Occupational health services (OHS) have developed together with other social protection measures in response to the challenges of the Industrial Revolution and associated demographic changes of the 19th century. They were perceived as necessary and often even initiated by industry. Their organization and tasks are defined by tripartite international labor law which is largely reflected in national legislations. Increasing global trade and competition based on new technology, have changed not only occupational hazards, but also resulted in a considerable shift of power from national states to corporate enterprises as visible also from increasing deregulation. The development requires adaptation from both, OHS and enterprises, in the best interest of a healthy and productive workforce, of social and economic stability, and of sustainability.

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It is the aim of the Cochrane Collaboration to gather, summarise and disseminate evidence of health care interventions. Recently, the Occupational Health Field has started to do so for occupational health interventions. In this article we would like to describe the organisation and the methods used by the Field. First, the use of research information to improve the quality of occupational health practice is explained. Next, the process and contents of Cochrane Reviews are described. The pros and cons of Cochrane Reviews are listed and what occupational health practitioners can learn from it. There is a great variety of occupational health interventions that requires flexibility in which research design to use. The Occupational Health Field will enhance our understanding of the effectiveness of occupational health interventions in the coming years.

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Expertise on work and health topics is the foundation for the added value of occupational health (OH) professionals to the health of the working population. Professionals should therefore practice in accordance with high quality standards and latest evidence. As adequate knowledge management and a supportive knowledge infrastructure is needed, OH professionals can discuss opportunities to strengthen both. Occupational health services ought to offer ICT facilities, stimulate organizational conditions and human resource development to implement evidence-based practice. On national level a portal including a virtual library, tailor-made for occupational health, providing access to high quality websites, abstracts and full text articles and books, is a backbone for further developments. Expert groups on various topics can function as a top reference level for new or complicated questions and issues. As an example of an initiative to foster progress, the Dutch Knowledge Infra Structure program for OH professionals (2004-2006) is introduced. This program included efforts to develop the infrastructure itself and projects to develop concrete tools and instruments.

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In this paper, the foundations of professional ethics in occupational health care is described and discussed. After an introduction reminding of the global developments of world economy, communications and trade and reference to cultural and social developments, reference is given the four basic ethical criteria of biomedical ethics of beneficence ("doing good"), non-malfeasance (avoidance of harm), autonomy (integrity) and Justice/Equity-The "Appletown consensus" of 1989. These criteria provide the basis for current thinking and practice in health professions of Western Europe. The principles of ethical analysis, as currently practiced is described using a practical case scenario drawn from experience of challenging tasks for Occupational Health Services in Western Europe. Specific challenges to professional ethics are discussed-the growth of knowledge in subjects and academic disciplines relevant to occupational health and the multiple loyalties of occupational health professionals. The principles of ethical codes and their implementation are touched on. In conclusion, the universality of professional ethical principles of bioethics-including occupational health-is discussed in observing global inter-cultural commonalities and convergence on ethical criteria of central importance. Emphatic recommendation is given to continue inter-cultural exchanges with a view to improve understanding of impact of contextual and cultural factors on ethics in professional occupational health practice.

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The purpose of this study was to evaluate the acceptance, validity, reliability and feasibility of the AGREE (Appraisal of Guidelines and REsearch and Evaluation) instrument to assess the quality of evidence-based practice guidelines for occupational physicians. In total, 6 practice guidelines of the Netherlands Society of Occupational Medicine (NVAB) were appraised by 20 occupational health professionals and experts in guideline development or implementation. Although appraisers often disagreed on individual item scores, the internal consistency and interrater reliability for most domains was sufficient. The AGREE criteria were in general considered relevant and no major suggestions for additional items for use in the context of occupational health were brought up. The domain scores for the individual guidelines show a wide variety: `applicability' had on average the lowest mean score (53%) while `scope and purpose' had the highest one (87%). Low scores indicate where improvements are possible and necessary, e.g. by providing more information about the development. Key experts in occupational health report that AGREE is a relevant and easy to use instrument to evaluate quality aspects and the included criteria provide a good framework to develop or update evidence-based practice guidelines in the field of occupational health.

