Nanotechnology is developing very quickly, and Japan is in many respects leading the world in this convergence of nanoscale engineering techniques. The public health community in Japan must start to think about the public health impacts of nanotechnology over the next 20 years. The responsibility for the benefits and the harms of nanotechnology lies with government, with corporations and the business community, with scientists and specialists in all related fields, and with NPOs and the public. There are very many questions of public health which are not yet being asked about nanotechnology. If nanoparticles are to be used in cosmetics, food production and packaging, how will they react or interact with the human skin and organs? What chemical-toxic effects on life might there be from the nanoparticles in car tires and vehicle plastic mouldings when they are disposed of by incineration? Will they pass into the soil and groundwater and enter into the food-chain? It is now an urgent ethical demand, based on the precautionary principle, that Japan join the governments of the world to take an intergovernmental initiative to intervene in the further development, production and marketing of nanotechnological products with precautionary research and regulation.

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Introduction To address delayed language development associated with severe-to-profound congenital hearing loss (CHL), universal newborn hearing screening (UNHS) has been implemented in many countries. In Japan, approximately 27,000 neonates (2.5% of newborn) are screened annually through public-funded programs. While foreign literature highlights the need for assessment, in Japan this has hitherto not been evaluated in detail.
Objective To investigate the efficacy of UNHS in Japan.
Methods We used two criteria to evaluate UNHS; accuracy of screening and the effectiveness of early detection, and searched the major medical and social research journal data bases for related research papers. Eleven articles were identified providing information on accuracy of screening tests and two on effectiveness of early detection.
Results 1) In two prefecture-based studies, 900 and 1,272 newborns were screened to find one case of bilateral CHL. In nine hospital-based programs, the number tested ranged from 313 to 1,910. None of the studies measured the sensitivity and specificity against a best practice standard. 2) The two studies suggested that early intervention might be beneficial, but neither provided conclusive evidence.
Conclusion The effectiveness of UNHS in Japan is still equivocal because of the difficulties associated with differential diagnosis of hearing loss and normal hearing at the early stage of life and the lack of evidence on effectiveness of early intervention. Before nationwide implementation of UNHS, these issues should be fully investigated and evaluated.

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 Changes in human behavior and lifestyle over the last century have resulted in a dramatic increase in the incidence of obesity, type 2 diabetes, and the metabolic syndrome. Differences in the reported overall prevalence of the metabolic syndrome, which is generally in the range of 10-30% depend on the diagnostic criteria and subjects of the study. Recently, Japanese criteria for diagnosis of the metabolic syndrome were defined. With these criteria, presence of visceral obesity is essential for the diagnosis and is simply determined by measurement of waist circumference. Reflecting a dramatic increase in the incidence of obesity and type 2 diabetes, the incidence of the metabolic syndrome is increasing in Japan as well as in Western countries, regardless of the criteria applied.
 Recently, the number of workers with elevated liver enzymes, in whom virus hepatitis, alcoholic liver disease, drug induced hepatitis, autoimmune hepatitis, and iron overload were ruled out as causal agents, has also be found to be increasing at workplace health checkups. Most of such workers have components of the metabolic syndrome and the presence of steatosis in the liver, this pathologic condition now being termed nonalcoholic fatty liver disease (NAFLD).
 In this review, we describe the relationship between NAFLD and the metabolic syndrome.

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Objective To clarify the “competencies” required of public health center directors in “public health emergency responses.”
Methods We selected as our subjects six major public health emergencies in Japan that accorded with a definition of a “health crisis.” Their types were: (1) natural disaster; (2) exposure to toxic substances caused by individuals; (3) food poisoning; and (4) accidental hospital infection. Item analysis was conducted using the Incident Analysis Method, based on the “Medical SAFER Technique.”
Results The competencies of public health center directors required the following actions: ① to estimate the impact on local health from the “first notification” of the occurrence and the “initial investigation”; ② to manage a thorough investigation of causes; ③ to manage organizations undertaking countermeasures; ④ to promptly provide precise information on countermeasures, etc.; and ⑤ to create systems enabling effective application of countermeasures against recurrence of incidents, and to achieve social consensus.
Conclusion For public health preparedness, public health center directors should have the following competencies: ① the ability to estimate the “impact” of public health emergencies that have occurred or may occur; ② be able to establish and carry out proactive policies; ③ be persuasive; and ④ have organizational management skills.

