Shorter sleep duration is associated with potential risks for overwork-related death among Japanese truck drivers: use of the Karoshi prodromes from worker's compensation cases.

PURPOSE: We aimed to cross-sectionally investigate how work and sleep conditions could be associated with excessive fatigue symptoms as an early sign of Karoshi (overwork-related cerebrovascular and cardiovascular diseases; CCVDs). METHODS: We distributed a questionnaire regarding work, sleep, and excessive fatigue symptoms to 5410 truck drivers, as the riskiest occupation for overwork-related CCVDs, and collected 1992 total samples (response rate: 36.8%). The research team collected 1564 investigation reports required for compensation for Karoshi. Of them, 190 reports listed the prodromes of Karoshi, which were used to develop the new excessive fatigue symptoms inventory. RESULTS: One-way analyses of variance showed that the excessive fatigue symptoms differed significantly by monthly overtime hours (p < 0.001), daily working time (p < 0.001), work schedule (p = 0.025), waiting time on-site (p = 0.049), number of night shifts (p = 0.011), and sleep duration on workdays (p < 0.001). Multivariate mixed-model regression analyses revealed shorter sleep duration as the most effective parameter for predicting excessive fatigue symptoms. Multiple logistic regression analysis confirmed that the occurrences of CCVDs were significantly higher in the middle [adjusted ORs = 3.56 (1.28-9.94)] and high-score groups [3.55 (1.24-10.21)] than in the low-score group. CONCLUSION: The findings suggested that shorter sleep duration was associated more closely with a marked increase in fatigue, as compared with the other work and sleep factors. Hence, ensuring sleep opportunities could be targeted for reducing the potential risks of Karoshi among truck drivers.

The Bioactive Peptide SL-13R Expands Human Umbilical Cord Blood Hematopoietic Stem and Progenitor Cells In Vitro.

Hematopoietic stem and progenitor cell (HSPC) transplantation is a curative treatment of hematological disorders that has been utilized for several decades. Although umbilical cord blood (UCB) is a promising source of HSPCs, the low dose of HSPCs in these preparations limits their use, prompting need for ex vivo HSPC expansion. To establish a more efficient method to expand UCB HSPCs, we developed the bioactive peptide named SL-13R and cultured UCB HSPCs (CD34+ cells) with SL-13R in animal component-free medium containing a cytokine cocktail. Following 9 days of culture with SL-13R, the numbers of total cells, CD34+, CD38- cells, and hematopoietic stem cell (HSC)-enriched cells were significantly increased relative to control. Transplantation of cells cultured with SL-13R into immunodeficient NOD/Shi-scid/IL-2Rγ knockout mice confirmed that they possess long-term reconstitution and self-renewal ability. AHNAK, ANXA2, and PLEC all interact with SL-13R. Knockdown of these genes in UCB CD34+ cells resulted in reduced numbers of hematopoietic colonies relative to SL-13R-treated and non-knockdown controls. In summary, we have identified a novel bioactive peptide SL-13R promoting expansion of UCB CD34+ cells with long-term reconstitution and self-renewal ability, suggesting its clinical use in the future.

Calibration and Testing of Small High-Resolution Transition Edge Sensor Microcalorimeters with Optical Photons.

Pulses of narrow line-width optical photons can be used to calibrate and test sub-2 eV full-width at halfmaximum (FWHM) energy resolution transition-edge sensor (TES) microcalorimeters at low energies (< 1 keV), where it is very challenging to obtain X-ray calibration lines comparable to (or narrower than) the detector resolution. This scheme depends on the ability to resolve the number of 3 eV photons in each pulse, which we have recently demonstrated up to photon numbers of about 300. At LTD-18 we showed preliminary results obtained with this technique on a 0.25 eV baseline resolution TES microcalorimeter designed for the ultra-high-resolution subarray of the Lynx mission. The line-shape was well described by a simple Gaussian. However, the difficulty of delivering photons to the small 46 µm square absorbers resulted in a large thermal crosstalk signal, whose random nature is expected to rapidly degrade the observed energy resolution towards higher photon numbers/energies. We have since improved the coupling between the optical fiber and the TES absorber and report here our current results.

