Biomedical subjects
E Yano
Publications and source records attributed to E Yano.
Ankle-arm index as an indicator of atherosclerosis: its application as a screening method.
The ankle-arm blood pressure index (AAI) is seldom used to screen for atherosclerotic diseases other than lower extremity arterial disease. This study was conducted to investigate whether the AAI can be used as a screening test for atherosclerotic diseases in general. The subjects were 446 male workers in a copper smelter. Fundoscopic examinations, electrocardiograms, serum cholesterol and triglyceride measurements, and AAI measurements were conducted. Information on past medical histories of diabetes mellitus and ischemic heart disease, smoking, alcohol intake, duration of sleep and physical activity were collected. The AAI correlated well with the results of the fundoscopic examinations, and an AAI of 1.00 gave the maximum sensitivity specificity product. The same AAI value also gave the maximum products for ST segment depression in electrocardiograms and the past history of ischemic heart disease. Multiple logistic regression analysis showed that a low AAI value was related to higher systolic blood pressure and current smoking but was inversely related to alcohol intake. Our study validated the AAI in predicting persons with risk factors of atherosclerotic diseases. The AAI measurements can be conducted at low cost, using simple techniques, and are noninvasive. We propose that the AAI be widely used to screen for atherosclerotic diseases.
Correlation between UVB irradiation and the proportion of cataract--an epidemiological study based on a nationwide patient survey in Japan.
Among the multiple factors affecting the human eye in work environment, ultraviolet B irradiation (UVB) has received much attention recently. To provide a clear information for the association between cataract and UVB irradiation, the prevalence data from the Patient Survey and UVB estimates in all the 47 prefectures in Japan were used to examine the relationship between cataract and UVB. In analyzing the relationship, we controlled possible effect modifiers; which were aged, that is 65 years old (yo.) or older, population per ophthalmologist, proportions of all the patients among the aged population and proportion of very elderly population (75 yo. or older) among the aged population. A sex-specific logistic regression analysis revealed that the adjusted odds ratio in women was 1.118 with a 95% confidence interval of 1.058-1.183. However, the adjusted odds ratio in men was not statistically significant (1.048 with 95% confidence interval 0.968-1.135). The unstable results of this study may be largely due to the non-definitive estimation of UVB exposure that this kind of study should be repeated when more valid UVB estimates is available.
[Simulation exercises, a problem oriented method of learning public health in medical education].
Using the case method of learning of American business schools, we introduced "Simulation Exercises (SE)," a problem oriented method of public health education for medical students. With SE, a group of students were given simulated cases of patients or situations (SC), and were asked to assume the role of physicians or other public health workers using their skills and knowledge of public health. Students learn on their own, with the aid of tutors, through discussion, role-play, investigation of literature, and a small field survey. There have been a whole variety of SC covering most of the current topics in public health ranging from mental health, dental health, industrial health, maternal & child health, elderly care, terminal care and international health. Each SC has 5 to 10 questions which stimulate and direct the students' group discussion. Some of the questions do not have a correct answer, but the criteria used to evaluate the students included clarity, consistency, and comprehensiveness of their ideas in addition to the positive commitment to the group discussion. At the end of the week-long group learning, each group demonstrated the results of their discussion. Role play was often used to demonstrate what they learned. As a result, students participated positively and concentrated and enjoyed the learning exercise very much. An anonymous survey shortly after SE showed that more than 80% of students felt a positive change in their rating of public health among the many subjects of study. Tutors also changed their rating of the students after observing their positive attitude and sometimes very creative ideas. In conclusion, we found SE to be useful for practical learning by medical students of public health.
Possible oral lead intake via contaminated facial skin.
Thirty-six workers exposed to low or moderate levels of lead at low temperature refining processes were surveyed to examine the route of lead intake. Blood lead level (BPb), delta-aminolevulinic acid in urine, lead in facial skin wipes (Face-Pb) and lead in fingernails (Nail-Pb) were measured and their personal hygienic behavior was surveyed by a questionnaire. BPb showed a significant correlation with Face-Pb and Nail-Pb (r = 0.730 and r = 0.590, respectively). Multiple regression analysis extracted the factors of smoking at the workplace, face-Pb and nail-Pb as significantly related to BPb level. Electron-microscopic observation revealed that the majority of dust particles collected from worker's faces were larger than respirable size. Lead ingestion from contaminated face skin and fingers may contribute to elevations in the BPb level among workers.