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This study was conducted to examine whether oral-health promotion programs provided as an occupational health service for employees were cost-beneficial for employers. The subjects were composed of 357 male workers (20-59 yr of age) who participated in oral-health promotion programs conducted at their workplaces between 1992 and 1997. The design of this study was a quasi-experimental study design in which the three programs (light: 1 visit; medium: 2-4 visits; and heavy: 5-6 visits) were compared through cost-benefit analysis conducted from the viewpoint of the employers. The programs consisted of oral-health checkups by dentists and oral-health education, including that on the proper brushing method, by dental hygienists. The costs of the program included direct costs for the payment of oral-health-care staff and for teaching materials, and indirect costs for the time for employee participation in the program (20 min/employee per visit). The accumulated dental expenses for the seven years were used to calculate benefits, which were determined, based on the differences between 0 visits and each program. The benefit/cost ratios of the three programs were -2.45, 1.46, and 0.73, respectively. These results suggest that a worksite oral-health promotion program of medium frequency is cost-beneficial for employers.

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Increasingly, workers have psychological work-related complaints, endangering their work ability and causing considerable economic losses. Many employees consult their general practitioner (GP). He, however, often pays insufficient attention to work-relatedness or to coordination with occupational physicians (OPs). Appropriate guidelines are missing. Consequently, we developed a GP guideline to handle these problems in coordination with OPs, and tested it in a pilot, using an explorative, evaluative study design. 23 GPs were trained to include employed patients and to test the guideline. Patients received questionnaires after 0, 4, 10 and 30 wk, GPs after 4 and 30 wk. The result was a new guideline, regarding problem orientation, diagnosis and advice, meant to avoid contradictory GP-OP advice and to activate patient responsibility. It included a GP-OP-patient communication form concerning information exchange and harmonization of insight/advice. Implementing GPs concluded that the guideline promotes recovery and work resumption and OP-GP contact benefits patients, prevents conflicting advice and promotes agreement on task division. They judged guideline efficiency and OP commitment less positively. Patients were positive, especially about GP-OP contact. Accordingly, an improved guideline, when tested for its effectiveness in a Randomized Controlled Trial, can help GPs to cope with a growing, complex problem, in collaboration with their occupational colleagues.

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Teachers and staff members engaged in nursing activity experience more stress than other workers. However, it is unknown whether teachers engaged in nursing activity in schools for handicapped children experience even greater stress. This study evaluated job stressors and job stress among such teachers using a cross-sectional study design. The subjects were all 1,461 teachers from all 19 prefectural schools for handicapped children in Shizuoka Prefecture, Japan. We used a brief job stress questionnaire for the survey and 831 teachers completed the questionnaire. Job stressors among teachers engaged in nursing activity were compared with those among teachers not engaged in nursing activity. Job stress among such teachers was estimated by the score for total health risk, and was compared with the score in the Japanese general population. Male and female teachers engaged in nursing activity had a significantly higher level of job stressors for physical work load and job control compared with those not engaged in nursing activity. The scores for total health risk among male and female teachers engaged in nursing activity were 102 points and 98 points, respectively. These scores were not markedly above 100 points which is the mean score in the Japanese general population.

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It is important for occupational health to justify the impact of health promotion programs on job satisfaction, which is associated with work-related outcomes. The aim of this study is to estimate the effects of lifestyle modification activity implemented by the community on job satisfaction, and to analyze the factors which contributed to the improvement of workers' job satisfaction. A lifestyle modification program consisting of aerobic exercise and diet counseling was conducted for 12 wk in the community. Data on 264 workers were obtained before and after the intervention. The subjects were asked to fill out questionnaires about work-related items, lifestyle, and mental health status. In addition to the ameliorations of GHQ, lifestyle, subjective complaints, and the risk factors of lifestyle-related diseases, an improvement in workers' job satisfaction was shown by the participation in the community-based lifestyle modification program. For analyzing factors which contributed to the improvement in job satisfaction, logistic regression analysis was employed. Refreshment from fatigue by sleep independently contributed to the improvement of job satisfaction even after adjusting for the other variables. The health promotion program implemented in the community may be useful for workers' job satisfaction especially through the dissipation of fatigue by refreshment sleep.

