Those Who Have Continuing Radiation Anxiety Show High Psychological Distress in Cases of High Post-Traumatic Stress: The Fukushima Nuclear Disaster.

BACKGROUND: this cross-sectional study aimed to clarify the associations among media utilization, lifestyles, and the strong radiation anxiety that has persisted 9 years after the 2011 nuclear accident. Moreover, the relationships among psychological distress, post-traumatic stress, and strong radiation anxiety were examined. METHODS: for the multivariate regression analysis, the independent variables were radiation anxiety at the time of the accident and the current status, categorized as "continuing/emerging strong radiation anxiety". Media utilization (local, national, internet, and public broadcasts, and public relations information) and lifestyle variables (sleep quality, regular exercise, and drinking habits) were set as the dependent variables. Moreover, the psychological distress of residents with continuing/emerging strong radiation anxiety was examined by an analysis of covariance stratified by post-traumatic stress. RESULT: there was no significant association between lifestyle variables and media utilization, except for local media (OR: 0.435, 95% CI: 0.21-0.90). Conversely, significantly high psychological distress was confirmed among residents with continuing/emerging radiation anxiety. The K6 score, representing psychological distress, for those with higher post-traumatic stress was 12.63; for those with lower post-traumatic stress, it was 5.13 (p = 0.004). CONCLUSIONS: residents with continuing/emerging strong radiation anxiety showed high psychological distress, which has been strengthened by higher post-traumatic stress.

Current Psychological Distress, Post-traumatic Stress, and Radiation Health Anxiety Remain High for Those Who Have Rebuilt Permanent Homes Following the Fukushima Nuclear Disaster.

Objective: The Fukushima Daiichi nuclear disaster in 2011 produced psychological reactions among evacuees. Despite the harsh situation, subsequently, there has been gradual progress in reconstruction, with more than half of the evacuees returning after the evacuation. Our hypothesis is that evacuee mental health will now be better due to new stable living conditions. This study aims to clarify the statuses of psychological distress, post-traumatic stress, and radiation health anxiety among evacuees who have rebuilt permanent homes after evacuation. Methods: A cross-sectional questionnaire survey of 1600 residents was conducted in 2020. As primary outcomes, the survey measured psychological distress (Kessler 6), post-traumatic stress (post-traumatic stress four-item checklist), and radiation health anxiety. The data are compared for residents who have rebuilt permanent home and those who did not evacuate. Results: In the co-variant analysis, the statuses of psychological distress (p < 0.001), post-traumatic stress (p < 0.001), and radiation health anxiety (p < 0.001) are found to still be high, with significant differences when compared to those who did not evacuate. These results are still at an equivalent level for the continuing evacuation. Conclusion: Our findings may indicate a necessity for continuing disaster-related mental health activities even though the living conditions have improved.

Associated factors related to participation in general health checkup and survey of the effect of low-dose radiation exposure on health of residents of Fukushima Prefecture after the Fukushima Daiichi nuclear power plant accident.

The Fukushima Daiichi nuclear power plant accident caused radioactive contamination of the surrounding area. In addition to annual health checkups, a survey of the effects of low-dose radiation exposure on health among Fukushima Prefecture residents after the accident has been conducted. Despite health literacy (HL) being recognized as essential to health, its association with participation in these checkups and the survey remains unknown. We aimed to describe the HL status of the Fukushima Prefecture residents and to verify the hypothesis that HL is associated with participation in both checkup and survey. In a cross-sectional study, a questionnaire was sent to 2000 randomly sampled Fukushima Prefecture residents; data from 770 individuals were analyzed. Communicative and critical HL were measured using a 5-point scale. Factors associated with participation were examined using logistic regression. The survey's valid response rate was 38.5%. The average HL score was 3.11 ± 0.81. HL was not associated with checkup or survey participation. Checkup participation was negatively associated with radiation anxiety (odds ratio 0.93, 95% confidence interval 0.86-0.99, p = 0.03). The HL of Fukushima Prefecture residents after the accident was relatively lower than that of the Japanese general population, which may be attributed to difference in educational background. The complexities involved in understanding the effects of radiation on the health of residents could explain why no association between HL and participation in a health checkup and survey was observed. Future studies with a longitudinal design should clarify causality between anxiety and checkup participation.