Upregulation of renal Na-K-2Cl cotransporter 2 in obese diabetes mellitus via a vasopressin receptor 2-dependent pathway.

Na-K-2Cl cotransporter 2 (NKCC2) in thick ascending limb (TAL) in the kidney plays a central role in tubuloglomerular feedback (TGF) system by sensing NaCl delivery to the distal tubules. Although accumulating data indicate that dysregulated TGF contributes to the progression of diabetic complications, the regulation of NKCC2 in diabetes mellitus (DM) remains unclear. We here show that NKCC2 is overactivated via a vasopressin receptor 2 (V2R)-dependent mechanism in db/db mice, a mouse model of obese DM. Compared with db/+ mice, we found that both aquaporin 2 and NKCC2 levels were significantly increased in the kidney in db/db mice. Immunohistochemical analysis of V2R and NKCC2 in the kidney demonstrated that V2R is present in the TAL, as well as in the collecting duct. Moreover, the administration of tolvaptan, a selective V2R antagonist, sharply decreased aquaporin 2 and NKCC2 in db/db mice, confirming the causal role of V2R signaling in NKCC2 induction in this model. Although tolvaptan reduced aquaporin 2 abundance also in db/+ mice, its effect on NKCC2 was modest compared with db/db mice. In total kidney lysates, uromodulin expression was not altered between db/+ and db/db mice, suggesting that V2R signaling alters NKCC2 without altering uromodulin levels. These data implicate the dysregulation of NKCC2 in the pathophysiology of type 2 DM, and underscore the complex nature of fluid volume disorders in diabetic kidney disease.

The effect of sleep restriction and psychological load on the diurnal metabolic changes in tryptamine-related compounds in human urine.

OBJECTIVE: The effect of a severely stressful situation (sleep restriction and psychological load) on the diurnal changes in novel tryptamine-related compounds (hydroxydiacetyltryptamine, sulphatoxymelatonin, and dihydromelatonin) was evaluated in human subjects for 16 days. METHODS: The subjects were allowed to sleep for 5 h on days three through 12 and for 8 h on the other days. On days three through 12, the subjects were asked to perform a psychological task. The first two and the last 4 days were viewed as control days. A performance test was administered to evaluate the extent of the subjects' fatigue. Total urine was sampled by collecting it into bottles three times a day [(1) during the sleeping period, (2) in the morning, and (3) in the afternoon]. Seven tryptamine-related compounds in urine were assayed using HPLC-fluorometry. RESULTS: The urine melatonin level was high at night and low during the day. In contrast, urinary levels of hydroxydiacetyltryptamine and sulphatoxydiacetyltryptamine were low at night and high during the day. Dihydromelatonin was undetectable in urine during the sleeping period. Sleep restriction and psychological load did not affect diurnal changes in urinary melatonin, hydroxydiacetyltryptamine, sulphatoxydiacetyltryptamine, or N-acetylserotonin levels. The concentrations of hydroxymelatonin and sulphatoxymelatonin in urine did not show diurnal changes and decreased gradually during the experimental days. A principal component analysis confirmed the diurnal changes and suggested two novel metabolic pathways: (1) N-acetylserotonin to sulphtoxydiacetyltryptamine via hydroxydiacetyltryptamine, and (2) melatonin to dihydromelatonin. CONCLUSION: Severely stressful situations did not affect diurnal changes in melatonin, hydroxydiacetyltryptamine, sulphatoxydiacetyltryptamine, or N-acetylserotonin levels in urine.

Prevalence of self-reported finger deformations and occupational risk factors among professional cooks: a cross-sectional study.

