Michiko Miyakawa

Analysis of factors that influence body mass index from ages 3 to 6 years: A study based on the Toyama cohort study

Abstract Background : The aim of the present study was to elucidate both environmental and behavioral factors that influence body mass index (BMI, kg/m2) among Japanese children from ages 3−6.

Re-evaluation of the latent period of bladder cancer in dyestuff-plant workers in Japan

Abstract Background: The carcinogenesis of benzidine (BZ) and beta‐naphthylamine (BNA) for bladder is well known. Although it was thought to be rare to develop occupational bladder cancer more than 20 years after the exposure to these chemicals, there are still new clinical cases even 30 years after exposure. The purpose of this study was to re‐evaluate the latent carcinogenic period of BZ and BNA, in order to set the safety period after exposure for the health surveillance system.

Temporal course of the development of obesity in Japanese school children: A cohort study based on the Keio Study

OBJECTIVE To demonstrate the temporal course of obesity development in Japanese school children by conducting a school-site cohort study over 12 years. METHODS From 1981 to 1984, height and weight of 479 subjects (343 boys and 136 girls) were measured every year from entrance into primary school until graduation from high school in Tokyo. Obese children were defined as those with a body mass index (BMI) at or above the age-sex-specific standard value, derived from Japanese nationwide data. RESULTS Approximately 50% of the children who were obese in the primary school period were obese at age 17. Likewise, 40% who were obese in the junior high school period and 70% who were obese in the high school period were obese at age 17. Among 44 children who were obese at age 17, 14 showed tracking of obesity from the preschool period, 14 showed tracking from ages 7 to 11 years, 10 showed tracking from the junior high school period, and 6 showed tracking from the high school period. CONCLUSIONS Among children who were obese at age 17, most tracked from the primary school age or earlier. The earlier the tracking commenced, the greater the BMI at age 17. This indicates the importance of conducting health education for school children at an early age.

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

ObjectivesThe 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.MethodsInformation was obtained by interviewing employees of pharmaceutical and chemical corporations in Japan.Results and discussionThe 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.ConclusionsThe 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.

Economic Damage Caused by Lowered Prices in the Agro-Food Sector in Areas Contaminated by Radioactive Materials Leaked from the Nuclear Power Plant Severely Damaged by the 2011 Great East Japan Earthquake

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

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

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

Role of the occupational physician in corporate management of health risks: an important aspect of corporate social responsibility (CSR)

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