Journal of Occupational Health
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Volume 58 , Issue 1
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Review
  • Norito Kawakami, Akizumi Tsutsumi
    Volume 58 (2016) Issue 1 Pages 1-6
    Released: February 29, 2016
    [Advance publication] Released: November 26, 2015
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    Objectives: The Japanese government launched a new occupational health policy called the Stress Check Program. This program mandates that all workplaces with 50 or more employees conduct the Stress Check Program for workers at least once a year. This article gives a brief overview and critical review of the program. Methods: We reviewed relevant laws, guidelines, and manuals, as well as the policy development process. The policy and the components of the program were compared using available scientific evidence and trends in the management of psychosocial factors at work according to the policies and guidelines of international bodies and European countries. Results: The process of program policy development was based on a discussion among employer and employee representatives, occupational health professionals, and mental health experts. Scientific evidence shows that mandated components of the program (i.e., feedback of stress survey results and physician's interview) may be ineffective. However, additional components recommended to employers, such as stress management skill provision and work environment improvement, in conjunction with the program may be effective in improving psychosocial stress at work. The Stress Check Program is unique compared with the global trend for psychosocial risk management because it focuses on the assessment of stress among individual workers. Conclusion: The new program may be effective in improving worker mental health by facilitating the psychosocial risk management approach in Japan. Concerns regarding the program include mass leakage of collected information, and possible disadvantages for workers labeled as having high stress.(J Occup Health 2016; 58: 1–6)
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Originals
  • Christian Silva Simoneti, Amanda Souza Freitas, Michelle Christiane Ro ...
    Volume 58 (2016) Issue 1 Pages 7-15
    Released: February 29, 2016
    [Advance publication] Released: October 20, 2015
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    Objectives: The aim of this estudy was to investigate the influence of allergen exposure levels and other risk factors for allergic sensitization, asthma, and bronchial hyperresponsiveness (BHR) in workers exposed to laboratory animals. Methods: This was a cross-sectional study performed at two universities, 123 workplaces with 737 subjects. Dust samples were collected from laboratories and animal facilities housing rats, mice, guinea pigs, rabbits, or hamsters and analyzed by enzyme-linked immunosorbent assay (ELISA) to measure allergen concentrations. We also sampled workplaces without animals. Asthma was defined by both symptoms and BHR to mannitol. The concentrations of allergens were tested for association with a skin prick test, respiratory symptoms, spirometry data, and BHR. This multivariate analysis was performed by using Poisson regression to estimate the relative risk (RR) for the exposed group. Results: Our sample comprised students and workers, with 336 subjects in the nonexposed group and 401 subjects in the exposed group. Sixty-nine subjects (17%) had positive results in the skin prick test for animal allergens in the exposed group; in the nonexposed group, 10 subjects had positive results (3%) (p<0.001). Exposure to laboratory animals over 2.8 years was associated with atopic sensitization (RR=1.85; 95% confidence interval: 1.09–3.15; p=0.02). Allergen concentration was not associated with sensitization, asthma, or BHR. Conclusion: Exposure to laboratory animals was associated with atopic sensitization. However, we did not find a cutoff allergen concentration that increased the risk for sensitization. Duration of exposure seems to be more relevant to sensitization than concentration of allergens in dust.(J Occup Health 2016; 58: 7–15)
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  • Rattaporn Sihawong, Ekalak Sitthipornvorakul, Arpalak Paksaichol, Praw ...