The Association between Utilization of Media Information and Current Health Anxiety Among the Fukushima Daiichi Nuclear Disaster Evacuees.

The 2011 nuclear disaster in Fukushima was not only a health disaster, but also an information disaster. Although media can promote health communication following disasters, studies have revealed associations between media information and negative psychological reactions. To clarify the relationship between media utilization and current health anxiety due to radiation exposure, a cross-sectional questionnaire survey was conducted in Fukushima. We selected 2000 subjects from evacuation (i.e., 500) and non-evacuation (i.e., 1500) areas by two-stage stratified random sampling. As the independent variable, participants were asked about current health anxiety due to radiation exposure at the time of answering the questionnaire. For utilization of media about radiation exposure, local media, national media, Internet media, public broadcasts, and public relations information from local government were set as the dependent variables. Questionnaire data were analyzed by evacuation type (i.e., forced/voluntary). In a multivariate logistic regression analysis, the use of public relations information was significantly associated with lower anxiety for the forced evacuees (odds ratio: 0.72; 95% confidence interval: 0.56-0.93). Our findings highlight the importance of public relations information from local government in terms of it being associated with lower current health anxiety, and this could potentially aid in preparing for future disasters.

Lingering health-related anxiety about radiation among Fukushima residents as correlated with media information following the accident at Fukushima Daiichi Nuclear Power Plant.

Following the March 2011 accident at Fukushima Daiichi Nuclear Power Plant, many residents of Fukushima have faced anxieties about the health impacts of radiation exposure. Considering that source of information may influence resident anxiety, this study aimed to elucidate the correlation between the two. In addition, a health literacy query was included to examine a possible relationship between anxiety and health literacy skills. A mail survey was conducted in August 2016 among 2000 residents of Fukushima Prefecture aged 20 to 79 years. Survey items included questions about current health anxieties caused by radiation, trusted sources of information about radiation, and media used to obtain information on radiation. The survey valid response rate was 43.4%. Results of multiple linear regression analysis revealed that anxiety was significantly higher for the groups indicating "trust in citizen groups" and "use of internet sites." Anxiety was significantly lower for the groups indicating "trust in government ministries," "trust in local government," and "use of local broadcast television." Also anxiety was significantly lower for groups with higher health literacy. It was found that the significant relationship to anxiety varies depending on the sources of trust and media used. There is a possibility that this was caused by the difference between the contents of each information and media reports. In preparation for any future nuclear accident, government may consider action to improve the media literacy of residents. In addition, improving health literacy of both the recipient and the sender of information can improve access to information and thereby safeguard the health and well-being of the public.

[Deterioration of Healthcare Service Quality Provided by Occupational Physicians Due to Dumping by Health Checkup and Switching Health Checkup Organizations].

INTRODUCTION: From 2007, competitive bidding for procurement became widely employed by the Japanese Government, and health check providers for government workers are selected every year by this method. Deterioration of health check quality due to excessive price competition is a serious concern. The National Federation of Industrial Health Organization (Zeneiren) conducted an investigative research on the contracting of health check providers and occupational physicians in workplaces in 2015-2016 in an effort to prevent low-cost but low-quality health checks. The report of the research is available on the homepage of Zeneiren. In this paper, we provide a brief overview of the report, and deterioration of health check quality due to dumping by and switching of health check providers is discussed from economic and legal viewpoints. METHOD: Information was obtained from articles in print and on the Internet. RESULTS: A questionnaire survey of health check providers revealed that excessive discounts due to both competitive bidding and demand from companies commissioning health checks occurred on a routine basis, and some providers were concerned about worsening business conditions in the future. In a separate questionnaire survey of occupational physicians, it was discovered that they were able to evaluate the quality of health checks, whereas administrative officials responsible for selecting the providers were seldom able to adequately evaluate the health check quality, resulting in contracting providers of questionable quality, which in turn caused considerable dissatisfaction on the part of occupational physicians. Moreover, when health check providers were switched, the reporting format of health check results changed. The physicians did not favor such a change because of the considerably increased workload involved in coordinating past and current data and the risk of decreased occupational health service quality. DISCUSSION: Dumping makes the management of health check providers very difficult and is a cause of loss of social capital. If health check providers of good quality withdraw from the market, the supply of high-quality health checks decreases. This corresponds to external diseconomy caused by dumping on the part of the health check providers and loss of social surplus (economic surplus). CONCLUSIONS: To avoid deterioration of occupational health service due to low-quality health checks and changes in the reporting format, occupational physicians must actively engage in the selection of health check providers of good quality.

