Eight skilled workers engaged in heat-exposed work in front of a blast furnace in a steel factory were asked to drink a sports drink or one of its dilutions of x 2, x 3, or x 5 during a regular daytime shift in the summer of 1999. A regular lunch was taken and the examined beverage was iced and was allowed to be consumed ad libitum. The beverage was changed each day during four days of the experiment without informing the dilution ratio. The non-diluted beverage contained 21mEq/ℓ of Na⁺, 5mEq/ℓ of K⁺, 6.7g/dl of carbohydrate. In average, the body temperature measured in the ear canal was elevated by 0.34℃, the loss of body weight was 1.77kg, total beverage intake was 1,875g, total amount of urine was 291g, and the total water loss was 3,732g (1,350〜5,810g) during a single shift. Twenty out of 24 cases experienced more than 1.5% of weight reduction during morning work without noticing any subjective symptoms of dehydration. The amount of weight loss during morning work was significantly smaller when x 2 or x 3 dilution was taken compared to a non-diluted beverage. The mean value of urinary Na⁺ concentration was decreased after 8 hours of work; however, the difference was not significant. The urinary K⁺ concentration was significantly increased. When the total amount of urinary sodium excretion in stored urine was calculated, the x 3 dilution recorded the largest amount. Regarding palatability, the x 2 dilution received the best evaluation, whereas all subjects felt the original beverage as too condensed. We did not observe any adverse effect from diluting the sports drink for x 2 or x 3, when supplying them as water and electrolyte replacements for dehydrated steel workers.

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Recent advances in pacemaker technology such as a thinner lead body, smaller size of pacemaker generators and pacemaker pulse generators with the neutral anode positioning (NAP) feature, have made pacemaker implantation easier. To date, however, the clinical disadvantages of this NAP feature have not been investigated. We investigated whether there are any clinically disadvantages in pacing and sensing thresholds, myopotential tracking thresholds and myopotential inhibition thresholds in 62 pacemaker patients with the NAP feature. All measured data from the NAP devices when the pacemaker was set to the bipolar system were acceptable and normal. In the unipolar system with NAP feature, no differences were observed in the numerous parameters measured compared to previously reported measured data in the unipolar system without the NAP feature. We concluded that the physician can also benefit from this feature since any pulse generator with the NAP feature is suitable for implant on either side of the body, without any disadvantages. Therefore, left- or right-sided pacers need no longer be ordered, stocked, or specified at the time of implant.

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This study examined trends of sickness absence before and after a psychosocial approached health promotion program (HPP) at a Japanese worksite. The subjects were 1029 male employees working at a manufacturing company from April 1991 to March 1999. The HPP was performed from April 1995 to decrease sickness absence through helping to improve all employees' lifestyles according to a psychosocial approach incorporating six characteristics : 1) concept based on the population strategy, 2) use of a health risk appraisal (HRA), 3) setting easy lifestyle targets, 4) praising the employees' personal lifestyle initiatives, 5) supported (sponsored) by the management, 6) award of subsidiary payments. Sickness absence was considered to be consecutive days calculated by medical certification and company records. Absences due to musculoskeletal diseases and total diseases decreased, when comparing four-year periods before and after the program's introduction. In this report we show that trends of sickness absence changed after the introduction of the psychosocial-approached health promotion program.