    Volume 58 (2016) Issue 1 Pages 16-24
    Released: February 29, 2016
    [Advance publication] Released: October 23, 2015
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    Objective: All occupations expose workers to varied and unique conditions. The nature of work has been recognized as influencing the health of workers. Whether predictors for chronic neck and low back pain would be occupation-specific is unknown. This study aimed to identify predictors for chronic neck and low back pain in a cohort of office workers. Methods: A prospective study was carried out among 669 healthy office workers. At baseline, risk factors were assessed using a questionnaire and standardized physical examination. A symptomatic case was defined as an individual who reported pain greater than 30 mm on a 100-mm VAS, and chronic pain was defined as experiencing ongoing neck or low back pain for greater than 3 months over the past 6 months. Two regression models were built to analyze the risk factors for developing chronic neck and low back pain. Results: Of the sample, 17 and 27% of office workers who reported a new onset of neck or low back pain developed chronicity, respectively. Predictors for chronic neck pain were high body mass index, frequent neck extension during the work day, high initial pain intensity, and high psychological job demands. The development of chronic low back pain was associated with history of low back pain and high initial pain intensity. Conclusions: The findings suggest that predictors for chronic musculoskeletal pain in a subpopulation may be a subset of predictors identified in a general population or occupation specific. Successful management to prevent chronic musculoskeletal pain may also need to consider the patient's occupation.(J Occup Health 2016; 58: 16–24)
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  • Tianan Yang, Mingjing Zhu, Xiyao Xie
    Volume 58 (2016) Issue 1 Pages 25-35
    Released: February 29, 2016
    [Advance publication] Released: October 20, 2015
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    Objectives: The aim of this study was to identify the determinants of presenteeism, taking health and individual factors into account. Methods: A quantitative analysis applying structural equation modelling analysis was conducted on the basis of secondary data from the Health and Retirement Survey (2008 wave), which measured presenteeism and its determinants. Results: Stress-related factors at work (β =−0.35, p<0.001), individual factors (α =−0.27, p<0.001), and health (β =0.24, p<0.001) were significantly related to presenteeism. Individual factors were found to be directly correlated with stress-related factors at work (β =0.22, p<0.001). Significant indirect effects between stress-related factors at work and presenteeism (Sobel z=−6.61; p<0.001) and between individual factors and presenteeism (Sobel z=−4.42; p<0.001), which were mediated by health, were also found. Overall, the final model accounted for 37% (R2=0.37) of the variance in presenteeism. Conclusions: Our study indicates some important and practical guidelines for employers to avoid the burdens of stress-related presenteeism among their employees. These findings could help select target factors in the design and implementation of effective presenteeism interventions in the aging working population.(J Occup Health 2016; 58: 25–35)
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  • Renato Pisanti, Margot van der Doef, Stan Maes, Cristiano Violani, Dav ...
    Volume 58 (2016) Issue 1 Pages 36-46
    Released: February 29, 2016
    [Advance publication] Released: October 31, 2015
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    Objective: This study examined the mediating role of personal goal facilitation through work (PGFW), defined as perceptions of the extent to which one's job facilitates the attainment of one's personal goals, in the association between psychosocial job characteristics and psychological distress and job-related well-being. Material and Methods: Questionnaire data from 217 nurses (84% female, with a mean age of 42.7 years, SD=7.2) were analyzed. Participants completed the following measures: the Leiden Quality of Work Questionnaire for Nurses, Workplace Goal Facilitation Inventory, Maslach Burnout Inventory-Human Services Survey, and Utrecht Work Engagement Scale (short version). A cross-sectional study design was applied. Hierarchical multiple regression analyses were conducted. Results: The results indicated that unfavorable psychosocial job characteristics (high demands, low control, and low social support) were associated with lower PGFW. Furthermore, personal goal facilitation through work explained significant additional variance (from 2 to 11%) in psychological distress (somatic complaints and emotional exhaustion) and job-related well-being (personal accomplishment, job satisfaction, and work engagement), controlling for demographic indicators and psychosocial job characteristics. Finally, the results provided support for the mediating effects of PGFW between all psychosocial job characteristics and all outcomes, except in the case of depersonalization. Conclusions: This study suggests that hindered personal goal facilitation may be a mechanism through which psychosocial job characteristics have a negative impact on employees' well-being.(J Occup Health 2016; 58: 36–46)