Role of the Occupational Physician in Corporate Management of Health Risks: An Important Aspect of Corporate Social Responsibility (CSR).

INTRODUCTION: There are various risks involved in corporate activities conducted both within and outside the corporation. Among these, health risks are very important and should be managed effectively as an integral part of corporate social responsibility (CSR). A corporation is responsible for health impairments caused by its activities and suffers great moral and economic loss when they occur. It is essential that corporate management takes proper preventive measures against such risks. Occupational physicians possess substantial knowledge of health risks in corporations. In this study, we examine the role of occupational physicians in the management of corporate health risks. METHOD: Information was obtained from articles in print and on the Internet. RESULTS AND DISCUSSION: Health risks due to corporate activities involve not only the employees of the corporation but also individuals outside the corporation. Each corporation should effectively use available resources to manage health risks. Occupational physicians are one such valuable resource. However, many corporations do not actively involve occupational physicians in health risk management. According to a current Japanese law, health risks for employees in corporations are managed by occupational physicians, but in general, health risks outside corporations are not. The 1984 Bhopal Disaster in India is an example in which physicians of the corporation were only minimally, if at all, involved in assessing and treating impaired health outside the corporation. The role of occupational physicians should be expanded to include management of health risks outside the corporation. This places a greater burden on the physicians and they must make the effort to train in many academic fields in order to better understand the entire context of health risks due to corporate activities. Some occupational physicians may be hesitant to take on such added responsibilities. Some corporations may not recognize the overall health risks due to its activities and do not understand the merit of occupational physicians working with the management to decrease health risks. However, an occupational physician is an important member of the corporation, so he/she must be involved in the management of health risks not only within the corporation itself, but also outside the corporation from the viewpoint of CSR. Effective management of health risks due to corporate activities should be widely discussed among occupational physicians, business entrepreneurs and managers of the division in charge of corporate health risk management as well as stakeholders. The authors propose expanding the role of occupational physicians to actively manage health risks not only inside but also outside the corporations.

Changes in Streptococcus pneumoniae serotypes in the nasopharynx of Japanese children after inoculation with a heptavalent pneumococcal conjugate vaccine.

In this study, we prospectively investigated changes in Streptococcus pneumoniae serotypes among Japanese children after heptavalent pneumococcal conjugate vaccine (PCV7) inoculation. We acquired nasopharyngeal swabs from the children at each routine PCV7 inoculation and again at least 2 months after the last PCV7 inoculation. We defined 2 periods with regard to each culture: the inoculation period as "the period of pre- or incomplete vaccination" and post-inoculation as "the period of post- or completed vaccination." The prevalence of vaccine-type (VT) pneumococci was significantly reduced from 9.5% in the inoculation-period cultures to 2.9% in the post-inoculation cultures (P < 0.01). There was no statistical difference in the prevalence of non-vaccine-type pneumococci between the inoculation-period and post-inoculation cultures (24.1% versus 23.4%). The protection of PCV7 against nasopharyngeal colonization was inferred from the decrease in VT carriage post-inoculation. The decrease in VT carriage may be conducive to reducing VT transmission within the study area.

