There is growing evidence that tobacco farming and use, among other critical livelihood factors, has an impact not only on health but also on the environment. The tobacco industry in Kenya has been on the rise with new production areas emerging. However, the nature of the environmental friendliness of the production, processing and consumption technologies have yet to be evaluated in many parts of Kenya. This study undertook an environmental auditing of tobacco farming activities in the South Nyanza region of Kenya for purposes of evaluating their compliance levels and policy formulation. Data collection was achieved through a detailed environmental audit checklist, focused group discussions, interviews, and field observations. Generally, the environmental compliance level with the National Environment Management Authority, World Health Organization standards and world best farming practices was dismal, at 13.6%. Tobacco companies’ compliance rating with standards in application of pesticides and agrochemicals, use and management of energy resources, tobacco leaf storage and disposal of uncollected leaves, occupational health and safety, and best established practices in corporate social responsibility stood at 19.8, 15.7, 27.7, 2.1 and 11.8%, respectively. The low compliance level implies unsustainable farming practices; thus the need for enhanced enforcement of good environmental practices in the sector. Development of policies and legislation on economically viable and environmentally sustainable alternative crops is therefore recommended.

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The World Health Organization (WHO) aims to enable all people to receive health services, and has proposed effective coverage (EC) as an index for this aim. EC refers to “the fraction of potential health gain that is actually delivered to the population through the health system, given its capacity,” and is used to indicate the percentage of the population whose diseases are well controlled among those who require treatment or are receiving treatment. This study aimed to evaluate the effects of occupational health services on EC. We hypothesized that occupational health services provided to employees by full-time occupational health practitioners, such as occupational physicians and occupational health nurses, improve EC for hypertension, diabetes mellitus and hyperlipidemia compared to those services provided by part-time occupational health practitioners. We conducted a cross-sectional study to analyze the results of general medical examinations, personnel information, and medical expense claims in fiscal year 2011. A total of 91,351 male employees at a company group participated in the study. The EC for hypertension, diabetes mellitus and hyperlipidemia was measured and compared between the employees in workplaces with occupational health practitioners (OH group) and the employees in workplaces without occupational health practitioners (non-OH group). The EC for hypertension and diabetes mellitus was significantly greater in the OH group than in the non-OH group (aOR: 1.41, 95% CI: 1.20 - 1.66 for hypertension; aOR: 1.53, 95% CI: 1.17 - 2.00 for diabetes mellitus), while the EC for hyperlipidemia was comparable (aOR: 1.11, 95% CI: 0.92 - 1.34). Occupational health services provided by full-time occupational health practitioners greatly improve health management after a medical examination.

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It is important to assess the eating and swallowing functions of elderly people because they often develop aspiration pneumonia due to dysphagia. The most reliable modalities for assessing the eating and swallowing functions are videofluoroscopic examinations and videoendoscopic evaluations; however, these diagnostic modalities often cannot be performed in elderly people. Therefore, we established the Assessment of Swallowing Ability for Pneumonia (ASAP), which is an assessment of eating and swallowing functions in elderly patients with pneumonia that can be conducted by all health care professionals, and examined the usefulness thereof. The subjects included 130 patients with pneumonia (58 males, 72 females, average age: 82.2 ± 13.0) who had been admitted to the internal medicine department at our hospital between January 2016 and June 2016. The coefficient of correlation between ASAP and the Mann Assessment of Swallowing Ability (MASA) was 0.97, indicating a strong correlation, and the area under the curves (AUC) between the ASAP and the degrees of severity were 0.98, 0.95, and 0.94, respectively. We suggest that ASAP can be useful as a modality for assessing the eating and swallowing functions in elderly patients with pneumonia.

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This study aimed to estimate the incidence and prognosis of neonatal disseminated intravascular coagulation (DIC) in Japan by analyzing data retrieved from a national administrative database. Clinically, the prognosis of DIC in neonates is poor, but there is little epidemiological data in Japan. This retrospective observational study identified patients diagnosed with neonatal DIC and who were registered in the Japanese diagnosis procedure combination (DPC) database between April 1, 2014 and March 31, 2016. The patients, who were diagnosed with neonatal DIC, included those with ICD-10 code D65 or P60 in primary and secondary diagnosis, with comorbid conditions existing at admission, and with complications occurring after admission. Of 78,073 neonates admitted to 1,474 neonatal intensive care units, 1,864 (2.4%) were diagnosed with DIC. There was no difference between sexes in incidence of DIC; the incidence of DIC was higher in extremely low birth weight infants (9.8%), and significantly higher than that in normal birth weight infants. The overall mean length of hospital stay was longer in neonates with DIC (69.5 days) than in those without DIC (32.6 days, P < 0.001). The number of deaths was 1,156 (1.5%). In-hospital mortality was significantly higher in neonates with DIC (14.1%) than in those without DIC (1.2%, P < 0.001), especially in premature babies. This nationwide study was the first report to investigate the incidence and in-hospital mortality of neonatal DIC in Japan. Neonatal DIC has a significant impact on prognosis, and its influence is greater in premature than in term infants.