Respiratory impairments due to dust exposure: a comparative study among workers exposed to silica, asbestos, and coalmine dust.
We conducted a comparative study of pulmonary dysfunction among workers who were exposed to silica, asbestos, or coalmine dust. The results showed that all three groups of dust-exposed workers, even those without radiographic signs of pneumoconiosis, had decreased spirometric parameters and diffusing capacity (DLco) in both nonsmokers and smokers. Pulmonary function was further decreased when pneumoconioses were present in the three groups. In accord with increasing radiographic categories, pulmonary function in the workers with either silicosis or asbestosis was even lower, whereas in those with coal workers' pneumoconiosis (CWP), it changed relatively little. Workers with mild to moderate (radiographic category I-II) silicosis or asbestosis showed similarly decreased DLco, but those with silicosis showed lower FEV1/FVC than those with abestosis. The workers with CWP also showed a lower FEV1/FVC than those with asbestosis. The major impairment patterns for silica workers, asbestos workers, and coal miners were mixed, restrictive and mixed, and obstructive, respectively. Smoking obviously increased the prevalence of obstruction for all the groups. We conclude from the present study that all the three dusts cause functional abnormalities that precede radiographic changes of pneumoconiosis. We should pay more attention to respiratory impairment in the initial stage of silicosis and CWP.
Cellular mechanisms of reactive oxygen metabolite generation from human polymorphonuclear leukocytes induced by crocidolite asbestos.
In our previous study, we demonstrated that reactive oxygen metabolites (ROM) generation from phagocytic cells may be involved in the carcinogenic mechanism of crocidolite asbestos. In the present study, the mechanism of human polymorphonuclear leukocytes (PMN) to generate ROM by crocidolite was investigated using verapamil, a calcium channel inhibitor; staurosporine, a NADPH oxidase inhibitor; and cytochalasin B (CB), an inhibitor of phagocytosis. The results indicate that whereas verapamil and staurosporine inhibited the crocidolite-induced ROM generation from PMN dose-dependently, CB caused an enhancement. We conclude that crocidolite-induced ROM generation involves a cell surface reaction due to influx of extracellular calcium through calcium channels and the activation of NADPH oxidase on the PMN cell membrane. This hypothesis was indirectly supported by dose-dependent enhancement of the ROM generation by CB, as CB increases calcium ion permeability in PMN. However, as in our previous studies, the time course of the ROM generation and the cell type difference suggested that ROM were also generated intracellularly from PMN due to phagocytosis of crocidolite. In conclusion, our evidence indicates that ROM generation from PMN by crocidolite involves cellular mechanisms related both to direct cell surface membrane interactions, together with an apparent phagocytic-dependent process.
Gender difference in the utilization and users' characteristics of community rehabilitation programs for cerebrovascular disease patients in Japan.
The purpose of this study was to see whether there was gender difference in the utilization of a community rehabilitation program for cerebrovascular disease (CVD) patients in Japan and to examine factors affecting this gender difference. For CVD patients who participated in 16 community rehabilitation programs in the Saitama prefecture (n = 190), we studied their clinical and functional status, socioeconomic conditions, the degree of family support, and their use of rehabilitation and transportation services. The general characteristics of the programs and the type of transportation services they offered were also surveyed. The female proportion of all the program participants was 34.2% and its proportion tended to be smaller when their ADL level was worse. However, such difference by gender lessened after the participants were stratified by the type of transportation services and by such conditions as being accompanied by a family member during transportation.
Effect of overtime work on 24-hour ambulatory blood pressure.
Recently, the adverse effects of long working hours on the cardiovascular systems of workers in Japan, including "Karoshi" (death from overwork), have been the focus of social concern. However, conventional methods of health checkups are often unable to detect the early signs of such adverse effects. To evaluate the influence of overtime work on the cardiovascular system, we compared 24-hour blood pressure measurements among several groups of male white-collar workers. As a result, for those with normal blood pressure and those with mild hypertension, the 24-hour average blood pressure of the overtime groups was higher than that of the control groups; for those who periodically did overtime work, the 24-hour average blood pressure and heart rate during the busy period increased. These results indicate that the burden on the cardiovascular system of white-collar workers increases with overtime work.