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Objective This study was performed to develop a estimation method for medical expenditures based on detailed data for the various kinds of liver disease.
Methods Using claim data from the Survey of National Medical Care Insurance Services and the Patient Survey in Japan, we estimated the medical expenditures for various liver diseases using a refined method, in which the amount of expenditure by age and sex was multiplied by the respective numbers of patients.
Results According to our estimates, the total medical expenditures per year for all liver diseases in Japan was 680 billion yen. The breakdown included: viral hepatitis (256 billion yen); malignant neoplasms of the liver and intrahepatic bile ducts (170 billion yen); cirrhosis of the liver (97 billion yen); other liver diseases (63 billion yen); chronic hepatitis (61 billion yen); and alcoholic hepatitis (33 billion yen).
Conclusion These are the first published estimates, not only for the total medical expenditure for all liver diseases, but also for individual categories. The method we employed in this study can readily be applied to estimate medical costs for other diseases.

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Objective We aimed to examine knowledge of smoking-related risks and opinions on tobacco control by smoking status and education level in Japan.
Methods We conducted a questionnaire survey in 2002 on a random sample of residents aged 20 to 79 years in two neighboring districts of northern Japan. In a total sample of 7,136, we analyzed data from 5,638 (79.0%) subjects (2,659 men and 2,979 women).
Results The length of education was positively associated with knowledge of smoking-related risks. Compared to current smokers, past male smokers and never female smokers were more likely to know about the harm of passive smoking. As for causal links between smoking and lung cancer, stroke, and low birth weight, those who had been educated longer tended to be more aware of the associations in both sexes. Compared to current smokers, past and never smokers of men and past smokers of women were more likely to know that smoking contributes to low birth weight, but no difference was observed between current and never female smokers in this regard. Opinions on tobacco control were associated with both smoking status and education level; past and never smokers compared to current smokers and those who were educated longer tended to be affirmative about tobacco control.
Conclusion Knowledge of smoking is largely associated with education, but opinions on tobacco control are dependent on both smoking status and education.

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Objective We performed the follow-up tests for three years for junior high school students by the quasi-experimental design to investigate the medium-term effect of smoking prevention education in the elementary school.
Methods The intervention group consisted of 106 school students of three elementary schools and received a smoking prevention program in the elementary school. Moreover, the follow-up tests were conducted at each grade of junior high school, and the booster program was mailed. The comparison group consisted of 193 school students of another three elementary schools without the program.
Results The intervention effects were recognized on knowledge up to the second grade of junior high school for boys and up to the third grade for girls, on awareness of the importance of not smoking at the second grade, and on the intention of smoking at the age of 20 for girls up to the first grade. On the other hand, the intervention effects were not recognized on smoking experience for boys and girls. However, increase of the rate of smoking experience was not significant in the intervention group, while it was significant in the comparison group.
Conclusion The effect of the program for three years was judged to be moderate.

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 We previously reported that the prevalence of elevated alanine aminotransferase (ALT) increases with accumulation of metabolic syndrome components, and a greater degree of involvement of aldehyde dehydrogenase 2 (ALDH2) than β3-adrenergic receptor gene (β3-AR) polymorphisms. The present study was designed to clarify the effect of aging, lifestyle and the two gene polymorphisms on the relationship between 4 components of the metabolic syndrome (obesity, hypertension, dyslipidemia and impaired glucose tolerance) and elevated ALT values in a subset of 73 out of 148 male workers who were 35 years of age in the baseline study and 40 years old in the present study.
 Study subjects completed questionnaires about drinking and smoking habits, and underwent urinalysis, physical examination and peripheral blood tests, blood chemistry, electrocardiogram and chest X-rays each year as required by Japanese law. Information from the questionnaires and physical examinations, including liver function tests, were compared with previously reported ALDH2 and β3-AR genotypes for the 73 workers.
 Of the 73 workers studied, 14 (19%) demonstrated decrease in metabolic syndrome components, 39 (53%) demonstrated no change, and 20 (27%) demonstrated an increase. Ten workers (14%) showed liver dysfunction at age 35 and 20 workers (27%) at age 40. Fourteen workers were newly diagnosed as having liver dysfunction at their 40-year checkup, thus being associated with the BMI and an active ALDH2 genotype. Accumulation of components of the metabolic syndrome were associated with the presence of liver dysfunction at 35 years.
 In conclusion, these findings indicate that ALDH2 genotyping as well as lifestyle habits may be important factors in causing metabolic syndrome with liver dysfunction.