[Economic damage caused by lowered prices in the agro-food sector in areas contaminated by radioactive materials leaked from the nuclear power plant severely damaged by the 2011 Great East Japan Earthquake--consideration from the viewpoints of epidemiology, economics and social psychology].

INTRODUCTION: Large amounts of radioactive materials were leaked into the environment from the Fukushima Daiichi Nuclear Power Plant (FDNPP) of the Tokyo Electric Power Company, which was severely damaged by the 2011 Tohoku Region Pacific Coast Earthquake and accompanying tsunami. Economic damage due to lowered prices and supplies of food products produced in the areas contaminated by the radioactive materials leaked from the damaged FDNPP to the agro-food sector in the affected areas is notable. In Japanese, this is known as fuhyo higai. In this study, we investigated fuhyo higai from the viewpoints of epidemiology, economics, and social psychology in an effort to seek solutions. METHOD: Information was obtained from articles in print and on the Internet. RESULTS AND DISCUSSION: Fuhyo higai, or economic damage of the agro-food sector, which is the main industry in the contaminated areas, is serious because it is difficult to reassure the general population regarding food safety. This fuhyo higai does not derive solely from rumor. It has been reported that improving the science literacy of the general population is important as a countermeasure against fuhyo higai, but this may not be effective because of the human social structure and behavior of people who seek subjective safety. Almost all radiological laboratory results of samples of food produced in the contaminated areas were below detectable limits. Very high values were rarely detected. In general, information about the dose-response relationship is obtained under the assumption that there may be error in the response but not in the dose. The rare cases of extremely high radiological values of food samples from the contaminated areas may correspond to large errors in dose. However, it is difficult to deny a high-dose risk. The reported information on the dose-response relationship obtained under the assumption that there is no error in dose is not sufficient. Thus, response, i.e., health risk, cannot be correctly estimated. This leads the general population to choose food products from areas far from the FDNPP over those from the contaminated areas. In order to resolve this problem, thorough decontamination of radioactive areas, including large forests, is necessary for the market to regain competitiveness to the level it was before the accident. The cost of such decontamination is enormous and requires much labor. Decontamination will create employment and is indispensable in restoring the deteriorated economic conditions of the affected areas.

Prevalence and risk factors of nasopharyngeal carriage of Streptococcus pneumoniae in healthy children in Japan.

The findings of this study revealed a 22% prevalence of Streptococcus pneumoniae among healthy children in Japan; the prevalence tended to increase with age. We identified attendance at day-care facilities and the presence of older siblings as the major risk factors associated with pneumococcal carriage. A significant decrease in pneumococcal colonization was observed among children during the summer; however, a seasonal variation was independent of various factors. Our findings suggest that prior immunization with heptavalent pneumococcal conjugate vaccine within the current recommended schedule is required for children exposed to these risk factors.

[Perspective on the nuclear power plant accident caused by the great east Japan earthquake and tsunami: health impairment risks due to pollution by radioactive materials from the damaged plant as recognized by experts and by the general population and role of the experts].