BACKGROUND: Previous studies have pointed out that the school lunch workers in Japan are suffering from work-related disorders including finger deformations. The purpose of this study was to investigate the prevalence of self-reported finger deformations and the association with job-related risk factors. METHODS: A cross-sectional questionnaire study of 5,719 subjects (response rate: 81%, 982 men and 4,737 women) was undertaken during September 2003 to February 2004. RESULTS: Finger deformations were found among 11.7% of the men and 35.6% of the women studied, with significant differences among sex, age and sex-age groups. For both men and women the pattern of finger deformations across the hand was similar for the right and the left hand. For women, the deformations were found in about 10% of the distal interphalangeal joints of all fingers. Based on multiple logistic regression analyses, the factors female sex, age, the number of cooked lunches per cook and cooking activities were independently associated with the prevalence of finger deformations. High prevalence odds ratios were found for those frequently carrying or using tools by hands such as delivering containers, distributing meals, preparing dishes, washing equipment, cutting and stirring foods. CONCLUSIONS: Among the school lunch workers studied, women had a higher prevalence of finger deformations on all joints of both hands. Various cooking tasks were associated with the prevalence of finger deformations. The results suggest that improvements in working conditions are important for preventing work-related disorders such as finger deformations.

Lung-to-finger circulation time can be measured stably with high reproducibility by simple breath holding method in cardiac patients.

Lung to finger circulation time (LFCT) has been used to estimate cardiac function. We developed a new LFCT measurement device using a laser sensor at fingertip. We measured LFCT by measuring time from re-breathing after 20 s of breath hold to the nadir of the difference of transmitted red light and infrared light, which corresponds to percutaneous oxygen saturation. Fifty patients with heart failure were enrolled. The intrasubject stability of the measurement was assessed by the intraclass correlation coefficient (ICC). The ICC calculated from 44 cases was 0.85 (95% confidence interval: 0.77-0.91), which means to have "Excellent reliability." By measuring twice, at least one clear LFCT value was obtained in 89.1% of patients and the overall measurability was 95.7%. We conducted all LFCT measurements safely. High ICCs were obtained even after dividing patients according to age, cardiac index (CI); 0.85 and 0.84 (≥ 75 or < 75 years group, respectively), 0.81 and 0.84 (N = 26, ≥ or < 2.2 L/min/M2). These results show that our new method to measure LFCT is highly stable and feasible for any type of heart failure patients.

A Possible, Non-Invasive Method of Measuring Dynamic Lung Compliance in Patients with Interstitial Lung Disease Using Photoplethysmography.

BACKGROUND: Measuring lung compliance is useful for evaluating progression of interstitial lung disease (ILD), because reduced lung compliance due to fibrosis progression is the main cause of decreased vital capacity. However, because insertion of a balloon into the esophagus is invasive, lung compliance is rarely measured. A recently developed method uses fingertip photoplethysmography to estimate intrathoracic pressure. This method non-invasively measures lung dynamic compliance (Cdyn) by simultaneously measuring tidal volume. We evaluated the efficacy of this method in assessing ILD. METHODS: This single-center, cross-sectional, observational study evaluated the efficacy of this method in patients with ILD and healthy controls. The primary outcome was estimated Cdyn (eCdyn), as determined with this method. We also evaluated baseline characteristics that are potential confounding factors for eCdyn. RESULTS: Median eCdyn was significantly lower in the ILD group (n = 14) than in the control group (n = 49) (0.122 vs. 0.183; P = 0.011). In univariate regression analysis, eCdyn was significantly correlated with height, weight, forced vital capacity, forced expiratory volume in 1 second, diffusing capacity for carbon monoxide, and usual interstitial pneumonia. In multivariate regression analysis, weight (ß = 0.49, P = 0.011) and usual interstitial pneumonia (ß = 0.52, P = 0.007) were significantly correlated with eCdyn. CONCLUSIONS: Using photoplethysmography, we noted a significant reduction in Cdyn in patients with ILD. This novel non-invasive method is a promising tool for evaluating fibrosis progression in ILD.

V-shaped trough in autonomic activity is a possible precursor of life-threatening cardiac events.