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  • Ayako Suzuki, Koichi Yoshioka, Susumu Ito, Yuko Naito
    Volume 58 (2016) Issue 1 Pages 47-55
    Released: February 29, 2016
    [Advance publication] Released: October 23, 2015
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    Objectives: We studied the physical and mental conditions of 8 healthy young female ambulance paramedics working 24-hour shifts during their menstrual cycle, including assessment of cardiac autonomic nervous system activity by heart rate variability power spectral analysis. Methods: The autonomic activity during the awake period of on- and off-duty days in the follicular, late luteal, and menstruation phases was measured. Questionnaires regarding fatigue and menstrual distress were administered and correlated with the autonomic profile. Results: While degrees of fatigue significantly increased after work, the changes in autonomic activity during the awake period on on-duty days were not significantly different from those on off-duty days (LF/HF, p=0.123; HF/(HF+LF), p=0.153). As for the sleeping period, there were no significant differences. Although the Menstrual Distress Questionnaire (MDQ) revealed the presence of mild menstrual discomfort in the late luteal and menstruation phases, no significant difference was observed in the autonomic profile of the three menstrual cycle phases. No significant correlation was observed between the degree of menstrual distress and autonomic profile, though there was a significant correlation in the late luteal phase between degree of menstrual distress and fatigue after work (p<0.01). Conclusion: These results showed that, while subjects experienced menstrual discomfort and fatigue after work, their autonomic profile did not alter in the menstrual cycle. It is suggested that healthy young female ambulance paramedics may tolerate 24-hour shifts, though attention should be paid to subjective menstrual symptoms and fatigue.(J Occup Health 2016; 58: 47–55)
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  • Hirotaka Sato, Yuki Ito, Jun Ueyama, Yuya Kano, Tomoya Arakawa, Masahi ...
    Volume 58 (2016) Issue 1 Pages 56-65
    Released: February 29, 2016
    [Advance publication] Released: November 07, 2015
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    Objectives: Paraoxonase 1 (PON1) in serum detoxifies organophosphate (OP) insecticides by hydrolysis. The present cross-sectional study aimed to clarify the relationship between PON1 single nucleotide polymorphisms (SNPs) and enzyme activities or OP metabolite concentrations in urine of workers occupationally exposed to low-level OPs. Methods: Among 283 workers in 10 pest control companies located in central Japan who underwent checkups, 230 subjects (male 199, female 31, average age 38.9 ± 11.1 years old) participated in the study. Q192R and L55M polymorphisms were determined by TaqMan assay. PON1 activity was measured using fenitrothion (FNT) oxon, chlorpyrifos-methyl (CPM) oxon, chlorpyrifos (CP) oxon, and phenyl acetate as substrates. Urinary OP metabolite concentrations were measured with gas chromatography-mass spectrometry. Results: The maximum differences in enzyme activities between individuals were 64.6-, 6.3-, 7.7-, and 2.0-fold for FNT oxonase, CPM oxonase, CP oxonase, and arylesterase (ARE), respectively. The activities of CPM oxonase and ARE in workers having the RR genotype were 53.5% and 18.2% lower than in those with the QQ genotype, respectively. CP oxonase activity was 15.0% lower in those having the M allele (LM + MM compared with LL). Urinary metabolite concentrations were not associated with PON1 polymorphisms, but negative associations were observed between the concentrations and activities of FNT oxonase and ARE. Conclusions: While PON1 SNPs can explain differences in catalytic activities toward some OPs, differences in urinary concentrations of OP metabolites are not attributable to PON1 SNPs but instead are attributable to its serum activities. Its serum activities might be more sensitive biomarkers for estimation of individual susceptibility to OP toxicities.(J Occup Health 2016; 58: 56–65)
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  • Rainbow Tin Hung Ho, Cheuk Yan Sing, Ted Chun Tat Fong, Friendly So Wa ...