INTRODUCTION: Large amounts of radioactive materials were leaked into the environment from the Fukushima Daiichi Nuclear Power Plant (FDNPP) of the Tokyo Electric Power Company damaged by the 2011 Great East Japan Earthquake and accompanying tsunami. Increased health impairment risks due to the leaked radioactive materials are of concern over a long period of time and over a wide geographical area. From the results of epidemiologic studies conducted after the Chernobyl accident, the health risks are not anticipated to be very marked. The purpose of the present study is to examine (i) the elevated health risks as viewed by the general population, (ii) tolerance to the risks that the general population suffer from their viewpoint, and (iii) the overall picture as seen by researchers and experts in specialized areas of study after the accident. METHOD: Information was obtained from articles in print and on the Internet and by interviewing a psychologist and tens of employees of several corporations. RESULTS AND DISCUSSION: Epidemiologic studies conducted after the severe accident of the nuclear power plant in Chernobyl revealed an elevated risk of thyroid cancer in children due to (131)I while elevated risks due to radioactive materials other than (131)I were not detected. The amount of radioactive materials leaked into the environment from the FDNPP was less than that in Chernobyl. Therefore, it is possible to estimate that health impairment risks due to the leaked radioactive materials from the FDNPP are low. However, it is impossible to conclude a zero risk. It is likely that the general population does not fully understand the health impairment risks due to the leaked radioactive materials from the FDNPP. Although no increased incidences of diseases other than thyroid cancer of children were scientifically shown en masse from studies in Chernobyl, individual risks and results in the future caused by the severe accident of FDNPP cannot be denied. Much of the general population is apt to demand the security of a zero risk from human-generated disasters such as the severe accident of FDNPP. Many are very intolerant of the health impairment risks factors and wish to avoid any risk altogether. The viewpoint of the general population differs considerably from that of epidemiologists and other research experts. Researchers and experts are often well versed in their own specialized areas but ignorant of other areas. Thus, it is difficult to grasp the complete view of an event under consideration. This so-called 'takotsubo' situation is dangerous in human society. Researchers and experts must make effort to understand areas other than their own specialized areas. Scientific researchers usually possess a great deal of conviction from the results of their own studies. They are apt to ignore criticism of their study results from individuals working in other research areas even when the results of their studies are inadequate. When the conditions of their studies are changed somewhat and insufficient information is obtained, the results may not be accurate. Researchers and experts should take full cognizance of this possibility, view with strong skepticism about the results of studies even in their own areas, and listen with humility to criticisms from those working in fields of discipline other than their own. CONCLUSIONS: It should be fully recognized that the viewpoint of the general population is considerably different from that of researchers and experts regarding health risks due to the severe accident of FDNPP. Researchers and experts must make effort to understand the opinions of those working in areas other than their own in order to grasp a true and complete view of an event under consideration.

Clinical experience treating Paecilomyces lilacinus keratitis in four patients.

BACKGROUND: Paecilomyces lilacinus is a saprobic fungus that occasionally causes keratitis in infected patients. Voriconazole, a triazole antifungal agent, is often administered to treat P. lilacinus keratitis, because it is resistant to many antifungal agents. However, some patients may not require voriconazole. Here, we report our experience of treating this infection and compare outcomes between patients treated with or without voriconazole. SUBJECTS: We retrospectively reviewed four cases of infectious keratitis caused by P. lilacinus and compared treatment course and outcomes among the four cases. OBSERVATIONS: P. lilacinus was isolated from corneal cultures in all four cases. Three cases developed corneal perforation and underwent keratoplasty. Voriconazole was given in two cases with severe and refractory infection. Both required long-term treatment despite the effectiveness of voriconazole. They also had a medical history of diabetes and corticosteroid therapy. In two cases that were not treated with voriconazole, the eye conditions improved with a short treatment period (2-3 weeks). Neither of these cases had a medical history of diabetes, nor had they used corticosteroids. CONCLUSION: Although voriconazole is the most useful antifungal agent for treating P. lilacinus keratitis, this infection can be resolved by other treatments. Voriconazole should be offered to patients with diabetes and/or prior corticosteroid use.

Ocular disorders due to eyelash extensions.