BACKGROUND: No reliable precursor of sudden cardiac death is known. METHODS AND RESULTS: Holter electrocardiograms of 34 patients experiencing a cardiac event (event group, 20 deaths) were compared with 191 controls (no event group). The event group included 25 patients with ventricular fibrillation or acute myocardial infarction (AMI), and 9 with cardiac arrest due to complete atrioventricular block. The logarithms were calculated of the moving average of 5 successive values for the low-frequency component (LF), the high-frequency component (HF), and the ratio LF/HF of heart rate variability: ln(LF), ln(HF) and ln(LF/HF). A V-shaped trough appeared in the curve of ln(LF/HF) [sV-trough] or ln(HF) [pV-trough] before such an event in 31 patients in the event group. The V-trough was marked by a small variation lasting 2 h, an abrupt descent lasting 30 min, and a sharp ascent for 40 min. An sV-trough was observed in 22 patients before the onset of ventricular fibrillation or AMI. A pV-trough was observed in all 9 patients before the onset of complete atrioventricular block. In the no event group, an sV-trough and a pV-trough were observed in 10 subjects (5%) and 20 subjects (10%), respectively. The positive predictive accuracy of an sV-trough for ventricular fibrillation or AMI and that of a pV-trough for complete atrioventricular block was 88% and 100%, respectively. CONCLUSIONS: A previously unidentified V-trough of autonomic activity is a potential precursor of lethal events.

Local temperature control improves the accuracy of cardiac output estimation using lung-to-finger circulation time after breath holding.

As timely measurement of the cardiac index (CI) is one of the key elements in heart failure management, a noninvasive, simple, and inexpensive method of estimating CI is keenly needed. We attempted to develop a new device that can estimate CI from the data of lung-to-finger circulation time (LFCT) obtained after a brief breath hold in the awake state. First, we attempted to estimate CI from the LFCT value by utilizing the correlation between 1/LFCT and CI estimated with MRI. Although we could obtain LFCT from 45 of 53 patients with cardiovascular diseases, we could not find the anticipated relation between 1/LFCT and CI. However, we realized that when we adopted only LFCT from patients with a finger temperature of ≥31°C, we could obtain a consistent and clear correlation with CI (correlation coefficient, r = .81). Thus, we next measured LFCT before and after warming the forearm. We found that LFCT decreased after the local temperature increased (from 27.5 ± 13.6 to 18.4 ± 5.3 s, p < 0.01). The correlation between the inverse of LFCT and CI improved after warming (1/LFCT vs. CI, from r = .69 to r = .82). The final Bland-Altman analysis between the measured and estimated CI values revealed that the bias and precision were -0.05 and 0.37 L min-1  m-2 , respectively, and the percentage error was 34.3%. This study clarified that estimating CI using a simple measurement of LFCT is feasible in most patients and a low fingertip temperature strongly affects the CI-1/LFCT relationship, causing an error that can be corrected by proper local warming.

Assessing the effect of mandatory progress reporting on treatment requirements identified during health examinations at the Fukushima Daiichi Nuclear Power Plant: A time series analysis.

OBJECTIVES: At the Fukushima Daiichi Nuclear Power Plant, run by the Tokyo Electric Power Company, new procedures were introduced as part of the fitness for duty program in July 2016. These were designed to ensure that treatment and further investigations identified as necessary during health examinations were carried out. This study aimed to assess the effectiveness of the initiative by testing whether workers who needed further health examinations obtained them promptly, and whether the number with unmet health needs decreased and the number of workers being treated increased. METHODS: The primary contractors reported aggregated quarterly results of health examinations of both their own and their subcontractors' employees, and follow-up visits to medical institutions were also reported over the next two quarters. The study used data for the period from July 2016 to December 2018. Incident rate ratios were estimated using a multilevel Poisson regression model, including the logarithm of the number of workers who took health examination for each primary contractor company as offset. The linear trend was assessed by treating the number of periods as a continuous variable. RESULTS: The incident rate ratio for workers who needed treatment having a follow-up examination promptly showed a significant decrease over time. The incident rate ratio for those with unmet needs decreased, and those being treated increased over time. CONCLUSIONS: The findings showed that the initiative was effective, with the number of early visits for further health examinations increasing and a decrease in the number of people with unmet health needs.