    Volume 58 (2016) Issue 1 Pages 66-71
    Released: February 29, 2016
    [Advance publication] Released: November 07, 2015
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    Objective: This study investigated the effects of burnout on the relationship between spirituality and mental health among healthcare workers in Hong Kong. Methods: Using a cross-sectional design, 312 healthcare workers (mean age=38.6, SD=9.9; 77.7% females) in a mental rehabilitation institution completed a self-administered questionnaire on anxiety, depression, burnout, and daily spiritual experiences. Multivariate regressions were used to test the effects of burnout on the relationships between daily spiritual experiences and anxiety and depression. Results: After adjusting for age, education level, marital status, and staff ranking, higher levels of daily spiritual experience were associated with lower levels of burnout (β=−0.22, p<0.01), depression (β=−0.68, p<0.01), and anxiety (β=−0.05, p<0.01). Burnout was found to have a significant partial mediating effect on the relationship between daily spiritual experiences and depression (z=−2.99, p<0.01), accounting for 37.8% of the variation in depression. Burnout also completely mediated the relationship between daily spiritual experiences and anxiety (z=−3.06, p<0.01), accounting for 73.9% of the variation in anxiety. Conclusions: The results suggested that the association between spirituality and mental health is influenced by the level of burnout, thereby supporting the role of burnout as a potential mediator. Moreover, day-to-day spiritual practice was found to be potentially protective against burnout and mental health problems. Future interventions could incorporate spirituality training to reduce burnout so as to improve the well-being of healthcare workers.(J Occup Health 2016; 58: 66–71)
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  • Seiichiro Tateishi, Mariko Watase, Yoshihisa Fujino, Koji Mori
    Volume 58 (2016) Issue 1 Pages 72-80
    Released: February 29, 2016
    [Advance publication] Released: November 07, 2015
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    Objectives: In Japan, employee fitness for work is determined by annual medical examinations. It may be possible to reduce the variability in the results of work fitness determination, particularly for situation, if there is consensus among experts regarding consideration of limitation of work by means of a single parameter. Methods: Consensus building was attempted among 104 occupational physicians by employing a 3-round Delphi method. Among the medical examination parameters for which at least 50% of participants agreed in the 3rd round of the survey that the parameter would independently merit consideration for limitation of work, the values of the parameters proposed as criterion values that trigger consideration of limitation of work were sought. Parameters, along with their most frequently proposed criterion values, were defined in the study group meeting as parameters for which consensus was reached. Results: Consensus was obtained for 8 parameters: systolic blood pressure 180 mmHg (86.6%), diastolic blood pressure 110 mmHg (85.9%), postprandial plasma glucose 300 mg/dl (76.9%), fasting plasma glucose 200 mg/dl (69.1%), Cre 2.0mg/dl (67.2%), HbA1c (JDS) 10% (62.3%), ALT 200 U/l (61.6%), and Hb 8 g/l (58.5%). Conclusions: To support physicians who give advice to employers about work-related measures based on the results of general medical examinations of employees, expert consensus information was obtained that can serve as background material for making judgements. It is expected that the use of this information will facilitate the ability to take appropriate measures after medical examination of employees.(J Occup Health 2016; 58: 72–80)
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  • Li-Fen Lu, Chao-Ping Wang, I-Ting Tsai, Wei-Chin Hung, Teng-Hung Yu, C ...