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There have been no reviews describing the efficacy of the combination of both rehabilitation and nutritional treatments. This systematic review aimed to assess the effects of nutritional therapy on patients with an acute and critical illness undergoing rehabilitation. Online searches using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, EMBASE (ELSEVIER), and Ichu-shi Web databases identified 986 articles, and 16 additional articles were found through other sources. Each trial assessed for the risk of bias using the Cochrane Collaboration’s tool, and the quality of the body of evidence with The Grading of Recommendations Assessment, Development and Evaluation approach. Two randomized controlled trials were included in this review. Jones et al reported that with an enhanced rehabilitation program, there was no effect of nutritional intervention on quality of life (standardized mean difference [SMD] 0.55, 95% confidence intervals [CI] -0.05 to 1.15; P = 0.12). However, Hegerova et al reported positive effects of physical therapy and oral supplements on muscle mass (0.65; 95% CI, 0.36 to 0.93; P < 0.00001) and activities of daily living (SMD 0.28, 95% CI 0.00 to 0.56; P = 0.05). Strengthened nutritional intervention with enhanced rehabilitation treatment for patients with acute and critical illness may possibly be effective for increasing muscle mass, as well as for improving activities of daily living within a short period after discharge.

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Angiopoietins play important roles in angiogenesis and the maintenance of hematopoietic stem cells. Angiopoietin-like proteins (ANGPTLs) are identified as proteins structurally similar to angiopoietins, and the ANGPTL family now consists of eight members. ANGPTLs are secretary proteins, and some ANGPTLs are not only angiogenic factors but also proteins with multiple functions such as glucose metabolism, lipid metabolism, redox regulation and chronic inflammation. Chronic inflammation is one of the key factors in carcinogenesis and cancer growth, proliferation, invasion and metastasis. ANGPTL 2, 3, 4, 6 and 7 are pro-inflammatory factors and regulate cancer progression, while ANGPTL1 inhibits tumor angiogenesis and metastasis. In this review, we describe the roles of ANGPTLs in cancer progression and discuss the possibility of disturbing the progression of cancer by regulating ANGPTLs expression.

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The consultation rate for uterine cervical cancer screening in Japan is markedly low in comparison with other developed countries. The purpose of this study is to investigate the trends in uterine cervical cancer screening during regular company checkups and to identify potential problems. Questionnaires were sent to occupational health physicians through Sansuiken (Alumni Association of the University of Occupational and Environmental Health, Japan). Overall, 127 valid responses showed that Papanicolaou (Pap) tests are conducted in 100 companies (79%). The detailed information from 50 of the 100 responses was analyzed. Mandatory cervical cancer screenings are performed at just 6 companies (12%). Pap test are started at 30 years of age at 9 of 49 companies, and only 18 of 49 companies (37%) start Pap tests for employees at 20 years old. Of the 86,695 women, 31,294 (36%) received cervical cancer screening. Abnormal Pap test results were detected in 3.0%. Although cervical cancer screening rates have slightly increased compared to our previous studies (17% in 2004, 23% in 2008), it remains at a low level. Complete examinations with colposcopy and punch biopsy were carried out in 70% (61 of 87 women) of those with an abnormal Pap test. Twelve of 26 companies had no information about detailed examination results. It is important to note that cervical cancer incidence and mortality are increasing among young women in Japan. Occupational physicians and health nurses should manage female health education and care at the workplace, by including uterine cervical cancer screening in the growing female working population.

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Cranial vault lymphomas are rare and challenging to diagnose. We present herein two cases of cranial vault lymphoma. The first patient was a 72-year-old woman who presented with a large mass in the parietal bone found incidentally following a head injury. The second patient was a 63-year-old man who presented with an occipital subcutaneous mass associated with visual disturbance and occipital headaches. The diagnosis of a malignant tumor in the second patient was straightforward due to his symptoms and considerable bone destruction, but the first patient was more difficult to diagnose due to a lack of symptoms and only slight bone destruction detected by computed tomography (CT). Both were histophathologically diagnosed with diffuse large B cell lymphoma (DLBCL) in the cranial vault. We also investigated the clinical features, including initial symptoms and patterns of bone destruction, in 23 patients with other types of skull tumors. This comparison showed that cranial vault lymphomas cause large masses on the scalp and lead to characteristic incomplete bone destruction, indicating that cranial bone is destroyed very slowly despite the expanding subcutaneous mass. This feature is unique compared with other benign and malignant skull tumors. In addition, cranial vault lymphoma can be confirmed via bone window CT.

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Left ventricular outflow tract obstruction (LVOTO) is sometimes accompanied by aortic stenosis (AS). Reliable estimation of the true severity of AS is often difficult because it cannot be discriminated from dual stenosis. A 75-year-old woman was referred to our hospital due to traumatic hemopneumothorax with exertional dyspnea. Echocardiography revealed AS and LVOTO by chance. A continuous Doppler echocardiography revealed a late-systolic peaking dagger-shaped profile with a 6.0 m/s of peak jet velocity across the LVOT and aortic valve, but it was difficult to discriminate between the coexisting peak flows. For an accurate evaluation of AS, we performed landiolol (short acting beta-blocker) and cibenzoline (Na⁺ channel-blocking agent) stress echocardiography with simultaneous recordings of both left ventricular and aortic pressure by catheter examination. Cibenzoline successfully eliminated the LVOTO, but landiolol did not. Cibenzoline stress echocardiography enabled us to evaluate the AS severity as less than moderate, resulting in proper decision-making. The findings in this case clearly showed that cibenzoline stress echocardiography has a potential utility for determining AS severity in a patient with coexistent dynamic LVOTO.

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