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Objective It is well established that job stress is a leading cause of cardiovascular disease. The relationship with the metabolic syndrome, however, has received only limited attention. The present study was designed to investigate associations between change of the type of job and the prevalence of metabolic syndrome components from the aspect of on-the-job stress and alteration in life style.
Methods Thirty-six male workers of the manufacturing department were transferred to the car-sales department at the same automobile company in 1992 to 1993. These same workers were transferred back to the manufacturing department after two years. We compared the first health-check data before the transfer in 1992 (Term A), a second set of data two years after transfer in 1994~95 (Term B) and a third set of data two years following transfer back to the manufacturing department in 1996~1998 (Term C). The workers were requested to provide information about drinking and smoking habits, and answer Karasek's questionnaire and a simple stress questionnaire in order to clarify the possibility of job stress in occurrence of the metabolic syndrome, defined in terms of obesity, hypertension, dyslipidemia, and impaired glucose tolerance as components.
Results Five workers had two or more components of the metabolic syndrome before the transfer to the car-sales department (Group I). One demonstrated improvement, three no change, and one increase in symptoms from A to B. Seven workers had more than two components after the transfer to car-sales department (Group II), and six of them exhibited decrease two years following transfer back to the manufacturing department. Five of them also showed elevated liver enzymes in serum with the appearance of the components, and three of them demonstrated recover. Three workers had two components of the metabolic syndrome only at time point C (Group III), while the remaining 21 workers had 0 to one component throughout the observation period (Group IV). Amount of drinking and smoking increased significantly when working in the sales department but these items returned to the previous values after rejoining manufacturing, though differences were not observed between workers with (Group II) and without (Group IV) components of the metabolic syndrome. Body mass index (BMI) and alanine aminotransferase (ALT) increased significantly when workers moved to the sales department and that was significant in Group II as compared to Group IV. Three components of Karasek's JCQ changed significantly during job transfer, though differences were not observed between the workers with (Group II) and without (Group IV) components of the metabolic syndrome. Logistic regression analysis with age, lifestyle, Karasek's JCQ, and ALT revealed that elevation of ALT value was associated with having two or more components of metabolic syndrome, while hours of sleep demonstrated an inverse association.
Conclusion Elevated ALT and reduction of sleep hours may be associated with development of the metabolic syndrome in workers who change their type of job.

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Objectives To illustrate how administrative sanctions (AS) and criminal prosecution (CP) differ with regard to application with doctors' misconducts.
Methods A total 465 doctors who were punished twice by AS and CP were analyzed using the proportional distribution method (PDM) to break down into the charge-specific months of suspension or imprisonment.
Results Overall, the Minister of Health, Labor & Welfare (MHLW) sanctioned doctors by suspending their licenses for twice the number of months that the court ordered for imprisonment. Charge-specific analysis of months (suspension or prison terms) revealed a different pattern of judgment. The MHLW judged obscenity more unethical, allocating a larger share of the total months of suspension to punish this misconduct, but judged bribery less unethical allocating a smaller share of the total months of suspension to punish this than the court. For traditional crimes like swindling, murder and psychostimulant abuse, both judgments followed similar patterns allocating the same share of months for punishment of such acts.
Discussion CP and AS were shown to have different patterns in their judgments of doctors' crimes or misconducts reflecting the different purposes they pursue: justice by CP and ethics by AS. (186 words)

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Objective The objective was to clarify factors, including Internet-accessed advice for smoking cessation, associated with smoking cessation among participants of the Quit Smoking Marathon (QSM), a one-month smoking cessation program involving use of e-mails and a mailing-list.
Methods The subjects were 88 volunteers who aimed to quit smoking and completed the QSM program. Those who remained abstinent from smoking at 1 year thereafter were defined as successful quitters. Factors associated with successful smoking cessation were examined by multiple logistic regression analysis adjusted for confounders and separately for use of nicotine replacement therapy (NRT).
Results Successful smoking cessation was reported by 49 subjects (55.7%). For the NRT-free group, sending 10 or more e-mails to the mailing-list was significantly associated with successful smoking cessation [odds ratio: 10.7, P=0.015].
Conclusion Frequent e-mailing to the mailing-list followed by obtaining personal advice is an effective way to quit smoking among QSM participants not using NRT.

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