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The purpose of this study is to determine the relationship between lifestyle and change of cardiovascular risk factors based on a five-year follow up. The subjects were 307 employees participating in annual health check-ups in Tokyo, Japan from 1998 to 2003. Personal health check-up data were collected on their systolic/diastolic blood pressure (SBP/DBP), serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), fasting serum glucose (FSG), uric acid (UA), body mass index (BMI), questionnaire on medication history and Breslow's lifestyle. Over five years, cardiovascular risk factors such as SBP/DBP, TC, TG, FBG, UA and BMI have become worse; however, some of these risk factors were significantly different after 5 yr among lifestyle groups. TG in the poor lifestyle group was significantly higher than in good or moderate lifestyle groups after adjusting for age in men. In women, SBP and BMI in poor lifestyle group were significantly higher than those in good or moderate lifestyle groups after adjusting for age and baseline values. These results show that aging is the major influencing factor of cardiovascular risk factor deterioration. At the same time, lifestyle conditions are related to changes in some cardiovascular risk factors among Japanese employees.

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The objective of this study is to develop an available empowerment model for workplace health promotion (WHP) in small and medium-sized enterprises (SMEs) and to evaluate its applicability and feasibility. Semi-structured interviews with employers and workers in SMEs were conducted to assess their actual requirements for support. The structure of our new empowerment model was discussed and established through several rounds of focus group meetings with occupational safety and health researchers and practitioners on the basis of results of our interviews. We developed a new participatory and action-oriented empowerment model based on needs for support of employers and workers in SMEs. This new model consists of three originally developed tools: an action checklist, an information guidebook, and a book of good practices. As the facilitators, occupational health nurses (OHNs) from health insurance associations were trained to empower employers and workers using these tools. Approximately 80 SMEs (with less than 300 employees) were invited to participate in the model project. With these tools and continued empowerment by OHNs, employers and workers were able to smoothly work on WHP. This newly developed participatory and action-oriented empowerment model that was facilitated by trained OHNs appears to be both applicable and feasible for WHP in SMEs in Japan.

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In this study, the present condition of occupational health nurse's role after performing general health examination was surveyed. Questionnaires were mailed to 41 companies, and returned questionnaires from 24 of them were analyzed. Although general health examination results were reported to all workers individually in 100% of companies, physician's opinion regarding the examination results were obtained in 86% of companies with part-time physicians comparing with 100% of those with full-time physicians. Health care support related to the examination results were performed by 90% of occupational health nurses and 70% of physicians in companies which employed full-time physicians, but by 100% of occupational health nurses and 50% of physicians in those which employed part-time physicians. In companies with part-time physicians, 64% of occupational health nurses played roles in submitting reports to Labor Standard Inspection Office, but only 30% of occupational health nurses did it in those with full-time physicians. These results show that occupational health nurses working in companies with part-time occupational health physicians were more active in providing health care for workers after general health examination than occupational health nurses working in those with full-time occupational health physicians.

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We treated two occupational lung diseases in different situations during military training. The purpose of this study is to investigate the availability of CT scanning for the evaluation of inhalation pulmonary edema. Two soldiers suffered severe lung edema after using a spray for the daily maintenance of their firearms. Four soldiers suffered severe dyspnea after undertaking drills in a narrow zone where numerous smoke bombs had been used. We evaluated these patients from several aspects. CT scans of the chest of spray-induced patients revealed bilateral infiltration predominantly in the upper lung fields. The patients received steroid pulse treatment and gradually recovered. CT scans of the chest of smoke-induced patients revealed bilateral ground-glass attenuation with peripheral lung sparing. The patients gradually recovered with steroid therapy. In accordance with previous studies, CT scans of the chest in our patients demonstrated that the periphery of the lungs remained normal, except in cases of serious injury. When differential diagnosis is required, we consider that CT scans of the chest are particularly useful; CT findings are useful in determining the severity of lung injury as well as the diagnosis of inhalation pulmonary edema.