PURPOSE: Eyelash extensions are a beauty treatment in which individual synthetic extensions are applied, lash by lash, to natural eyelashes. The procedure is becoming popular worldwide because they seem more natural and last longer than other types of false eyelashes. However, partly because a bonding agent (glue) containing organic substances is applied near the eyes, consultations with ophthalmologic clinics and the National Consumer Affairs Center of Japan have increased annually. In the present study, we investigated eye disorders due to eyelash extensions. METHODS: Ocular disorders were retrospectively investigated in 107 women (age 21-52 years) who visited ophthalmologic clinics in Japan with complaints of eye symptoms resulting from eyelash extensions between March 2007 and March 2010. The patients had no history of eye diseases. Of the patients 42 were 21 to 29 years of age, 44 were 30 to 39 years, 19 were 40 to 49 years, and 2 were 50 to 60 years. Three glues, the ingredients of which are not disclosed, were chemically analyzed for detection of more than 70 substances suspected to be ingredients. RESULTS: The ocular disorders due to eyelash extensions included keratoconjunctivitis due to invasion of glue or removing agents in 64 patients, allergic blepharitis due to glues in 42 patients (4 of these patients developed both keratoconjunctivitis and allergic blepharitis), conjunctival erosion due to eyelid-fixing tapes in 3 patients, allergic blepharitis due to eyelid-fixing tapes in 1 patient, and subconjunctival hemorrhage due to compression during removal of extensions in 1 patient. In all 107 patients, the symptoms were resolved by adequate treatments with eye drops and/or ointments. Ingredient analysis detected formaldehyde in concentrations above the standard threshold level in all 3 glues. In addition, lead and benzoic acid were also detected; however, concentrations of these particular compounds were low and therefore unlikely to cause disorders in humans. CONCLUSIONS: Eyelash extension procedures may cause ocular disorders, such as keratoconjunctivitis and allergic blepharitis; indeed, all glues for eyelash extensions analyzed in the present study contained formaldehyde, which can cause keratoconjunctivitis. From the viewpoint of hygienics, it is necessary to disinfect devices, provide handling instructions for organic solvents, improve glue ingredients, and improve the ophthalmologic knowledge of the practitioners.

Symptoms related to glaucomatous visual field abnormalities among male Japanese workers in a population-based setting.

PURPOSE: To identify symptoms potentially related to glaucomatous visual field abnormalities (VFAs) in a population-based setting, and to assess the applicability of using these symptoms to identify persons at risk of developing glaucoma. METHODS: In this study, 10,214 Japanese male general workers (mean age, 45.3±8.8 years) filled out a self-administered questionnaire and underwent frequency doubling technology (FDT) perimetry testing. The questionnaire inquired about whether the participant was suffering from any of nine symptoms, with scores for each response graded on a four-item Likert scale: 0 (none), 1 (rarely), 2 (sometimes), and 3 (always). Results from the questionnaire were compared among three groups: participants without any VFAs (9767), participants with VFAs as determined by the FDT test (FDT-VFA; 447), and 227 participants (of the 447 FDT-VFA participants) with glaucomatous VFAs who were newly diagnosed by ophthalmologic examinations. RESULTS: The mean summed scores for the total items were significantly (p<0.01) higher in FDT- and glaucomatous VFA groups than in normal subjects. In particular, responses citing the symptoms 'feeling of something in the front of the eye' and 'feeling of hardness to see in dark places' were significantly (p<0.05) more frequent in subjects with FDT- and glaucomatous VFAs than among normal participants. However, the respective areas under the receiver operating characteristic curve of summed scores for the nine total items and for the two items which showed significant differences for the glaucoma groups were 0.57 (95% confidence interval=0.53-0.60) and 0.58 (95% confidence interval=0.54-0.61). CONCLUSION: Although the symptoms 'feeling of hardness to see in dark places' and 'feeling of something in the front of the eye' could be associated with glaucomatous VFA in a population-based setting, inquiring about symptoms is of little aid in identifying subjects with glaucomatous VFA as a strategy for public health.

Health impairment of system engineers working on projects with heavy workload.