Follow-Up of Occupational Health Issues and Measures Taken in Fukushima Daiichi Nuclear Power Plant Where Decommissioning Work Has Continued Over 6 Years Since 2014.

OBJECTIVES: To follow up arising occupational health (OH) issues, measures taken, and their performances in the Fukushima Daiichi Nuclear Power Plant since 2014, and thus share experiences and extend the contribution of OH to long-term decommissioning work and preparation for future disasters. METHODS: Necessary information from official reports and through the OH-related activities involved was collected and analyzed. RESULTS: The issues were categorized into establishment of the OH management system, three individual issues, and others. During the 6 years until end 2019, the OH management system has been strengthened and OH measures have been enriched gradually by visualizing the broader picture, even though some resistance and problems have been encountered. CONCLUSIONS: Improvement in the autonomy of contractors and their ability to respond to environmental changes is necessary.

Phosphate binding by sucroferric oxyhydroxide ameliorates renal injury in the remnant kidney model.

Recent clinical studies indicate that the disturbed phosphate metabolism in chronic kidney disease (CKD) may facilitate kidney injury; nonetheless, the causal role of phosphate in CKD progression remains to be elucidated. Here, we show that intestinal phosphate binding by sucroferric oxyhydroxide (SF) ameliorates renal injury in the rat remnant kidney model. Sprague-Dawley rats received 5/6 nephrectomy (RK) and had a normal chow or the same diet containing SF (RK + SF). RK rats showed increased plasma FGF23 and phosphate levels, which were suppressed by SF administration. Of note, albuminuria in RK rats was significantly ameliorated by SF at both 4 and 8 weeks. SF also attenuated glomerulosclerosis and tubulointerstitial injury. Moreover, several different approaches confirmed the protective effects on podocytes, explaining the attenuation of glomerulosclerosis and albuminuria observed in this study. As a possible mechanism, we found that SF attenuated renal inflammation and fibrosis in RK rats. Interestingly, von Kossa staining of the kidney revealed calcium phosphate deposition in neither RK nor RK + SF rats; however, plasma levels of calciprotein particles were significantly reduced by SF. These data indicate that latent positive phosphate balance accelerates CKD progression from early stages, even when overt ectopic calcification is absent.

Lynx x-ray microcalorimeter.

Lynx is an x-ray telescope, one of four large satellite mission concepts currently being studied by NASA to be a flagship mission. One of Lynx's three instruments is an imaging spectrometer called the Lynx x-ray microcalorimeter (LXM), an x-ray microcalorimeter behind an x-ray optic with an angular resolution of 0.5 arc sec and ∼2 m2 of area at 1 keV. The LXM will provide unparalleled diagnostics of distant extended structures and, in particular, will allow the detailed study of the role of cosmic feedback in the evolution of the Universe. We discuss the baseline design of LXM and some parallel approaches for some of the key technologies. The baseline sensor technology uses transition-edge sensors, but we also consider an alternative approach using metallic magnetic calorimeters. We discuss the requirements for the instrument, the pixel layout, and the baseline readout design, which uses microwave superconducting quantum interference devices and high-electron mobility transistor amplifiers and the cryogenic cooling requirements and strategy for meeting these requirements. For each of these technologies, we discuss the current technology readiness level and our strategy for advancing them to be ready for flight. We also describe the current system design, including the block diagram, and our estimate for the mass, power, and data rate of the instrument.

Continuous improvement of fitness-for-duty management programs for workers engaging in stabilizing and decommissioning work at the Fukushima Daiichi Nuclear Power Plant.

