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.

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.

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.

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.

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.

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.

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.

Comparing medical expenditures of smokers and nonsmokers in studies using direct methodology in Japan.

Numerous epidemiologic studies have revealed that smoking is a significant risk factor of many diseases. Some studies reported increase in medical expenditure by smoking using odds or hazard ratios between smoking and diseases in epidemiologic studies. The purpose of the present study is to investigate the ratios of mean medical expenditures between smokers and nonsmokers from studies conducted observing medical expenditure directly in Japan. We collected 11 published articles of studies conducted observing medical expenditures of smokers and nonsmokers directly in Japan. The weighted geometric mean of ratios between age-adjusted mean medical expenditures for smokers and nonsmokers of National Health Insurance and Government-Managed Health Insurance beneficiaries which included many elderly individuals was somewhat greater than 1.0, while the value of Society-Managed Health Insurance that included a small number of elderly people was less than 1.0. Smoking and smokers' indifference to health increase the medical expenditure of the smokers, especially elderly smokers. It was not determined, however, whether the mean medical expenditure of smokers is actually greater than that of nonsmokers.

[Long-term results of S-1 administration as adjuvant chemotherapy for advanced head and neck cancer].

The long-term results of a multi-institutional study were analyzed in 101 cases (27 with stage III and 74 with stage IV) with advanced head and neck squamous cell carcinoma (HNSCC) given S-1 administration for 6 months after definitive treatments. The 3-year disease-free survival rate was 66.3% in cases overall. In terms of the survival rates in two groups with different administration methods, i.e., 2-week administration followed by 1-week rest or 4-week administration followed by 2-week rest, there was no significant difference. The risk factors of relapse were examined by multivariate analysis. The relapse rate increased according to the advancement of N staging and the higher risk of distant metastasis in cases with laryngeal (especially, supraglottic type) or hypopharyngeal carcinomas. Now, the efficacy of S-1 administration as adjuvant chemotherapy after definitive treatments for advanced HNSCC is under investigation,and the adequate administration period of S-1 should be evaluated in a controlled randomized study in future.

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.

Postmetamorphic changes in parvalbumin expression in the hindlimb skeletal muscle of the bullfrog, Rana catesbeiana.

Anuran amphibians, animals that spend a terrestrial life after metamorphosis, exhibit a marked development of hindlimbs during and after metamorphosis. In order to see whether changes occur in the muscle protein components in the course of postmetamorphic development, we subjected gastrocnemius muscle extracts from growing froglets to two-dimensional electrophoresis (2DE). As a result, we found two proteins to undergo a change in level. One spot, indicating a molecular mass of approximately 12 kDa and an isoelectric point (pI) of 5.0 first became detectable at 45 days after metamorphosis. Another spot, corresponding to a protein of 11 kDa and pI 4.8, was prominent until the former spot appeared. N-terminal amino acid sequence analysis and comparison of the spots with those of parvalbumin (PA) revealed that these two proteins were PA alpha and PA beta. Northern blot analysis using PA alpha and PA beta cDNAs as probes revealed that the PA beta mRNA level declined whereas that of PA alpha mRNA rose as the frogs grew.

Long-term physiologic changes of intraocular pressure: a 10-year longitudinal analysis in young and middle-aged Japanese men.

OBJECTIVE: Although the intraocular pressure (IOP) is the most important factor related to the onset and progression of glaucoma, there is little evidence on long-term aging effects on IOP. This article examines the changes of IOP over 10 years in normal eyes to assess physiologic changes related to aging. DESIGN: Population-based long-term longitudinal study. STUDY POPULATION AND OBSERVATION PROCEDURE: Two thousand nine hundred eighty-seven Japanese male aircraft crew members underwent IOP measurement by Goldmann apparatus and received physical and complete ophthalmologic examinations every year for 10 years. A total of 2330 healthy persons (21-49 years; mean age, 35.9+/-6.8 [standard deviation]) who had no history of treatment for ophthalmic diseases, current illnesses, and no missing data for 10 consecutive years were analyzed. MAIN OUTCOME MEASURES: For analysis of the longitudinal index (trend), the linear regression coefficients for 11 points of measurement were determined. Ophthalmologic and physiologic factors affecting the 10-year mean values and a trend of IOP were examined by multivariable linear regression analysis. RESULTS: Intraocular pressure tended to decrease with age in all age groups. The mean linear regression coefficient (right eye/left eye) = -0.076/-0.060 (95% confidence interval [CI]: (-0.094 to -0.057)/(-0.078 to -0.041), -0.073/-0.060 [95% CI: (-0.084 to -0.062)/(-0.071 to -0.049)], and -0.060/-0.050 [95%CI: (-0.075 to -0.046)/(-0.064 to -0.036)] (mmHg/year) in the 20s, 30s, and 40s, respectively). In investigating correlations between the 10-year mean values of IOP and factors examined in this study, multivariate analysis showed a significantly inverse correlation with spherical power (partial regression coefficient [B] = -0.155/-0.144) and positive correlation with esophoria (B = 0.536/0.521), systolic blood pressure (B = 0.021/0.022), heart rate (B = 0.024/0.024), and hematocrit (B = 0.041/0.043) with IOP. The trend of IOP was significantly positively associated with the trends of systemic factors: body mass index (BMI) (B = 0.117/0.119), blood pressure (systolic) (B = 0.020/0.020), and hematocrit (B = 0.057/0.045), but not with any ophthalmologic factor. CONCLUSIONS: The long-term observation clearly demonstrated that, in normal eyes, the IOP decreased with aging. The IOP value was negatively associated with spherical power and positively with esophoria, blood pressure, heart rate, and hematocrit. The change of IOP could be affected mainly by the change of body mas index, blood pressure, and hematocrit.