Dyspnea and exercise testing in workers exposed to silica.
In order to provide a better objective assessment of exertional dyspnea and functional impairment due to exposure to silica, 153 workers exposed to silica dust (workers) and 62 patients with silicosis (patients) were performed the medical questionnaires with special reference to exertional dyspnea and exercise testing on bicycle ergometer. Complaints of breathlessness were present in 77 (50%) workers and 53 (85%) patients. The findings of exercise tests indicated that there were definite correlations between index of dyspnea (ID), or breathing reserve (BR) and complaint of breathlessness in both the workers and patients. ID increased and BR decreased with the increasing degree of breathlessness. We defined ID > 70% or BR < 25 I/min as abnormal criteria and checked the ratios of dyspnea quantified objectively. Thus, 30% of the workers and 56% of the patients in this study were verified to have slight or moderate breathlessness, which were considerably lower than that derived from questionnaire on dyspnea. OUr results suggest that objective physiological measures like exercise testing may be of value in evaluating dyspnea in workers exposed to silica.
Effects of smoking on respiratory function and exercise performance in asbestos workers.
To determine the role of smoking in the development of pulmonary impairment in asbestos workers, 66 nonsmoking asbestos workers and 70 smoking asbestos workers were studied. Occupational and medical questionnaires, lung function and exercise test were conducted in all subjects. The frequencies of dyspnea and cough on questions were significantly higher in the smoking workers than those in nonsmoking workers. Similarly, FEV1, FEV1/FVC and DLco were significantly lower in the smoking workers. Exercise performance showed that the smoking workers had higher index of dyspnea and lower breathing reserve, Vo2 and Vo2 max than nonsmoking workers did. We concluded that cigarette smoking has marked effects on both of respiratory function and exercise performance in asbestos workers. Among them, smokers show more serious obstructive impairment in static lung function testing and more significant limitation during exercise. The history of cigarette smoking deserves close attention in the evaluation of pulmonary impairment from asbestos exposure.
Results of pneumoconiosis examination--different trends among industries.
In this report we describe yearly changes in pneumoconiosis patients and pneumoconiosis progression in each industry in Japan, using statistics of Ministry of Labour based on the results of pneumoconiosis examinations performed at plants in accordance with the Pneumoconiosis Law. We found that the number of workers exposed to mineral dust decreased yearly. The number of subjects with positive findings, the number of new cases with pneumoconiosis, the ratio of positive findings, and the incidence rate of pneumoconiosis also decreased. In particular, the number of subjects with positive signs of pneumoconiosis clearly decreased. A similar tendency was seen in the number of cases including voluntary applications. Industry-wise, however, there was a large difference among the industries. The ratio of pneumoconiosis with complications, along with the progression ratio, decreased. Subjects with progressed pneumoconiosis decreased annually, exhibiting less-serious signs and symptoms. There have been reports with a different view about the general trend of pneumoconiosis. We examine and discuss the cause of discordance between the studies.
Crocidolite-induced reactive oxygen metabolites generation from human polymorphonuclear leukocytes.
In order to study the mechanism of carcinogenicity of crocidolite asbestos, we have investigated the species of reactive oxygen metabolites (ROM) induced by crocidolite from human polymorphonuclear leukocytes (PMN) utilizing both an electron spin resonance (ESR) spin trapping method with 5,5-dimethyl-1-pyrroline N-oxide (DMPO), and a luminol-dependent chemiluminescence (CL) method. The present study confirms the generation of OH. from human peripheral blood PMN stimulated by UICC crocidolite utilizing ESR. In addition, PMN incubated with 25-400 micrograms/ml of crocidolite produced CL, the intensity of CL increasing in a dose-dependent manner. Superoxide dismutase, catalase, and dimethyl sulfoxide, which are scavengers of O2-, H2O2, and OH., respectively, inhibited the production of crocidolite-stimulated CL from PMN, also in a dose-dependent manner. Sodium azide, an inhibitor of myeloperoxidase (MPO) to produce OCl-, also inhibited CL production. These results suggest the involvement of O2-, H2O2, OH., and OCl- in the production of CL by crocidolite-stimulated PMN. In conclusion, it is proposed that OH. is a key ROM species in the mechanism of crocidolite-induced carcinogenesis.
