Eiji Yano

Somatic symptoms for predicting depression: One‐year follow‐up study in annual health examinations

Abstractu2002 It has recently been noted that screening for depression can improve clinical outcomes. The purpose of the present study was to examine whether somatic symptoms reported at health examinations predicted depression in the following year. Subjects were 1066 Japanese workers (732 men, mean age 35u2003years) attending annual health examinations at an institute in two successive years. A self‐administered questionnaire including items of 12 major somatic symptoms was given to all the subjects. Then clinical interviews of the DSM‐IV were used to diagnose major depression and minor depression in both years. In addition, the 17‐item Hamilton Depression Scale (HDS‐17) was measured as one of the outcomes of depression in the following year. The prevalence of major (minor) depression was 3.7 (7.8)% at baseline and 3.4 (5.9)% for the following year, respectively. The following years HDS‐17 scores were higher (all Pu2003<u20030.05) in those who had complained of each somatic symptom at baseline than in those who had not. Three somatic symptoms (low back pain, dizziness, and abdominal pain) at baseline were significant risk factors of major depression for the following year. Dizziness at baseline significantly predicted major and minor depression for the following year as well. Somatic symptoms may be good predictors to screen for depression at health examination.

Efficacy and Effectiveness of Liver Screening Program to Detect Fatty Liver in the Periodic Health Check-Ups

Efficacy and Effectiveness of Liver Screening Program to Detect Fatty Liver in the Periodic Health Check‐Ups: Kyoko Nomura, et al.: Department of Hygiene and Public Health, Teikyo University School of Medicine—To determine whether the current liver screening program for fatty liver has sufficient scientific evidence to justify its continued implementation. The liver screening program to detect fatty liver was performed on 411 Japanese workers utilizing serum aspartate aminotransferase (ALT), alanine aminotransferase (AST), and gammaglutamyl transpeptidase (γ‐GTP). Based on the preceding studies, subjects with viral and alcohol hepatitis were excluded from the evaluation. The diagnosis of fatty liver was based on ultrasound findings. The program was evaluated by efficacy and effectiveness; efficacy was measured according to the receiver operating characteristic (ROC) curves in comparison with the Body Mass Index (BMI). Effectiveness, based on the efficacy determinations, was assessed by means of the positive predictive value (PPV) test performance, the disease characteristics, and the program price. The diagnostic performances of ALT and BMI were nearly acceptable but far from excellent. The areas under the curves of the two indices were 0.69 and 0.63, respectively and these were statistically equivalent. The PPV ranged from 15 to 28% where the prevalence of fatty liver was 12.3%. The price of the program was estimated at US 4 dollars per person based on the medical reimbursement fee rate. The efficacy of the liver screening program was found to be insufficient and BMI monitoring may provide a more suitable and inexpensive alternative. Furthermore, the effectiveness of the program is open to question, considering the generally benign prognosis of the disease in the absence of any accompanying morbid conditions and the high price of the program.

Benchmark Dose of Lead Inducing Anemia at the Workplace

To estimate the critical dose of lead inducing anemia in humans, the effects of lead on hemoglobin (Hb) and hematocrit (Hct) levels and red blood cell (RBC) count were examined in 388 male lead-exposed workers with blood lead (BPb) levels of 0.05-5.5 (mean 1.3) micromol/L by using the benchmark dose (BMD) approach. The BPb level was significantly related to Hb (regression coefficient beta=-0.276), RBC (beta=-11.35), and Hct (beta=-0.563) among the workers (p < 0.001) when controlling for age and working status. The average BPb levels were significantly higher in the workers with anemia (1.85 micromol/L), based on the WHO criteria, than in those without anemia (1.26 micromol/L). The benchmark dose levels of BPb (i.e., lower 95% confidence limits of BMD), calculated from the K-power model set at an abnormal probability of 5% in unexposed workers and an excess risk of 5% in exposed workers were estimated to be 0.94 micromol/L (19.5 microg/dl) for Hb, 0.94 micromol/L (19.4 microg/dl) for RBC, and 1.43 micromol/L (29.6 microg/dl) for Hct. These findings suggest that reduction in hematopoietic indicators may be initiated at BPbs below the level currently considered without effect.

Somatosensory amplification and its relationship to somatosensory, auditory, and visual evoked and event-related potentials (P300).