Performance of glaucoma mass screening with only a visual field test using frequency-doubling technology perimetry.

PURPOSE: To report the performance of glaucoma mass screening with only a visual field test utilizing frequency- doubling technology (FDT) perimetry in general populations. DESIGN: Hospital and population-based cross-sectional study. METHODS: This study took place in a multicenter setting. One hundred three consecutive glaucomatous patients and 14,814 persons were randomly selected. We had created a glaucoma screening protocol (GSP) using FDT perimetry (FDT-GSP). Frequency-doubling technology-glaucoma screening protocol was tested on consecutive glaucoma patients diagnosed with Humphrey visual field analyzer (30-2 SITA standard), and then FDT-GSP was applied to general populations. Frequency-doubling technology-glaucoma screening protocol positive subjects were ophthalmologically diagnosed. Detection ability of FDT-GSP was determined in consecutive patients, and the positive predictive value (PPV) of FDT-GSP to detect definitive glaucoma was estimated in general populations. RESULTS: Frequency-doubling technique-glaucoma screening protocol detected 83.3% and 100% of definitive glaucoma patients with an early (mean deviation [MD] > -6 dB) and more advanced stage (MD < or = -6 dB), respectively. In the population-based screening, there were 660 (4.5%) subjects who had positive FDT-GSP, including 512 in whom no visual field abnormalities (VFA) had been pointed out previously. Of them, 370 subjects underwent ophthalmologic diagnosis. Then, 266 (71.9%, 266/370) subjects had a glaucomatous disk and 167 had definitive glaucomatous VFA. Fifty-five (14.9%) and 39 (10.5%) subjects were diagnosed as having other diseases and as normal, respectively. The PPV of FDT-GSP ranged from 32.6% (167/512)-45.1% (167/370). CONCLUSIONS: Frequency-doubling technology-based screening with only a visual field test showed reasonable performance on mass screening for detection of definitive glaucoma in this study population, considering the glaucoma prevalence.

Possible association between heavy computer users and glaucomatous visual field abnormalities: a cross sectional study in Japanese workers.

STUDY OBJECTIVE: To study the association between computer use and visual field abnormalities (VFA) and to assess whether heavy computer users have an increased risk of glaucoma. DESIGN: Cross sectional multicentre study. Subjects and observation procedures: A total of 10 202 randomly selected Japanese workers (mean (SD) age 43.2 (9.8) years) were screened for VFA using the frequency doubling technology perimetry (FDT-VFA), in addition to undergoing a general medical check up, and then ophthalmologically examined. Information about their computer use and refractive errors was obtained from a questionnaire and interview, respectively. MAIN RESULTS: As a result of FDT test, 522 and 8602 subjects were positive and negative for FDT-VFA, respectively. A significant (p = 0.004) interaction was found between computer use and refractive errors regarding the risk of FDT-VFA. In stratified analysis, heavy computer users with refractive errors showed a significant positive association with FDT-VFA (odds ratio (OR) = 1.74, 95% confidence interval (CI) 1.28 to 2.37), while those without refractive errors did not. Comparison of 165 subjects with an ophthalmological diagnosis of glaucoma and 2918 controls showed that the OR for glaucoma of heavy computer users with refractive errors was 1.82 (95% CI 1.06 to 3.12). Of 165 subjects with glaucoma, 141 had refractive errors, especially myopia (96.4%, 136 of 141). CONCLUSIONS: Although there are limitations to this study, such as its cross sectional design, heavy computer users with refractive errors seem to have an increased risk of FDT-VFA. Glaucoma might be involved in an underlying disease and myopia in a risk factor for FDT-VFA.