It has been reported that many system engineers must work hard to produce computer systems, and some of them suffer from health impairment due to their hard work. The purpose of the present cross-sectional study was to investigate the situation of impaired health status of system engineers in projects with high job strain. Countermeasures against health impairment of the subjects in the projects with high job strain in practices of occupational health fields are discussed. The study subjects were five superiors and their 35 subordinates working on computer system projects with high job strain at a large computer systems corporation in the Tokyo area. The control group was comprised of three superiors and their 18 subordinates in the same corporation. From July to November, 2006, the above were interviewed by six occupational health nurses, who evaluated their health and recorded their health evaluation scores. The problems involved in producing the computer systems were sometimes very difficult to solve, even if they spent long hours working on them. The present study detected a tendency showing that healthy superiors' subordinates were unhealthy and unhealthy superiors' subordinates were healthy in the overload projects with high job strain, while this was not detected in the control groups. A few employees whose health deteriorated were faced with very hard jobs in the overload projects. This means that heavy workloads were unevenly distributed in the overload projects among superiors, and their subordinates, and the health of a few members with heavy workloads deteriorated due to the heavy workload. In order to improve such a situation, it may be important not only to commit the necessary number of employees whose working ability is high to the section but also to even the workload in the overload project by informing all members of the project the health impairment of a few members due to heavy workload, from the viewpoint of the practice of occupational health and risk management.

Effect of a group health education program in the workplace at the age of 35: a population approach.

Using a population approach, we investigated whether a group health education program exerted a preventive effect on checkup items at five years later. Workers turning 35 years old before the initial implementation of the program were entered in the control group (n = 422) and those turning 35 years on this date or after were entered in the intervention group (n = 206). These groups were compared using data obtained from routine health checkups at 35 and 40 years of age. In the intervention group, self-management ability prior to and after completion of the program was compared using a 2 item questionnaire based on the General Self-Efficacy Scale (GSES) and the Health Locus of Control (HLC). In males, the intervention group showed significant inhibition of increases in body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), and gamma-glutamyl transpeptidase (gamma-GTP) compared to the control group. In females, however, a similar outcome was seen for gamma-GTP only. The evaluation index of self-management ability for both GSES and HLC significantly improved among males but did not significantly change among females at five years post-completion of the program. In particular, the group with a high GSES evaluation index experienced significant inhibition of weight gain. As a population approach, adoption of this program in the workplace for males aged 35 years may have an inhibitory effect on five-year weight gain. Further, programs which improve GSES appear effective in inhibiting weight gain.

Relationship between environmental exposure to cadmium and bone metabolism in a non-polluted area of Japan.

OBJECTIVES: The purpose of this study was to investigate the effects of environmental low-grade cadmium exposure on bone in the population of a non-polluted area. We investigated the relationship between environmental cadmium exposure (via rice intake) and bone metabolism in middle-aged and elderly women living in a non-polluted area in Japan. METHODS: Four hundred and twenty-nine women over the age of 39 years (54.6 ± 9.1 years; arithmetic mean ± SD) participated in this study in 2003. We investigated blood and urine, and rice intake, and performed ultrasonic bone evaluation, and obtained individual information about the subjects' health. Multiple regression analysis was performed in the statistical analysis. RESULTS: The arithmetic mean of cadmium content in rice was 70.8 ± 44.7 µg/kg (AM ± SD). The geometric mean of daily cadmium intake (Cd intake) from rice calculated based on food consumption data was 9.12 µg/day (GSD 2.33). The geometric means of serum and urine cadmium concentrations were 1.57 µg/l (GSD 2.11) and 1.93 µg/g creatinine (cr.) (GSD 2.05), respectively. Multiple regression analysis showed positive correlations between (1) urinary free deoxypyridinoline (FDPD-U) and Cd intake (p < 0.05), (2) urinary cross-linked N-telopeptides of type I collagen (NTx-U) and Cd intake (p < 0.05), and (3) FDPD-U or NTx-U and cadmium concentration in urine (p < 0.01). No significant correlation between the parameters of ultrasonic bone evaluation and cadmium associated biomarkers was observed. CONCLUSIONS: The results of the present study suggest the possibility of bone metabolic disorder induced by environmental low-grade cadmium exposure. With respect to osteoporosis, a long-term follow-up survey is required to assess the tolerable intake of cadmium in environmental exposure.

A second national questionnaire survey of TMA.