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Threshold limit values (TLVs) are intended to protect workers from the severest effects of thermal stress and to establish the exposures to heat in working conditions. Earlier, acute heat strokes often occurred as a result of working in hot environments in Japan. However, acute heat strokes recently sometimes occurred in outdoor work environments such as industrial constructions and agriculture. Seasonal variations in weather are significant and the climatic conditions vary. The criteria are mainly set for working in mines, factories, and so on. WBGT is a useful evaluation index for hot environments; however, it is not commonly used for work practices. WBGT could be calculated and should be commonly used as a standard during summer. Japan mainly has a very hot and humid climate during summer. With regard to the thermal standard for offices, humidity also creates a problem in the indoor thermal conditions. Therefore, it is better to decide the TLVs of the thermal conditions according to seasons and activity levels. Inadequate thermal stress may cause discomfort and adversely affect the performance, safety, and harm to health. Further, thermal factors in the work environment must be measured and evaluated under light workload conditions like deskwork for safety and work efficiency.

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In the present study, a survey on subjective symptoms and hot prevention measures in summer was conducted in 204 male traffic control workers and 115 male construction workers. Work loads of traffic control workers and construction workers were estimated at RMR 1-2 and RMR 2-4, respectively. A self-administered questionnaire was used to collect information on age, occupational career, working habit, present or past history of diseases, individual preventive measures to the heat, and subjective symptoms in the summer. Daily working hours in the sunshine of the traffic control workers were significantly longer than those of the construction workers. Prevalence rates of changing clothes frequently, avoiding direct exposure of face and neck to sunlight using towel like materials, and wearing sunglasses in the traffic control workers were significantly lower than the construction workers. Prevalence rates of symptoms in the upper extremities in the traffic control workers were significantly lower than those in the construction workers. Prevalence of work difficulty due to hot weather during work in the traffic control workers was significantly lower than the construction workers. On the basis of the results obtained, some preventive countermeasures to improve working environment are presented.

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To test an economically reasonable method to reduce thermal stress, we performed an alternated intervention-control study on 2 groups of 8 male steel workers performing the same jobs, using 2 l of water at ambient temperature (23.5°C ± 1.4), poured on the head and hands. Each group participated for 2 d as control and 2 d as intervention during 4 consecutive summer days in Brazil, 5 h per shift per day. Testing was done by: 1) recording of temperature by thermistors placed on the external ear canal through earplug, skin (chest, upper arm, inner thigh, outer calf) and clothes; 2) recording of heart rate; and 3) Wet Bulb Globe Temperature recording. The intervention was held hourly, when body weight and water intake were evaluated. Symptoms and subjective sensations were evaluated in the beginning and at the end of each shift. No differences were observed in external ear canal and skin temperatures. Subjective thermal sensation (p=0.018), sweat perception (p=0.043), and tiredness (p=0.028) presented positive statistically significant results when comparing intervention to control measurements. In conclusion, our results could not provide evidence that the proposed method cools the analyzed temperatures, although the subjective evaluation suggests a decrease in the head skin temperature, which could be a useful comfort measure.

