Michiko Hoshiko

Doppler Detection in Ama Divers of Japan

OBJECTIVE Symptoms consistent with neurological decompression sickness (DCS) in commercial breath-hold (Ama) divers has been reported from a few districts of Japan. The aim of this study was to detect circulating intravascular bubbles after repetitive breath-hold diving in a local area where DCS has been reported in Ama divers. METHODS The participants were 12 partially assisted (descent using weights) male Ama divers. The equipment (AQUALAB system) consisted of continuous-wave Doppler with a 5-MHz frequency, and the Doppler probe was placed in the precordial site with the ultrasonic wave directed into the pulmonary infundibulum. We carried out continuous monitoring for 10 minutes at the end of the series of repetitive dives, and the recordings were made on numerical tracks and graded in a blind manner by 2 experienced investigators, according to the Spencer Doppler code. RESULTS Depths and number of dives were 8 to 20 m and 75 to 131 times. Mean diving duration and surface interval were 64 ± 12 seconds and 48 ± 8 seconds, respectively (mean ± SD). We detected the lowest grade of intravascular bubbles (Spencers grade I) in an Ama diver whose mean surface interval was only 35.2 ± 6.2 seconds. His mean descending, bottom, and ascending times were 10.4 ± 1.6 seconds, 39.2 ± 8 seconds, and 18.2 ± 3.0 seconds, respectively, over the course of 99 dives. CONCLUSIONS Intravascular bubbles may be formed after repetitive breath-hold dives with short surface intervals or after a long breath-holding session in Ama divers. Symptoms consistent with neurological accidents in repetitive breath-hold diving may be caused in part by the intravascular presence of bubbles, indicating the need for safety procedures.

3次元型睡眠尺度（3 Dimensional Sleep Scale: 3DSS）―日勤者版―のカットオフ値について：ピッツバーグ睡眠質問票（Pittsburgh Sleep Quality Index: PSQI）による睡眠障害判定を用いた検討

NHKが行っている国民生活時間調査の40年間に及ぶ 調査の中で,一,二を争う発見は睡眠時間の減少である といわれている 1).睡眠外来においては,睡眠時間の減 少に加えて睡眠位相の後退による概日リズム睡眠障害 もここ十数年前から問題となってきており,これらは時 代の流れによる新しい睡眠障害といわれている 2).こう した現代における睡眠問題へ対応するために,我々は 2014年に3次元型睡眠尺度(3 Dimensional Sleep Scale, 以下3DSS)-日勤者版-という新しい睡眠尺度を開発 した 3).従来の睡眠尺度はほぼ睡眠の質的問題・量的問 題に限定し,かつ両者を合わせた総合点で睡眠の評価 を行うものが主流であった.我々の開発した3DSSは24 時間型社会特有の睡眠の位相的問題まで網羅し,さら に位相・質・量を別々に点数化し個人の睡眠状態を評 価できる尺度である.位相・質・量すべて0点から15 点満点で評価し,点数が高いほど睡眠状態が良好であ ると判断する.本尺度を現場でより活用するためには 睡眠障害に対する感度・特異度を求めカットオフ値を 検証していくことが必要とされる.その第一段階とし て,我々はピッツバーグ睡眠質問票(Pittsburgh Sleep Quality Index,以下PSQI)4, 5)の判定に基づいた睡眠障 害の有無を用いて3DSSの推奨されるカットオフ値につ いて追加検討を行ったので報告する.

Predictive factors of psychological disorder development during recovery following SARS outbreak.

OBJECTIVE To investigate strategies for broad mass isolation during outbreaks of infectious diseases. DESIGN A survey using a self-administered questionnaire was conducted on 300 printing company workers in Beijing, China, which was under mass isolation following the 2003 SARS outbreak, in the 7-8 months after the isolation was lifted. MAIN OUTCOME MEASURES Individuals with psychological disorders were classified on the basis of scores on the 30-item General Health Questionnaire during the recovery period. Psychological disorders were observed in 49 of 187 respondents (26.2%; 95% CI = 20.2, 32.7). RESULTS The predicting factor with the highest correlation was income reduction, with an odds ratio of 25.0. Other items obtained were gender, range of activities, eating restrictions, restrictions in going out, disinfection of clothing, and infection control, with odds ratios of 3.2, 5.5, 3.9, 3.2, 0.2, and 0.1, respectively, and the contribution ratio was 87.7%. CONCLUSION Securing income is suggested to be important in future strategies.

Assessing the validity of health impact assessment predictions regarding a Japanese city's transition to core city status: A monitoring review

BACKGROUND The validity of health impact assessment (HIA) predictions has not been accurately assessed to date. In recent years, legislative attempts to promote decentralization have been progressing in Japan, and Kurume was designated as a core city in April 2008. An HIA into the transition of Kurume to a core city was conducted before the event, but the recommendations were not accepted by city officials. OBJECTIVE The aim of this study was to examine the validity of predictions made in the HIA on Kurume by conducting a monitoring review into the accuracy of the predictions. METHOD Before Kurume was designated as a core city, the residents completed an online questionnaire and city officials were interviewed. The findings and recommendations were presented to the city administration. One year after the transition, a monitoring review was performed to clarify the accuracy of the HIA predictions by evaluating the correlation between the predictions and reality. RESULTS Many of the HIA predictions were found to conflict with reality in Kurume. Prediction validity was evaluated for two groups: residents of Kurume and city officials. For the residents, 17% (2/12 items) of the predictions were found to be compatible, 58% (7/12) were incompatible and 25% (3/12) were difficult to evaluate. For city officials, the analysis was divided into those whose department was directly involved in tasks transferred to them (transfer tasks) and those whose department was not. For the city officials in departments responsible for conducting core city transfer tasks, 33% (3/9 items) of the predictions were found to be compatible, 33% (3/9) were incompatible and 33% (3/9) were difficult to evaluate. However, for the city officials whose responsibilities were unrelated to core city transfer tasks, 11% (1/9) of predictions were found to be compatible, 78% (7/9) were incompatible and 11% (1/9) were difficult to evaluate. CONCLUSION Although it was possible to validate some of the HIA predictions, the results of this monitoring review found substantial discrepancies between the predictions and reality 1 year after the transition of Kurume to a core city. This suggests that the accuracy of HIA predictions may be called into question. However, it should be noted that the review was conducted very soon after the transition and the steering group was very small, which may explain why the HIA predictions were inaccurate. Further, long-term studies may be needed to assess the accuracy of HIA predictions in similar contexts.