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The present study investigated the reliability and validity of the Japanese version of the Rathus Assertiveness Schedule (RAS) preparatory to study the relationship between self-expression skills and mental health status of employees at a Japanese worksite. Assertiveness is one of self-expression skills and defined as standing up for one's own rights as well as for others. RAS that the most widely used was developed by Rathus in the U.S.A. and consists of 30 items.
We developed the Japanese version of RAS (J-RAS) along with a back-translation.
The subjects were 173 participants of a 2-day assertiveness training course from July to December, 2001 and 364 workers in a manufacturing company in the Kyushu area. We sent then J-RAS to the 173 participants before they commenced the course, and of them 170 participants returned sufficient answers for analysis. During the course their trainers completed the objective evaluations on assertive self-expression. We compared their answers with the trainers' evaluations by the Pearson's correlation to certify the J-RAS's validity.
We also mailed the J-RAS to the manufacturing workers in June, 2001. Of them, 266 workers returned sufficient answers by the end of the month. We calculated the Cronbach's alpha coefficient by them to certify the internal consistency reliability of the J-RAS.
In August, 2001, we mailed the J-RAS again to 98 workers who agreed to retake the test. We studied the Pearson's correlation between the initial answers and the following ones to certify the test-retest reliability of the J-RAS, using the 98 answers of the workers who agreed to be retested.
Our results found that 19 item sets, excluding Q3－7, 9, 13, 19, 20, 25, 28, had significantly positive correlation with the objective evaluations. The sum of the 19 items of the J-RAS (19-item J-RAS) had significantly higher correlations with the objective evaluation than that of 30 items of the J-RAS (30-item J-RAS). The internal consistency reliability of the 19-item or 30-item J-RAS was high, because their Cronbach's alpha coefficient was more than 0.80. Their test-retest reliability was also high, because the Pearson's correlation coefficient between the initial test and the subsequent test was more than 0.84 (ps＜0.001). Our results implied that the validity and reliability of the J-RAS was could be considered as acceptable and that the 19-item J-RAS measured the assertiveness of Japanese people more exactly than the 30-item J-RAS.

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Within contemporary society both 'pseudoscience' and 'pseudomedicine' can be found. Such knowledge is seen as incorrect, wrong or irrational. I call them 'unorthodox (uncertain) knowledge'. Conversely, 'orthodox knowledge' －for example, science, medicine, etc. －is seen as correct, right or rational. Some people believe 'unorthodox (uncertain) knowledge'. Experts castigate such people from the standpoint that they lack the basic understanding of 'orthodox knowledge'. That is, experts see the ordinary lay person as subjective, ignorant or irrational (whereas they see themselves as objective, analytical, prudent or rational). But are people ignorant or irrational? The aim of this paper is to examine this question in terms of analyzing the interplay among the characteristics of 'orthodox knowledge', 'unorthodox (uncertain) knowledge' and the nature of people's concerns. Thus, this paper explains that people develop certain situated understandings of 'orthodox knowledge' and/or 'unorthodox (uncertain) knowledge' through their intensive experiences. Also, this paper suggests that people need to rethink or reflect on the good institutions which mediate between people and experts.

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For the sake of water conservation, a system for circulating hot water is widely used at public baths in Japan. Recently, large outbreaks of Legionella infection have occurred in public baths in Miyazaki and Kagoshima prefectures. More than three hundred persons were infected with Legionella pneumophila, and eight died. These outbreaks revealed that the Manual of Prevention Measures against Legionella Infection in a Circulating Hot Water Bath, which was published by the Ministry of Health, Labour and Welfare in Japan in 2001, was not fully understood or conformed to by managers of the baths. Microbiological features about legionellae should be fully understood for prevention of Legionella infection in a circulating hot water or spring bath. This review describes the microbiological characteristics of legionellae, their habits in the environment, pathogenesis, symptoms of Legionella infection, and disease outbreaks in Japan. I also describe practical prevention measures to deal with this organism in a circulating hot water or spring bath.

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From January 1997 to December 2001, patients with subarachnoid hemorrhage (SAH) among 14,008 residents in an isolated mountainous area ; Oguni and Minamioguni towns in Kumamoto Prefecture, were evaluated. The subjects were patients being treated at Oguni Municipal Hospital.
Over a period of 5 years, 19 patients were found to be suffering from SAH in this area, 3 of whom were visitors (residing outside this area). The annual incidence rate of SAH in this area was calculated as 22.9 per 100,000. The sex ratio (men : women) was 4: 12. The average age was 67.9 years ; 65.0 years for men and 68.8 years for women. Eleven patients were older than 65, and constituted 68.8% of the subjects. The risk factors of SAH were recognized, and both hypertension and smoking constituted 31.6%. Alcohol was 21.1 % and hyperlipemia was 15.8%. In 13 clipping operated cases excluding 1 test craniotomy, Hunt & Kosnik's Grades at admission were G.I : 2, G.II : 5, G.III : 3, G.IV : 2 and G.V: 1, and Fisher's Groups were G.I : 0, G.II : 8, G.III : 3 and G.IV : 2. The sites of 16 operated aneurysms were internal carotid-posterior communicating artery (IC-PC) : 2, anterior communicating artery (A Co.A) : 4, middle cerebral artery (MCA) : 10 and vertebral artery-basilan artery (VA-BA) : 0. The aneurysmal sizes were ＜5 mm: 5, 6ー 10 mm: 9 and 11mm ＜: 2 (average 7.6 mm, 2－15mm). The results were evaluated at discharge, excluding 1 SAH of unknown etiology. 9 were good, 2 were dependent and 7 including 5 non-operative cases had died. We were satisfied with these results, because we were treating older patients.
Although we attempted the clipping operation using only a three dimensional computed tomographic angiograply (3D-CTA ; X-Vision GX (TOSHIBA) &X-Tension), we had no problem, except for 1 test craniotomy. 3D-CTA was useful during the clipping operation in the small hospital, especially, in regard to cost.

