the Brain?

Nitrogen (N2) accumulation in the blood and tissues can occur due to breath-hold (BH) diving. Post-dive venous gas emboli have been documented in commercial BH divers (Ama) after repetitive dives with short surface intervals. Hence, BH diving can theoretically cause decompression illness (DCI). "Taravana," the diving syndrome described in Polynesian pearl divers by Cross in the 1960s, is likely DCI. It manifests mainly with cerebral involvements, especially stroke-like brain attacks with the spinal cord spared. Neuroradiological studies on Ama divers showed symptomatic and asymptomatic ischemic lesions in the cerebral cortex, subcortex, basal ganglia, brainstem, and cerebellum. These lesions localized in the external watershed areas and deep perforating arteries are compatible with cerebral arterial gas embolism. The underlying mechanisms remain to be elucidated. We consider that the most plausible mechanisms are arterialized venous gas bubbles passing through the lungs, bubbles mixed with thrombi occlude cerebral arteries and then expand from N2 influx from the occluded arteries and the brain. The first aid normobaric oxygen appears beneficial. DCI prevention strategy includes avoiding long-lasting repetitive dives for more than several hours, prolonging the surface intervals. This article provides an overview of clinical manifestations of DCI following repetitive BH dives and discusses possible mechanisms based on clinical and neuroimaging studies.

Diving-related disorders in commercial breath-hold divers (Ama) of Japan.

Decompression illness (DCI) is well known in compressed-air diving but has been considered anecdotal in breath-hold divers. Nonetheless, reported cases and field studies of the Japanese Ama, commercial or professional breath-hold divers, support DCI as a clinical entity. Clinical characteristics of DCI in Ama divers mainly suggest neurological involvement, especially stroke-like cerebral events with sparing of the spinal cord. Female Ama divers achieving deep depths have rarely experienced a panic-like neurosis from anxiety disorders. Neuroradiological studies of Ama divers have shown symptomatic and/or asymptomatic ischaemic lesions situated in the basal ganglia, brainstem, and deep and superficial cerebral white matter, suggesting arterial insufficiency. The underlying mechanism(s) of brain damage in breath-hold diving remain to be elucidated; one of the plausible mechanisms is arterialization of venous nitrogen bubbles passing through right to left shunts in the heart or lungs. Although the treatment for DCI in Ama divers has not been specifically established, oxygen breathing should be given as soon as possible for injured divers. The strategy for prevention of diving-related disorders includes reducing extreme diving schedules, prolonging surface intervals and avoiding long periods of repetitive diving. This review discusses the clinical manifestations of diving-related disorders in Ama divers and the controversial mechanisms.

[What is the Best Therapeutic Strategy for Decompression Illness? First Aid Oxygen Inhalation and Hyperbaric Oxygen Therapy].

Decompression illness (DCI), a syndrome following inadequate reduction in environmental pressure, has two forms: decompression sickness and arterial gas embolism after pulmonary barotrauma. Recompression therapy using oxygen, a kind of hyperbaric oxygen therapy, has been considered the gold standard treatment for DCI, although there is no randomized controlled trial evidence for its use. We evaluated the effectiveness of recompression therapy in treating DCI by reviewing the reported therapeutic results of serious DCI, especially neurological disorders. Early or ultra-early recompression therapy did not dramatically improve clinical recovery from DCI symptoms, including spinal cord disorders. In contrast, early first aid normobaric oxygen inhalation highly improved or stabilized clinical conditions of DCI. Based on these clinical results, the international committee for hyperbaric and diving medicine has stated that cases of mild DCI may be managed without recompression therapy. Further work is needed to clarify the clinical utility of recompression therapy for spinal injury as a common symptom of DCI. We also point out that the Japanese decree "Ordinance on Safety and Health of Work under High Pressure", which describes work under hyperbaric environments, has some serious issues and should be amended on the basis of scientific evidence.

Hyperacute brain magnetic resonance imaging of decompression illness in a commercial breath-hold diver.

Decompression illness in breath-hold diving is a rare dysbaric disease mainly characterized by stroke-like neurological disorders. The early use of DWI-MRI combined with ADC map in suspected cases can help in the early diagnosis and treatment.