Somatosensory amplification refers to the tendency to experience benign and ambiguous somatic sensation as intense, noxious, and disturbing. The construct is helpful in assessing the perceptual style of a variety of somatizing conditions, but there is no human study clarifying the effects of neurological function on somatosensory amplification. The present study examines the relationship between somatosensory amplification and different types of evoked potentials. In 33 healthy volunteers (mean age 24 years, 18 men), latencies and amplitudes were recorded using the following parameters: short-latency somatosensory, brainstem-auditory, and visual evoked potentials (SSEP, BAEP, and VEP, respectively) and auditory event-related potentials (ERP). All subjects completed questionnaires for the Somatosensory Amplification Scale (SSAS), 20-item Toronto Alexithymia Scale (TAS-20), and Profile of Mood State (POMS). The SSAS scores were significantly associated with the P200 latency (p=0.020) and P300 amplitude of ERP (p=0.041), controlling for the significant effect of the TAS and POMS depression and tension-anxiety scales. The SSEP, BAEP, and VEP latencies or amplitudes were not statistically significant (all p>0.05). When the subjects were divided into high and low SSAS groups based on the median of the SSAS scores, the P300 amplitude of ERP significantly discriminated the two groups (p=0.023) by multiple logistic regression analysis. Although the findings should be viewed as preliminary because of the small sample size, somatosensory amplification appears to reflect some aspects of long-latency cognitive processing rather than short-latency interceptive sensitivity from the viewpoint of encephalography.

Gender and somatosensory amplification in relation to perceived work stress and social support in Japanese workers.

ABSTRACT To examine gender-related differences in somatization among workers, 490 Japanese municipal office employees (248 women) completed the Medical Symptom Checklist, Somatosensory Amplification Scale (SSAS), and Profile of Mood States (POMS), along with questionnaires on their working environment. In women, SSAS scores were positively associated with perceived work stress, and negatively with social support levels (both p < 0.01). Female sex was significantly associated with SSAS scores (p < 0.01), controlling for the effects of total somatic symptom count, POMS tension-anxiety and depression scores, perceived working stress, and social support. The phenomenon of somatosensory amplification might be essential in estimating gender-specific symptoms in a working population.

Controlled Trial of Worksite Health Education through Face-to-Face Counseling vs. E-mail on Drinking Behavior Modification

Controlled Trial of Worksite Health Education Through Face‐to‐Face Counseling vs. E‐mail on Drinking Behavior Modification: Ikuno Araki, et al. Department of Medicine & Occupational Health, ExxonMobil Yugen Kaisha—This study examined the effectiveness of a traditional face‐to‐face health education and e‐mail health education on alcohol usage among male workers in comparison with a control group. Male workers at a manufacturing plant (N=36) who had abnormal serum γ‐GTP were stratified by age and job types, then randomized into three groups: face‐to‐face education, e‐mail education, and the control. The subjects were assessed on their knowledge about and attitude towards drinking, reported alcohol consumption, and serum γ‐GTP before the start of education and 2 months later after comparison of the education. Paired t‐test and repeated ANOVA were conducted to test the significance of changes pre and post the intervention and across groups. In the face‐to‐face group, knowledge (p=0.001), attitude (p=0.026), alcohol consumption (p=0.003) and serum γ‐GTP showed significant improvement. In the e‐mail group, only alcohol consumption showed marginal improvement (p=0.077). In the control group, no variables remarkably changed. These results indicate that the face‐to‐face health education was more effective than the e‐mail program. We discuss why the face‐to‐face approach was superior to the e‐mail approach in this study by referring to self‐monitoring, goal setting processes and timely feedback. We concluded that further studies are warranted to identify the effect of health education using e‐mails and other network tools in consideration of the above three factors.

Relationship between Smoking and Major Depression in a Japanese Workplace

Smoking and depression are among the most common and serious health problems in the world. More than 25% of smokers are reported to show some symptoms of depression 1) , and 70% of men and 80% of women with a history of major depression are estimated to have a smoking habit 2) . The relationship between smoking and depression has shown an association between smoking and depression, but the causal relationship is unknown. Thus in the present study we have two research tasks: one is to conduct a cross-sectional study with the database for the first year in order to clarify the prevalence of major depression in smoking status. In addition to smoking status, the Brinkman index 3) was used as a nicotine parameter to examine the causal relationship of smoking to depression. The second task is to conduct a cohort study, examining the causal relationship of major depression in the first year to smoking in the following year by assessing the risk of smoking progression or the potential for smoking cessation associated with prior depression. To investigate the causal relationship between smoking and depression in both directions, the risk for the onset or improvement of depression associated with the prior smoking status was also examined in the present study.