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The farmers in tropical climate are exposed to high heat during the summer months. The study examined the physiological strains of farmers (N=26) to six combined exposures of work and high heat, with moderate and heavy work (26 to 50%, and 51 to 75% VO_2max) and three ambient conditions, i.e., 34.4 to 42.2°C WBGT (inside) in an environmental chamber. While the cardio-respiratory responses and T_cr were predominantly influenced by the work severity (p<0.001), the environmental warmth greatly influenced the sweating response (p<0.001). The importance was placed on the segmental T_sk as the first rank indicator of the bodily heat strain. Both the environmental warmth and work severity had independent discernable effects on the dynamic equilibrium of the central and peripheral mechanism to regulate the body temperature. The segmental and compartmental (core, muscle, fat and skin) heat balance analysis indicated the span of convergence of the segmental core and muscle temperatures to the divergence of skin and fat temperatures (CORE-SHELL) as a quantitative estimate of the segmental gradient for heat transfer. The summation of heat exchange across the compartments and segments yielded the transient change in T_cr (0.06 to 0.12°C/min), with significant difference between the moderate and heavy work. The T_cr of 39°C was taken as the limit of tolerance for the farmers, and by defining the criteria limit of T_cr of ~2.5°C gradient from the basal T_cr and the rate of change in T_cr, the tolerance times were estimated. Corollary to the development of ISO 7933 standard (PHS index), the predictions of tolerance times from the transient change in T_cr or the exponential relationship with the WBGT (tolerance time, min = 1,841 e ^{-0.103 WBGT}) were useful to suggest the protective limit for men at work in extremely hot environment. The simplicity of prediction lies in using WBGT as a criterion. The exponential equation estimated the tolerance time of 55 min at 34°C WBGT, and up to 38°C WBGT, the decrease in tolerance time was 4 to 5 min per degree increase in environmental warmth. Beyond 38°C WBGT, the estimated tolerance time decreased by 2 to 3 min per degree increase in WBGT. Further optimization and validation of the knowledge for men and women farmers in different age groups will have application in managing heat illnesses and disorders in tropical farming.

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We introduced a computer program developed for the numerical analysis of thermal conditions of all segments and blood circulatory systems in the human body to precisely evaluate human thermal physiological responses. In this program, a cylindrical model consisting of internal multi-layers is adapted for the segment of the human body. For the multi-layered concentric cylindrical model we adopted a new numerical solution method. By using this computer program the internal tissue temperatures, heat fluxes and blood temperatures of all segments in the human body could be calculated simultaneously. This program also included a subroutine for calculation of thermoregulatory response. This paper describes the improvements made to this computer program for simulating individual physical differences and its application to various working levels. The main points for improvement were the assigning procedures of physical characteristics of individuals and local muscle heat production. The improved computer program was used to simulatethe whole body temperatures of the subjects during exercise described in Gagge, Stolwijk and Saltin (1969)¹⁾ were simulated. The calculated results were agreed with the measured results under the combination of the three kinds of exercise and the three types of environmental condition.

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A literature review of 105 studies on the effects of extended daily working hours was conducted. Potential negative effects of extended working hours are discussed: More accidents on the job; more accidents off the job; reduced duration and quality of sleep due to moonlighting; sleepiness; reduced alertness; fatigue; adverse effects on performance; prolonged toxic exposure; adverse effects on health; increased absenteeism; problems communicating with managers; and problems while driving home. Potential positive effects of extended working hours are discussed: Less travel time and costs; more time for the family, social life, and domestic duties; increased satisfaction with working hours; fewer handovers; and less overtime. No firm conclusions can be drawn because of the partly contradictory results and the methodological problems of many studies. However, caution is advised when considering the introduction of extended work shifts, particularly where public safety is at stake. A checklist is provided (concerning work load, breaks, staffing level, systematic assessments of health and safety factors) to support decisions for or against the use of extended work shifts.

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There are many sources of ultraviolet (UV) radiation in the workplace. Action spectrum data are necessary for establishing methods to evaluate UV hazards. We determined a UV action spectrum for cell killing in the human lens epithelial cell line SRA 01/04 by measuring the viability of cells exposed to UV at 8 different wavelengths ranging from 259.5 to 300.5 nm in a carefully designed and controlled experiment. The action spectrum based on LD₅₀ is nearly flat or falls slightly with wavelength in the short-wavelength region and then rises increasingly steeply at longer wavelengths. UV at 267.5 nm is most effective in cell killing, with an LD₅₀ of 8.86 Jm^-2. The action spectrum for killing lens epithelial cells in humans (in vivo action spectrum) derived from the present results falls monotonically with wavelength in the range studied, suggesting that UV at wavelengths longer than 300.5 nm may also be highly effective in killing lens epithelial cells in humans and, therefore, in causing cataract. Further studies should be conducted with UV at longer wavelengths.