[Central Nervous System Involvement in Breath-Hold Diving].

Diving accident in breath-hold (BH) divers (Ama) is a stroke-like neurological condition involving the brain. Ama divers are at a risk of ischemic brain injuries which are situated in watershed or terminal zones of cerebral arteries, and/or corticomedullary junctional area of cerebral arteries. The underlying mechanisms of brain damage in BH diving remains to be elucidated. After repetitive BH dives, nitrogen (N2) bubbles may be formed in the venous side of tissues and flow into the right atrium. N2 bubbles passing through the heart or the lungs is the most likely contributing factor. The pathophysiology of diving accident in BH diving is unclear, and more studies for stroke are needed to further elucidate its nature. (Received 29 July, 2019; Accepted 10 January, 2020; Published 1 May, 2020).

Remarkable Improvement in Clinical Course and Serum KL-6 Levels after Initiation of High-Dose Inhaled Budesonide in Pulmonary Sarcoidosis.

We present a pulmonary sarcoidosis patient with specific elevation of serum Krebs von den lungen-6 (KL-6) levels, who was successfully treated with inhaled corticosteroids. Pulmonary sarcoidosis was initially identified as a chest radiograph abnormality during a routine medical examination, and subsequently confirmed by a high serum level of soluble interleukin 2 receptor. The patient was started on high-dose inhaled budesonide because of high serum levels of angiotensin-converting enzyme (ACE) and KL-6. Following treatment, radiographic findings improved, ACE levels normalized, and serum KL-6 levels markedly decreased. No recurrence was detected at 100 months with a budesonide dosage of 800 µg/day. This case demonstrates the efficacy of highdose inhaled corticosteroids for the initial treatment of pulmonary sarcoidosis.

Advantages of the Variable Shift System, and Effective Use of Break Time to Better Support the Work Engagement of Nurses on Extended Day Shifts.

OBJECTIVES: The aim of this study is to clarify factors that support the work engagement of nurses, who bear the burden of extended day shifts, by focusing on the advantages of the variable shift system and workday break activities. METHODS: Nurses who were working under a variable shift system were asked to complete a self-report questionnaire to examine the workload, work engagement, work stressors, stress-coping strategies, and stress-coping break time activities, as well as the advantages and disadvantages of the variable shift system. Nine break activities were classified into the following four categories: social activities, rest/relaxation, entertainment, and cognitive activities. The advantages or disadvantages of the variable shift system were scored by developing composite variables using principal component analysis. These variables were used to perform a multiple regression analysis with work engagement as the dependent variable. RESULTS: The advantage score was the variable most strongly correlated with work engagement. In contrast, "Quantitative workload" was negatively correlated with work engagement. Among break activities, in the social activities category correlations were observed in "Both conversation and Email/SNS" and "Conversation only". Although in fact most nurses chose conversation as one of the break options, more than half of the nurses selected rest/relaxation as their ideal break activity. CONCLUSION: Our study suggested that the variable shift system supported the work engagement of nurses who worked extended day shifts. The results also suggested that it would be useful to arrange the employee lounge environment so that employees could freely choose between "conversation" or "taking a rest" depending on the circumstances.

[Present Situation of Wind Turbine in Major European Countries and Outlook of Wind Turbine in Japan].

The Renewable energy is a key driver of generating clean energy because it continuously lower air pollution. In particular, the development of wind power energy has been remarkable, and it currently accounts for approximately one-third of renewable electricity. Germany has the largest onshore wind deployment. On the other hand, the United Kingdom is most highly expected to develop offshore wind power. Germany and Denmark have assessed the usefulness of wind turbines, and they benefited from wind energy. Execution of not only environmental impact assessment (EIA) but also health impact assessment (HIA) is an obligation in the United Kingdom, the practice of EIA and HIA is important for the successful construction of wind turbine facilities. We in Japan should learn the method of handling renewable energy systems from major European countries.

The relationship of sleep complaints risk factors with sleep phase, quality, and quantity in Japanese workers.