A second questionnaire survey of Japanese patients with thrombotic microangiopathy (TMA) was carried out to investigate the frequency, laboratory abnormalities and outcome in 2004 and 2005. The first and second surveys evaluated 397 patients including 19 with familial TMA and 378 with acquired TMA. The patients with acquired TMA included 165 with Escherichia coli O-157 infection-related TMA (O-157 TMA), 70 with ADAMTS13-related TMA (ADAMTS13 TMA) and 38 with other types of TMA (other TMA). The rate of ADAMTS13 TMA was significantly higher in patients with collagen diseases than in patients with all other underlying diseases (p < 0.001). The treatment of acquired TMA included plasma exchange (PE), steroids, antiplatelet agents, and anticoagulants, PE was carried out in 91.4% of patients with ADAMTS13 TMA, 68.4% of patients with other TMA and 12.7% of patients with O-157 TMA. The efficacy of PE and steroid therapy tended to be higher in patients with ADAMTS13 TMA than in those with other TMA. The complete remission rate was the highest and the mortality rate was the lowest in the patients with O-157 TMA. The mortality rate tended to be lower in patients with ADAMTS13 TMA than in those with other TMA. However, not all of the patients in our study were examined for ADAMTS13 at the time that this questionnaire survey was conducted.

Additional candidates to conventional genes susceptible for lung cancer and changing trend in Japan.

The polymorphism of CYP1A1*2A or CYP1A1*2B, and the linkage of CYP1A1*2A, CYP1A1*2B, GSTM1 and GSTT1 polymorphisms have been established as susceptible genes or gene-gene interactions of tobacco-related lung cancer. New candidate genes susceptible for lung cancer such as NQO1 (NAD(P)H:quinine oxidoreductase), NAT2 (N-acetyltransferase 2), and several others have been reported. In the present review we focus on new candidate genes susceptible for lung cancer, then examine all Japanese references by meta-analysis on susceptible genes over the past 20 years, and discuss whether new candidates and changing trend in Japan could be caused by environmental change.

Economic analysis of use of counterfeit drugs: health impairment risk of counterfeit phosphodiesterase type 5 inhibitor taken as an example.

OBJECTIVES: The size of the market for counterfeit drugs throughout the world is considerable. Many cases of health impairment due to counterfeits have been reported. The market share of counterfeits in drug markets in developed countries is smaller than that in developing countries. However, the size of the market for counterfeits of phosphodiesterase type 5 inhibitors (PDE5Is) used as anti-erectile-dysfunction drugs is not small. The purpose of the present study was to analyze the health impairment risk of taking the counterfeit PDE5Is and the convenience of obtaining the counterfeits in Japan, using an economic methodology in order to work out countermeasures for reducing the health impairment risk. METHODS: Information was obtained by interviewing employees of pharmaceutical and chemical corporations in Japan. RESULTS AND DISCUSSION: The size of the market for counterfeit PDE5Is in Japan was recently estimated to be about 2.5 times larger than that of genuine PDE5Is. The price of the counterfeits in their market is reported to be nearly equal to that of the genuine PDE5Is. An outbreak of severe hypoglycemia among users of counterfeit PDE5Is containing an antidiabetic drug in Singapore was reported in 2008, and seven patients remained comatose as a result of prolonged neuroglycopenia. Four of them subsequently died, so the health impairment risk due to counterfeit PDE5Is should not be ignored. In order to obtain a genuine PDE5I in Japan, a patient must be examined and have a prescription written at a medical institution, and buy it at a dispensing pharmacy. Focusing on the health impairment risk due to counterfeit PDE5Is and the convenience of obtaining the counterfeits in Japan, we analyzed the effects on the prices and quantities of PDE5Is in the market from demand and supply curves, using an economic methodology. From the analysis, it was shown that the health impairment risk due to the counterfeits is underestimated in the market in Japan. Physicians should warn their patients not to buy counterfeit PDE5Is, and when they write a prescription for purchasing genuine PDE5Is, should inform their patients of the severe health problems that occurred in Singapore. CONCLUSIONS: The present economic analysis indicates that the health impairment risk due to counterfeit PDE5Is is underestimated in the market in Japan. Clarification of the underestimation of the severe health impairment risk due to counterfeits is important.