Laterality of the performance of glaucoma mass screening using frequency-doubling technology.

PURPOSE: This study investigated laterality during the performance of glaucoma mass screening with a frequency-doubling technology perimetry test. MATERIALS AND METHODS: A frequency-doubling technology screening mode (C-20-1, version 2.6) test was performed on both eyes of 14,784 persons. Subjects with visual field abnormalities detected by the frequency-doubling technology test or with fixation error underwent retesting without a specified interval for rest. Consequently, 206 subjects who fulfilled the screening criteria of the frequency-doubling technology-based glaucoma screening protocol [FDT-GSP(+)] were further investigated using the Humphrey visual field analyzer (30-2). As a result, 74 right eyes and 57 left eyes were shown to have definite glaucoma. RESULTS: Frequency-doubling technology data for the left eye demonstrated a significantly (P<0.001) higher rate of artifacts, such as no reproducibility of results between the first and second tests (left/right: 2.4%/1.7%) as well as fixation errors (left/right: 2.8%/1.0%). The false-positive rate of the FDT-GSP for glaucoma was more than 1.5-fold higher in the left eye than in the right eye (16.3%/9.8%). In the case that either eye exhibited FDT-GSP(+), the positive predictive value of the FDT-GSP for definite glaucoma in the left eye was almost half of that in the right eye (28.4% vs. 53.8%). Specificity of the FDT-GSP for detection of definite glaucoma also exhibited a lower trend (P = 0.097) in the left eye (44.6%) than in the right eye (55.3%), but the sensitivity of the test was similar in both eyes (91.2% vs. 90.5%, respectively). CONCLUSIONS: When frequency-doubling technology-based mass screening is performed on the general population, performance is lower for the left eye than for the right eye. This performance disparity is likely to be primarily associated with a difference in specificity.

Allergic bronchial asthma: airway inflammation and hyperresponsiveness.

The international consensus report on diagnosis and treatment of asthma was published in 1992 (Clin Exp Allergy 22: 1-72). According to the report, asthma is a chronic inflammatory disorder of the airways in which many cells play a role, including mast cells and eosinophils. Airway inflammation causes various symptoms of asthma which are usually associated with widespread but variable airflow obstruction and causes an associated increase in airway responsiveness to a variety of stimuli. The definition of asthma, provided in this report, is an epoch-making revision of the conventional recognition of asthma based on respiratory physiology and does not contradict the empirical knowledge that asthma responds well to steroid therapy. One reason, which led airway inflammation to be understood as a major factor in the pathophysiology of asthma is the technological advance and the widespread use of bronchoscopes. The use of bronchoscopy as a research tool has markedly improved the understanding of the pathology of asthma. It became also possible to link biopsy findings to autopsy findings in patients who died of asthma. However, it is relatively difficult to repeat a biopsy of the airway mucosal membranes in individual asthmatic patients. Here, animal models of asthma play a significant role. Findings from animal models can provide a clue for the development of new anti-asthmatic drugs. This paper will deal with the paradigm of allergic asthma and focus on recent topics of interleukin (IL)-4 and IL-5, which seem to play a central role in allergic asthma. The causative relationship between airway inflammation and hyperresponsiveness will be discussed.

Estimating cadmium absorption rate in digestive organs calculated from information of studies on cadmium conducted in Japan.

The absorption rate of cadmium (Cd) in the digestive organs is reported to be 0.5-8% in Friberg's textbook. This value was obtained from experimental studies. The object of the present study is to obtain the value from the Cd intake amount by ingestion, the Cd absorption amount by respiration and smoking, and the total Cd absorption amount calculated from the Cd accumulation amount in organs reported in articles including not only experimental but also epidemiologic studies conducted in Japan. The oral intake amounts of Cd in Japan were obtained from a published article to be 48 micrograms/day for males in the 1970s. The total Cd absorption amount that was calculated from the Cd accumulation amount in organs of 223 male subjects autopsied following sudden death was found to be 6.8 micrograms/day for male adults in the 1970s. The Cd exposure before the 1970s reflected the Cd absorption amount calculated from the Cd accumulation amount in the 1970s. The Cd absorption amount by respiration and smoking for males in the 1960s was 1.0 microgram/day, and the difference of 5.8 micrograms/day between the above two corresponds to the Cd absorption amount in digestive organs before the 1970s. The rice intake amount for Japanese in 1955-1965 was reported to be about 1.4 times as much as that in 1975. Therefore the Cd absorption rate in digestive organs was estimated to be about 10% from these values, assuming that most of the change in Cd intake from food is derived from the amount of rice eaten in Japan. This value is somewhat greater than the values published in the literature.