Numerous studies have determined that lifestyle factors (smoking, drinking, snacking, etc.) and the bedroom environment can influence sleep. We developed a new sleep scale-the 3-Dimensional Sleep Scale (3DSS)-which measures three elements of sleep: phase, quality, and quantity. The purpose of this study is to determine which risk factors of sleep complaints are associated with these sleep elements. Data were obtained from 366 Japanese day workers (302 men and 64 women). Sleep condition was assessed with the 3DSS, and we also assessed various habits within 2 h of going to bed, including smoking, drinking, snacking, caffeine intake, mobile phone use, and working. We also asked about bedroom environmental conditions (noise, lighting, and temperature and humidity). Multivariate logistic regression analysis using the backward selection method (likelihood ratio) was used, with 3DSS scores as the outcome (i.e., over or under the cutoff). The results showed that smoking was associated with significantly greater odds ratio [2.71 (1.65-4.44)] of disordered sleep phase, while lighting as well as temperature and humidity led to greater odds [3.67 (1.55-8.68), 1.93 (1.20-3.11)] of poor sleep quality. Finally, only noise was significantly related to greater odds [1.98 (1.13-3.46)] of low sleep quantity. These findings indicated the various risk factors of sleep complaints could be associated with different sleep elements. This might help in the effective treatment of sleep complaints.

Influences of low-frequency and other noises produced by wind turbines: An epidemiological literature review.

Objectives　Due to its' environment-friendly and clean energy characteristics, wind power has been increasingly used globally, particularly in advanced countries. However, concerns about health hazards, especially due to low-frequency and other noises generated from wind turbines, have been reported repeatedly. In order to manage adverse health effects appropriately, regulatory standards or guidelines that consider the health of residents need to be developed. To provide a scientific basis for the development of such regulatory standards and guidelines, this paper conducted a literature review to analyze epidemiological studies involving residents living in the vicinity of wind farms.Methods　Using the PubMED database, epidemiological papers that examined the health effects of noises produced by wind turbines were searched and collected. Additional papers were collected from the abstracts presented at relevant international academic conferences such as the Inter-Noise 2013 and Wind Turbine Noise 2015. An evidence table comprising the study design, subjects, exposure assessment, outcomes, confounders, and research results of each selected study was created.Results　A total of 11 papers were collected (2 of which were abstracts from the international academic conferences). These studies reported outcomes such as perception of noises, annoyance caused by the noises, and the association of the noises with stress and sleeplessness. Significant associations between the noises or annoyance produced by wind turbines and subjective adverse health effects were reported repeatedly. Two studies reported an odds ratio of 1.1 for an increase of 1 dB in the A-weighted sound pressure level as a factor representing the influence level. For other factors, it was not possible to compare the magnitude of the impact among the collected studies. Individual attitudes toward wind power and landscapes, economic benefits of wind farms, visibility of wind turbines, sensitivity to sounds, and concerns over health hazards were reported as confounders.Conclusion　Significant associations between the noises or annoyance produced by wind turbines and subjective adverse health effects were reported repeatedly. However, there was insufficient evidence to conclude whether the annoyance was caused by the psychological response to the construction of wind farms or by the actual exposure to noises generated by wind farms.

Cerebrospinal vascular diseases misdiagnosed as decompression illness: the importance of considering other neurological diagnoses.

The diagnosis of decompression illness (DCI), which is based on a history of decompression and clinical findings, can sometimes be confounded with other vascular events of the central nervous system. The authors report three cases of divers who were urgently transported to a hyperbaric facility for hyperbaric oxygen treatment of DCI which at admission turned out to be something else. The first case, a 45-year-old experienced diver with unconsciousness, was clinically diagnosed as having experienced subarachnoid hemorrhage, which was confirmed by CT scan. The second case, a 49-year-old fisherman with a hemiparesis which occurred during diving, was diagnosed as cerebral stroke, resulting in putaminal hemorrhage. The third case, a 54-year-old fisherman with sensory numbness, ataxic gait and urinary retention following sudden post-dive onset of upper back pain, was diagnosed as spinal epidural hematoma; he also showed blood collection in the spinal canal. Neurological insults following scuba diving can present clinically with confusing features of cerebral and/or spinal DCI. We emphasize the importance of considering cerebral and/or spinal vascular diseases as unusual causes of neurological deficits after or during diving.