Blood lead and erythrocyte protoporphyrin levels in association with smoking and personal hygienic behaviour among lead exposed workers

Aims: To investigate the effects of smoking and personal hygienic behaviour on blood lead (BPb) and free erythrocyte protoporphyrin levels (FEP) in lead exposed workers. Methods: Subjects were 105 lead exposed male workers in a battery recycling plant during the years 2000–03. BPb and FEP were measured as part of the ongoing occupational surveillance. Each worker completed a questionnaire for assessment of smoking and four measures of personal hygienic behaviour (glove and mask use, hand and face washing before meals during working hours). Results: Statistically significant decreases in mean BPb and FEP occurred during the three years. The proportion of BPb reduction in the non-smoking workers was significantly higher (mean 24.3%) than in the smoking workers (15.3%). When the workers were classified into three groups (excellent, good, and poor) based on the four personal hygienic behavioural indicators, the greatest decreases of BPb and FEP were observed in the non-smoking workers of the excellent group. Conclusions: The consistent use of protection devices and cleanliness at work appeared to contribute to the lowering of BPb and FEP. Cessation of smoking in the workplace was also of importance.

Effect of Overtime Work and Insufficient Sleep on Postural Sway in Information-Technology Workers

In Japan, death from overwork (“karoshi” in Japanese) is the focus of social concern. Extremely long work hours and deprivation of sleep exert vital exhaustion and mood changes, resulting in disease conditions such as depression and ischemic heart disease . As the prevention of diseases caused by heavy overtime schedules is a live issue in Japan, decisive and objective indicators are necessary for the early detection of irrecoverable damage to workers’ health. Young overtime workers, under forty, are often passed over by routine medical check-ups, nevertheless they have been suffering from shortened sleep and lack of effective rest. Especially information-technology workers in Japan are involved in extreme overwork beyond daytime working hours in order to compete in the global market. Detailed health assessments should be carried out with a view to identifying and implementing measures to relieve adverse health effects in overtime workers. The critical flicker fusion frequency (CFF) test is a suitable method for the measurement of short-term visual strain , however, few studies have indicated that CFF is sensitive as an objective measure of chronic fatigue. Therefore other convenient tools are required to detect exhausted workers at risk. Computerized static posturography has been used to examine balance function disorders, measuring displacements of the body’s center of pressure by the use of a force platform during static upright posture. The posturographic measurements are reportedly suitable for monitoring fatigue. Since continued insufficient sleep can lead to inability to concentrate, perceptual changes and dizziness, we performed a quantitative study using postural sway parameters as the disturbance stimulation of foot pressure movement in order to evaluate fatigued conditions of overtime workers at the early stage. The purpose of this study was to find medical evidence for the effects of extended working hours and short sleep time among younger workers under forty, and to recommend certain measures for their health assessment and control.

Tsunami inundation after the Great East Japan Earthquake and mortality of affected communities.

OBJECTIVEnTo examine the relationship between mortality rate and tsunami inundation after the Great East Japan Earthquake (GEJE) in 2011.nnnSTUDY DESIGNnCross-sectional study.nnnMETHODSnOne hundred and fifty-five town or village sections in Ishinomaki, Myagi Prefecture, were included in this study. Three areas in the city were classified by characteristic landforms: plains area (n = 114), ria coastal area (n = 27) and Kitakami riverside (n = 14). The correlation coefficient between tsunami inundation depth and mortality rate was calculated for each area, and the differences between the areas were examined. Furthermore, multivariate analyses adjusted for the characteristics of the sections were conducted using census data taken before the GEJE.nnnRESULTSnAn association was found between inundation depth and mortality rate for Ishinomaki as a whole (rxa0=xa00.65, Pxa0<xa00.001), Kitakami riverside (rxa0=xa00.85, Pxa0<xa00.001) and the plains area (rxa0=xa00.75, Pxa0<xa00.001) in separate analyses. However, no association was detected between inundation depth and mortality rate for the ria coastal area (rxa0=xa00.14, Pxa0=xa00.47).nnnCONCLUSIONnThe ria coastal area has good accessibility to the hills and tight bonding between members of the community. These factors seemed to play crucial roles in the lower mortality rate in this area despite the deep inundation.