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In September 2001, twelve neonatal intensive care unit (NICU) patients were found to be colonized with pigment-producing strains of Serratia marcescens. The UOEH Infection Control Group (ICG) committee investigated the source of this epidemic and carried out several remedial measures. Immediate investigation of both the environment and the hands of health care workers were enforced. The most likely means of transmission was thought to be from the hands contaminated with S. marcescens that was found on antiseptic cotton, kept in shared stainless steel canisters, used for wiping the patients' buttocks. Therefore, we suggested the following interventions : 1) abolish the stainless steel canisters, and prepare antiseptic cottons for each patient, 2) monitor cultures with some specimens for all patients in the NICU, 3) periodically investigate the environment, 4) enforce workers to wash and disinfect their hands before and after patient care, 5) use new gloves for each treatment, 6) re-examine and modify the caring procedures for inpatients by the nursing staff.
In January 2002, this nosocomial colonization came to an end without any serious infection. One of the key points of this success was the quick response by the clinical staff and ICG committee members to the laboratory results of bacteriological examinations. Furthermore, the early investigation of reservoir and good communication between the clinical staff and ICG committee members mostly prevented this nosocomial colonization from becoming worse.

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The multiple inspection train nicknamed "Doctor Yellow" is capable of taking necessary measurements of the track and electrical facilities, and maintains the safety and reliability of the Tokaido Shinkansen corridor. We performed a workplace inspection to examine environmental conditions in this train. The workers were engaged in VDT (visual display terminal) work including the inspection task. The labor environments such as vibration, noise, temperature and lighting, were comfortable. However, some of the working conditions while the Bullet train is running are inevitably restricted. The occupational physicians of the Central Japan Railway Company are expected to play important roles in providing effective health management for the employees under the characteristic work environments on the railroad.

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Japanese Industrial Health Organizations (IHOs) have been taking part in medical checkups for employees in accordance with the law of industrial safety and health in Japan. We carried out a questionnaire survey for each IHO in order to learn the actual number of full-time doctors and their proportion of work time. We sent a questionnaire to 112 IHOs (members of International Federation of Industrial Health Organizations) by mail, of which 77 replied (68.8%). In addition, we carried out an interview survey in 3 IHOs. The actual number of fulltime doctors was 0 to 51, about half of IHOs have less than 5 doctors/each. Regarding the proportion of work time, among full-time doctors, half of them take part in general health checkups. About 70% of nurses' work time is taken up doing health checkups. The results revealed that the number and the proportion of work time of full-time doctors depends on the characteristics of the area and the background of the organization, for instance, what kind of hygiene services they provide. Depending on the doctors' work style (e.g. fulltime or part-time) and their specialities and experience, their work may be shared. Japanese employers are required to report the number of workers with abnormal findings found by medical checkups to the Labor Standards Office. Many IHOs provide service to employers in filling out their reports. Thus, we also asked each IHO about this service. Forty out of the 77 IHOs (51.9%) answered that they are providing statistical analysis and the filling-out service. They count the number of workers with abnormal findings in each company and helped the employer to fill out the report form. Twenty-nine of those 40 IHOs responded that they decided which findings were "abnormal" by using only items that are set by law. However, 7 IHOs reported the fact that they also add some optional items when making the decision. The prevalence of workers with abnormal findings in annual medical checkups, which is one of the most important indices of the state of occupational health, should be measured by using an objective definition and by being compatible with future systems of medical checkups for all Japanese workers. Although IHOs are endeavoring to improve their level, it will be difficult, and because of diversities in the way of periodical medical checkups among IHOs, there are still many problems to be solved.

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