BACKGROUND: Numerous workers have participated in recovery efforts following the accident that occurred at the Tokyo Electric Power Company (TEPCO) Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake. These workers, belonging to various companies, have been engaged in various tasks since the accident. Given the hazards and stress involved in these tasks and the relatively long time required to transport sick or injured workers to medical institutions, it became necessary to quickly implement a more stringent management program for fitness for duty than in ordinary work environments. CASE: It took considerable time to introduce and improve a fitness-for-duty program because of several concerns. Various efforts were conducted, sometimes triggered by guidance from the Ministry of Health, Labour and Welfare (MHLW), but the implementation of the program was insufficient. In April 2016, a new program was initiated in which all primary contractors confirmed that their subcontractors had achieved five conditions for workers' fitness for duty on the basis of guidance from the MHLW and occupational health experts. TEPCO confirmed that all primary contractors had implemented the program successfully as of the end of November 2016. CONCLUSION: Following a disaster, even though the parties concerned understand the necessity of fitness-for-duty programs and that companies in high positions have responsibilities beyond their legal requirements, it is highly possible that they may hesitate to introduce such programs without guidance from the government. It is necessary to prepare a governmental framework and professional resources that introduce these stringent management programs quickly.

Prevalence and risk factors for low back pain among professional cooks working in school lunch services.

BACKGROUND: The prevalence of self-reported low back pain among professional cooks was estimated to examine the effects of daily life conditions, job-related factors, and psychological factors on this disorder. METHODS: Data was collected using a mailed self-administered questionnaire. RESULTS: Of 7100 cooks, 5835 (82%) replied to the questionnaire, including 1010 men and 4825 women. The mean age was 41.4 for men and 47.5 for women. The prevalence of low back pain during a 1-month period was 72.2% among men and 74.7% among women, with no significant differences between groups. By logistic regression analyses, factors significantly associated with the prevalence of low back pain in 1 month were female gender (prevalence ratio [PR] 1.32; 95% CI, 1.03-1.68), current smoking (PR 1.57; 95% CI, 1.24-1.98), and past smoking (PR 1.35; 95% CI, 1.01-1.79). As for job-related factors, the number of cooked lunches per person (PR 1.28; 95% CI, 1.05-1.56), breaks in the morning session (PR 1.33; 95% CI, 1.13-1.56), kitchen environment (PR 1.09; 95%, CI, 1.03-1.15), and height of cooking equipment (PR 1.13; 95% CI, 1.08-1.19) were associated with the prevalence of low back pain. As for psychological factors, job satisfaction (PR 1.22; 95% CI, 1.03-1.45), stress at work (PR 1.68; 95% CI, 1.42-1.99), financial constraints (PR 1.23; 95% CI, 1.03-1.47), health-related stress (PR 1.31; 95% CI, 1.08-1.59) and worries about the future (PR 1.24; 95% CI, 1.01-1.52) were similarly associated. CONCLUSION: Daily life conditions, job-related factors, and psychological factors are associated with the occurrence of low back pain. It is important to take comprehensive preventive measures to address a range of work and life conditions that can be improved to decrease the incidence of low back pain for professional cooks.

Results of recognition tests on Japanese subjects of the labels presently used in Japan and the UN-GHS labels.

The UN-GHS, a globally harmonized system of classifying and labeling chemicals that was recommended by the United Nations in 2003, will be implemented globally in 2008. This system is expected to encourage people to behave in a way that reduces the risk of accidents or diseases caused by chemicals. However, the UN-GHS differs significantly from the present Japanese system of classifying and labeling chemicals. In particular, since the Japanese system does not require pictographic labels, ordinary Japanese people are not familiar with the new pictographic labels defined in the UN-GHS. Hence, before introducing the UN-GHS at the Japanese workplace, it is critical to clarify the actual usage conditions and the problems that this labeling system of hazardous chemicals poses, and to manage the related problems. We conducted recognition tests on Japanese subjects of the labels presently used in Japan and the UN-GHS labels. The results revealed that the subjects faced some difficulty in recognizing the meanings of some UN-GHS labels. The percentage of questions that were answered correctly with regard to the labels depicting 'cylinder,' 'corrosion,' 'health hazard,' and 'aqueous hazard,' with no accompanying explanatory statements, was less than 60. The results of the answers regarding the labels depicting 'flame' and 'flame over circle' revealed that many subjects were unable to distinguish one from the other. Further, many subjects were unable to clearly distinguish 'skull and crossbones' from 'health hazard.' These results indicate that it is very important to impart correct education regarding these labels.