    Volume 58 (2016) Issue 1 Pages 81-88
    Released: February 29, 2016
    [Advance publication] Released: November 07, 2015
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    Objectives: Even though shift work has been suspected to be a risk factor for cardiovascular disease, little research has been done to determine the logical underlying inflammation mechanisms. This study investigated the association between shift work and circulating total and differential leukocyte counts among Chinese steel workers. Methods: The subjects were 1,654 line workers in a steel plant, who responded to a cross-sectional survey with a questionnaire on basic attributes, life style, and sleep. All workers in the plant received a periodic health checkup. Total and differential leukocytes counts were also examined in the checkup. Results: Shift workers had higher rates of alcohol use, smoking, poor sleep, poor physical exercise, and obesity than daytime workers. In further analysis, we found that the peripheral total WBC, monocyte, neutrophil, and lymphocyte counts were also greater in shift workers than in daytime workers. When subjects were divided into quartiles according to total WBC, neutrophil, monocyte, and lymphocyte counts, increased leukocyte count was associated with shift work. Using stepwise linear regression analysis, smoking, obesity, and shift work were independently associated with total WBC, monocyte, neutrophil, and lymphocyte counts. Conclusions: This study indicates that peripheral total and differential leukocyte counts are significantly higher in shift workers, which suggests that shift work may be a risk factor of cardiovascular disease. Applicable intervention strategies are needed for prevention of cardiovascular disease for shift workers.(J Occup Health 2016; 58: 81–88)
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  • Gerhard Blasche, Jelena Zilic, Oskar Frischenschlager
    Volume 58 (2016) Issue 1 Pages 89-95
    Released: February 29, 2016
    [Advance publication] Released: November 21, 2015
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    Objective: The aim of this study was to investigate the time course of recovery after an academic exam as a model of high workload and its association with stress-related fatigue. Methods: Thirty-six medical students (17 females, 19 males) filled out diaries during an exam phase, starting 2 days prior to the exam, and a control phase 4 weeks after the exam for 14 days, respectively. Fatigue, distress, quality of sleep, and health complaints were assessed. Recovery time was determined for each individual and variable by comparing the 3-day average with the confidence interval of the control phase. Recovery time was predicted by Cox regression analyses. Results: Recovery times of all variables except health complaints were predicted by stress-related fatigue. Half of the individuals had recovered after 6 days, and 80% of the individuals had recovered after 8 days. Conclusion: The time necessary for recovery from work demands is determined by fatigue as a measure of resource depletion.(J Occup Health 2016; 58: 89–95)
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Field Studies
  • Constance d'Aubarede, Philippe Sarnin, Pierre-Loïc Cornut, Sandrine To ...
    Volume 58 (2016) Issue 1 Pages 96-106
    Released: February 29, 2016
    [Advance publication] Released: November 07, 2015
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    Background: Health-care workers in emergency departments are frequently exposed to risk of antisocial behavior and violence (ABV) by users. Underreporting of ABV by health-care professionals has been identified. In order to understand this phenomenon, we explored the experience of ABV in 30 health workers in an ophthalmology emergency department in the Rhône-Alpes administrative region of France. Methods: A grounded theory qualitative approach was followed. Data were collected from field observations, 30 semistructured individual interviews, violence report forms, and 364 patient satisfaction questionnaires. Qualitative thematic content analysis of the interviews was performed with qualitative data analysis software. Results: Third-party antisocial behaviors and violence were an everyday occurrence, with varying levels of seriousness: impoliteness, vulgarity, nonrecognition, insults, verbal threats, and aggressive gestures. Health-care workers adopted various strategies to adapt to such violence: proactive and reactive attitudes and avoidance. Several organizational factors concerning the political and economic context, hospital work organization, and health workers' behavior were identified as potentially contributing to ABV. Excessive waiting times, lack of user information, and understaffing emerged as factors contributing to users' ABV. Conclusions: Antisocial behaviors by hospital users are underreported by professionals and under-recognized. They appear to be like continuous occupational exposure leading to delayed adverse consequences either on workers' health or motivation. However, violence in hospitals is not the result of only the action of users, and it may be related to work organization and workers' own behaviors. Only a grounded analysis of the causes of violence in the local work context can uncover relevant solutions.(J Occup Health 2016; 58: 96–106)
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  • Leap Van, Naesinee Chaiear, Chat Sumananont, Chheng Kannarath
    Volume 58 (2016) Issue 1 Pages 107-117