[Relationship between occupational factors and medical indicators related to arteriosclerotic diseases].
The relationship between occupational factors and indicators related to arteriosclerotic diseases which include blood pressure, total cholesterol, triglyceride, HDL-cholesterol, body mass index, and HMS (Hitachi mental health scale) score. The study subjects were 7226 male electric company employees (40 to 59 years old). Records of annual health examinations were reviewed, and those of 3553 blue-color workers and 1860 white-color workers were used for analyses. The main results were as follows: Work style (overtime work and frequency of business trips) was strongly related to life style. Overtime work and walking time from home to the workplace did not relate to indicators of arteriosclerotic diseases. However, frequency of business trips, working posture and job category were related to most of the indicators. Smoking and frequency of drinking were strongly related to the indicators in both blue-color and white-color workers. In both blue-color and white-color workers, HMS score was not related to work style, but related strongly to psychological factors. In white-color workers, HMS were also related to life style. In addition, this study suggests that a cohort study about the progress of arteriosclerotic diseases in middle-aged workers is necessary, and that more accurate information on work style should be obtained for further investigation.
[Pulmonary diseases related to MMMF (man-made mineral fiber) exposure].
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Communication between patients and physicians about terminal care: a survey in Japan.
We assessed patient-physician communication about terminal care in Japan by examining the accuracy of physicians' estimation of their patients' preferences as regards (1) information about diagnosis and prognosis, (2) the place of death and (3) the therapeutic strategy at terminal stage (life prolongation vs pain control). We conducted a questionnaire survey on inpatients (n = 201) in three hospitals; two in rural areas (Nagano and Okinawa) and one in an urban area (Tokyo). Simultaneously we asked physicians (n = 40) in charge of the patients to estimate their attitudes. The accuracy of physicians' estimation was assessed by correct estimation rate (CER) and kappa coefficient. (1) Approximately 80% of the patients preferred to have candid information about diagnosis and prognosis, regardless of the nature of their disease. The physicians were correct in estimation only in about half of the cases. About one sixth of the physicians' guesses were in opposite direction, while about one third failed to make any estimation at all. Thus, the overall CER was 42%, 57% and 62% in Nagano, Okinawa and Tokyo respectively. (2) While 70% of the patients wished to meet their death at home, the physicians estimated this fact correctly in less than half of the cases. The physicians frequently could not make any estimation (CER: 21%, 36% and 40% respectively). (3) Two thirds of the patients preferred pain control over life prolongation. Again, CER remained in the neighborhood of 50% (CER: 49%, 49% and 64% respectively). The analysis by kappa coefficients showed that the concordance between patients' preferences and physicians' estimation was not far from a figure expected by chance alone.(ABSTRACT TRUNCATED AT 250 WORDS)
Length of in-patient stay in teaching hospitals in Japan.
The average length of in-patient stay (LOS) in Japan is longer than that of the other Organization for Economic Cooperation and Development (OECD) countries. The tendency towards long LOS is also apparent in teaching hospitals in Japan. This paper examines factors responsible for the long LOS in teaching hospitals, focusing on conditions of residency training. The study was conducted as a part of the first nation-wide study of teaching hospitals for postgraduate medical education in Japan and covered most teaching hospitals (61 university hospitals out of 80 and 153 non-university general hospitals out of 193). The multivariate analysis suggested that longer LOS was more common in the hospitals with lower autopsy rate per bed, higher operation rate per admission, and smaller number of in-patients (P < 0.01, respectively). It was also suggested that those hospitals where residents decided a work-up plan and where residents were engaged in out-patient clinics tended to show shorter LOS (P < 0.05, respectively). The results indicated that LOS was related to not only general characteristics of the hospitals but also the conditions of residency training.