Development of interactive workplace improvement programs in collaboration with trade associations of small-scale industries.

Serial participatory action programs for reducing occupational safety and health risks were undertaken to know the types of support suited for small-scale industries. Working groups were formed with workplace people and occupational safety and health experts. It was agreed to develop an action-oriented strategy focusing on improving both work environment and productivity by making low-cost improvements through group work. Many workplace improvements achieved by participating enterprises and the group work procedures taken were analyzed. As supporting tools for effectively implementing the workplace improvement action programs, we developed action checklists according to industry and workplace implementation guides. Collections of local good examples also served as part of these support tools. These experiences show that keys to the sustainable action in small-scale industries are: (1) mobilization of the industry-wise network by trade associations, (2) an output-oriented strategy based on interactive group work and (3) the effective use of support tools such as low-cost action checklists and group work methods.

The Impact of Normal Range of Serum Phosphorus on the Incidence of End-Stage Renal Disease by A Propensity Score Analysis.

BACKGROUND: Although hyperphosphatemia is deemed a risk factor of the progression of chronic kidney disease (CKD), it remains unclear whether the normal range of serum phosphorus likewise deteriorates CKD. A propensity score analysis was applied to examine the causal effect of the normal range of serum phosphorus on the incidence of end-stage renal disease (ESRD). METHODS: A retrospective CKD cohort of 803 participants in a single institution was analyzed. Propensity score was estimated using 22 baseline covariates by multivariate binary logistic regression for the different thresholds of time-averaged phosphorus (TA-P) in the normal range of serum phosphorus incremented by 0.1 mg/dL from 3.3 to 4.5 mg/dL. RESULTS: The incidence rate of ESRD was 33.9 per 1,000 person-years over median follow-up of 4.3 years. Total patients showed the mean baseline phosphorus of 3.37 mg/dL and were divided to quartile. The higher quartile was associated with the parameters consistent with the advancement of CKD. A stratified Cox regression showed the highest hazard ratio (HR) at TA-P 3.4 mg/dL (HR 17.60, 95% CI 3.92-78.98) adjusted for baseline covariates such as sex, age, diabetic nephropathy, estimated GFR, serum albumin, Na-Cl, phosphorus, LDL-C and proteinuria. Adjusted HRs remained high up to TA-P 4.2 mg/dL (HR 2.22, 95% CI 1.33-3.71). After propensity score matching conducted at the thresholds of TA-P 3.4, 3.6, 3.8 and 4.0 mg/dL, the higher levels of TA-P showed the higher HRs by Kaplan-Meier analysis (p < 0.05 by stratified log-rank test). The numbers needed to treat were calculated as 3.9 to 5.3 over 5 years. CONCLUSIONS: The propensity score analysis shows that even the normal range of serum phosphorus clearly accelerates CKD progression to ESRD. Our results encourage clinicians to target serum phosphorus to inhibit CKD progression in the manner of 'the lower the better.'

Transition of occupational health issues associated with stabilization and decommissioning of the nuclear reactors in the Fukushima Daiichi Nuclear Power Plant through 2013.

OBJECTIVE: To clarify the occupational health (OH) issues that arose, what actions were taken, and the OH performances during the disaster involving the Fukushima Daiichi Nuclear Power Plant and thus improve the OH management system with respect to long-term decommissioning work and preparation for future disasters. METHODS: We used information in advisory reports to the Tokyo Electric Power Company by an OH expert group, observation through support activities, and data officially released by the Tokyo Electric Power Company. RESULTS: Occupational health issues transitioned as work progressed and seasons changed. They were categorized into OH management system establishment, radiation exposure control, heat illness prevention, infectious disease prevention and control, and fitness for workers' duties. CONCLUSIONS: Occupational health management systems involving OH experts should be implemented to manage multiple health risks with several conflicts and trade-offs after a disaster.