    Released: February 29, 2016
    [Advance publication] Released: November 21, 2015
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    Objectives: The main objectives of this cross-sectional descriptive study were to identify the prevalence of musculoskeletal symptoms and workstation biomechanical risk levels for garment workers in Kandal Province, Cambodia. Methods: This cross-sectional descriptive study used multistage sampling techniques to select 714 workers from three garment factories among 22 medium-size factories (250–1,000 workers). Face-to-face interviews and direct observation using the rapid upper limb assessment scale (RULA) were used to collect data. Results: The response rate was 98.3% (702/714), and the majority (89.3%) of the respondents were female. Ninety-two percent (95% CI=90.0–94.0) of the workers reported musculoskeletal symptoms in at least one body region in the previous 12 months and 89.0% (95% CI=86.7–91.3) of the workers reported such symptoms in the past seven-day period. The neck, shoulder, and lower back were the most affected body regions. In addition, the RULA data showed that 81.2% of the workers' postures were rated as action level 3, indicating that investigation and change were required soon, and that 7.5% their postures were rated as action level 4, indicating that investigation and change were required immediately. Conclusions: Cambodian garment workers reported a high prevalence of musculoskeletal symptoms in upper body regions, and their workplaces were rated as high risk ergonomically.(J Occup Health 2016; 58: 107–117)
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  • Fan-Yun Lan, Yuh-Wehn Liou, Kuo-Yuan Huang, How-Ran Guo, Jung-Der Wang
    Volume 58 (2016) Issue 1 Pages 118-127
    Released: February 29, 2016
    [Advance publication] Released: November 07, 2015
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    Objective: This study aimed to determine if occupational exposure to whole-body vibration is associated with cervical intervertebral disc herniation among container truck drivers. Methods: We conducted a walk-through survey among container truck drivers and unexposed workers. We also measured the vibration hazard of the container truck over the driver's back and seat when the driver was loading a container and driving the loaded truck. Results and Discussion: Among the 38 workers interviewed, 32 were container truck drivers. Four of them reported cervical herniated discs, and all of these individuals were container truck drivers with a job tenure of greater than 10 years. Self-reported cervical herniated disc, nuchal pain, nocturia, arm/forearm weakness, arm/forearm numbness, and finger numbness were significantly more prevalent as the driver's duration of exposure increased (all p values of test for trend <0.05). The vibration of the truck during and after loading a container was considered the main cause of herniated disc. When a container truck was driven with a loaded container, both the vertical and horizontal vibrating acceleration over the seat and back sites exceeded the 8-hr exposure level based on the ISO 2631-1 criteria. The transient vibration dose values (VDVs) measured during misaligned or unsmooth loading operations were usually greater than the upper bounds of the health guidance caution zone for the 8-hr VDV. Conclusions: Our investigation disclosed a cluster of cervical intervertebral disc herniation that was associated with the vibration hazard during long-term container truck driving under full load and possibly aggravated by misaligned loading operations.(J Occup Health 2016; 58: 118–127)
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Brief Report
  • Risako Kabata, Shanika Nanayakkara, STMLD Senevirathna, Kouji H. Harad ...
    Volume 58 (2016) Issue 1 Pages 128-133
    Released: February 29, 2016
    [Advance publication] Released: November 07, 2015
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    Objectives: Neonicotinoid insecticides have been widely used around the world since the 1990s. Reports have been made since the 1990s of rice paddy farmers in the North Central Region (NCR) of Sri Lanka suffering from chronic kidney disease with unknown etiology (CKDu). A preliminary evaluation of the exposure of local farmers in the NCR of Sri Lanka to neonicotinoids was performed. Methods: We analyzed neonicotinoid and neonicotinoid metabolite concentrations in spot urine samples. We selected 40 samples, 10 from farmers with CKDu and 10 from controls from each of two areas, Medawachchiya and Girandurukotte. Results: Imidacloprid and desmethyl-acetamiprid were found at significantly higher concentrations in the control samples (with medians of 51 ng/l and 340 ng/l, respectively) than in the CKDu samples (medians of 15 ng/l and 150 ng/l, respectively) when the results were not adjusted for the creatinine contents. None of the six compounds that were measured in the urine samples were found at significantly higher concentrations in the CKDu samples than in the control samples. None of the neonicotinoid concentrations in the samples analyzed in this study exceeded the concentrations that have been found in samples from the general population of Japan. Conclusions: Farmers (both with and without CKDu) living in CKDu-endemic areas in the NCR of Sri Lanka are exposed to lower neonicotinoid concentrations than non-occupationally exposed residents of Japan.(J Occup Health 2016; 58: 128–133)
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