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Benzyl alcohol (BeOH) is a urinary metabolite of toluene, which has been seldom evaluated for biological monitoring of exposure to this popular solvent. The present study was initiated to develop a practical method for determination of BeOH in urine and to examine if this metabolite can be applied as a marker of occupational exposure to toluene. A practical gas-liquid chromatographic method was successfully developed in the present study with sensitivity low enough for the application (the limit of detection; 5 μg BeOH /l urine with CV=2.7%). Linearity was confirmed up to 10 mg BeOH/l, the highest concentration tested, and the reproducibility was also satisfactory with a coefficient of variation of 2.7% (n=10). A tentative application of the method in a small scale study with 45 male workers [exposed to toluene up to 130 ppm as an 8-h time-weighted average (8-h TWA)] showed that BeOH in the end-of-shift urine samples was proportional to the intensity of exposure to toluene. The calculated regression equation was Y=50+1.7X (r=0.80, p<0.01), where X was toluene in air (in ppm as 8-h TWA) and Y was BeOH in urine (in μg/l of end-of-shift urine). The levels of BeOH in the urine of the non-exposed was about 50 μg/l, and ingestion of benzoate as a preservative in soft drinks did not affect the BeOH level in urine. The findings as a whole suggest that BeOH is a promising candidate for biological monitoring of occupational exposure to toluene.

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The purposes of this study were to describe health-promotion lifestyle profile of 264 Turkish workers, to determine the factors which affect their lifestyle and to describe occupational health nurses' responsibilities in their health promoting activities to compare their profile with those published from other studies using Health-Promoting Lifestyle Profile. This is a descriptive study. Study was conducted in a food industry. 530 workers are working in this workplace. Approximately fifty percent of the workers participated in this study. The convenience sample composed of 264 workers. Data were collected using a questionnaire about socio-demographic features developed by the investigators and Health Promoting Lifestyle Profile developed by Walker et al. Subscales with the highest means in this study were interpersonal support and self-actualization. Compared to workers reported from other studies, Turkish workers got low scores of self-actualization, nutrition, interpersonal support and stress management. There was no statistically significant difference between total scores and gender, marital status and education. However, there was a statistically significant difference between age and exercise and nutrition. Moreover, as income increased, so did health promoting behaviors. There was a statistically significant difference between perceived health status and importance placed on health and overall health promoting life style and each health promoting behavior. It is important that occupational health nurses identify health behaviors, perceived health status and cultural aspects likely to affect health behaviors among workers. Thus, they may develop effective tools to protect and promote workers' health.

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We investigated the effects of a 5-h sleep restriction for 7 d on subjective sleepiness in an ambulatory condition by comparing them with baseline conditions consisting of an 8-h sleep for 7 consecutive days. Subjects were 13 healthy male students (mean age 21.1 yr). Each subject was required to get 8 h of sleep (baseline, from 2300 to 0700) for 7 d, and 5 h of sleep (sleep restriction, from 0100 to 0600) for 7 d in an ambulatory condition. The order of the two sleep schedules was randomly assigned. Subjective sleepiness was assessed by a Visual Analog Scale (VAS) every 3 h at 0900, 1200, 1500, 1800, and 2100 for 7 successive days during each sleep schedule. The VAS score during sleep restriction gradually increased up to the 5th day and then reached a plateau. The patterns of time-course changes in the VAS score were similar to those at baseline. The VAS scores showed a peak at 0900, taking a dip at 1200, and then gradually increasing toward 2100. The mean VAS score of the last three days of the 5-h sleep restriction was significantly higher than that at baseline (p<0.001). A 5-h sleep restriction for 7 d in an ambulatory condition increased subjective sleepiness up to the 5th day and then reached a plateau. The patterns of the time-course changes in sleepiness of 5-h sleep restriction per day did not differ from that at baseline.

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There are many rice mills and food grain depots where a large number of workers are engaged for processing paddy and rice, storage and distribution. Lifting, carrying and depositing sacs of food grain are the major jobs carried out by these workers. The present study was undertaken to evaluate the workers with respect to their nutritional status, workload, energy expenditure and musculoskeletal pain or discomfort resulting out of work practice. Average peak heart rate of the depot and rice mill workers suggested the workload as moderate to very heavy. Their average energy expenditure values also indicated the workload as moderate to heavy. Subjective assessment of the workers showed the workload as heavy for 60.7% depot workers and 23.1% rice mill workers. Musculoskeletal pain or discomfort was maximally reported in knee by 59% depot workers whereas low back and knee was reported by 61.5% rice mill workers. Besides the weight of the sac, awkward postures like bending and twisting of trunk adopted frequently causes the problem. Further studies and rationalization of work method may improve the health and safety of the workers.

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The aim of the study is to evaluate if the occupational exposure to urban pollutants could cause alterations on 17-alfa-hydroxy-progesterone plasma levels and related diseases in male traffic policemen. 17-α-OH-P is synthesized in Leydig cells and in adrenals; it influences spermiogenesis, acrosoma reaction, testosterone biosynthesis, blocking of gonadotropin secretion; it regulates learning, memory and sleep. After excluding principal confounding factors, i.e., rotating or night shifts, exposure to solvents, paints and pesticides during time-off and smoking, traffic policemen were matched with controls by age, working life and drinking habit. Finally, 112 traffic policemen and 112 controls were included in the study. In traffic policemen 17-α-OH-P mean values were significantly higher vs. controls. The distribution of 17-α-OH-P values in both groups was significant. An increased frequency of fertility disorders referred to the questionnaire items were found in traffic policemen vs. controls, but the difference was not significant. The occupational exposure to low doses of chemical urban stressor, interacting with and adding to the psychosocial ones, could alter plasma 17-α-OH-P concentrations in traffic policemen vs. controls. 17-α-OH-P could be used as an early biological marker, even before the onset of the reproductive and mental health diseases.

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The number of suicides in Japan has increased from approximately 22,000 per year in 1988-1997 to over 30,000 per year since then. It has also increased in Mie prefecture during that period. In the present study, we investigated the correlation between annual suicide rates in Mie prefecture, Japan from 1996-2002 and the annual unemployment rate in Japan from 1996-2002 among males. Among the results, annual suicide rates in total correlated with the unemployment rate in Japan, but the relation was not statistically significant: r(7)=0.76, r²(7)=0.58, p=0.05 (y=3.54x+6.37); the rates in males, however, correlated significantly with the unemployment rate in Japan: r(7)=0.85, r²(7)=0.73, p=0.01 (y=5.72x+4.49). In addition, we found that annual suicide rates in total correlated significantly with the male unemployment rates. When a patient is unemployed and in a bad situation, the medical staff and the family should be aware of the correspondence between suicide rates and unemployment.

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This study was performed to determine the associations of depressive symptoms with regular leisure activity and family social support among Japanese workers. The study participants consisted of 1,605 men and 348 women. Depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression scale. Multiple logistic regression analysis was used to adjust for potentially associated variables. Depressive symptoms were associated with lack of regular leisure activity for men [odds ratio (OR) = 2.05, 95% confidence interval (CI) = 1.55-2.71] and for women (OR = 2.53, 95% CI = 1.30-4.95). Depressive symptoms were also associated with lack of family social support for men (OR = 1.87, 95% CI = 1.43-2.43). Although a cross-sectional study does not determine which factors are determinants or consequences, these findings suggest regular leisure activity for men and women and family social support for men are independently associated with depressive symptoms.

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