Developmental Manganese Exposure Causes Lasting Attention Deficits Accompanied by Dysregulation of mTOR Signaling and Catecholaminergic Gene Expression in Brain Prefrontal Cortex

Elevated manganese (Mn) exposure is associated with attentional deficits in children, and is an environmental risk factor for attention deficit hyperactivity disorder (ADHD). We have shown that developmental Mn exposure causes lasting attention and sensorimotor deficits in a rat model of early childhood Mn exposure, and that these deficits are associated with a hypofunctioning catecholaminergic system in the prefrontal cortex (PFC), though the mechanistic basis for these deficits is not well understood. To address this, male Long-Evans rats were exposed orally to Mn (50 mg/kg/d) over PND 1-21 and attentional function was assessed in adulthood using the 5-Choice Serial Reaction Time Task. Targeted catecholaminergic system and epigenetic gene expression, followed by unbiased differential DNA methylation and gene regulation expression transcriptomics in the PFC, were performed in young adult littermates. Results show that developmental Mn exposure causes lasting focused attention deficits that are associated with reduced gene expression of tyrosine hydroxylase, dopamine transporter, and DNA methyltransferase 3a. Further, developmental Mn exposure causes broader lasting methylation and gene expression dysregulation associated with epigenetic regulation, inflammation, cell development, and hypofunctioning catecholaminergic neuronal systems. Pathway enrichment analyses uncovered mTOR and Wnt signaling pathway genes as significant transcriptomic regulators of the Mn altered transcriptome, and Western blot of total, C1 and C2 phospho-mTOR confirmed mTOR pathway dysregulation. Our findings deepen our understanding of the mechanistic basis of how developmental Mn exposure leads to lasting catecholaminergic dysfunction and attention deficits, which may aid future therapeutic interventions of environmental exposure associated disorders.

Significance Statement

Attention deficit hyperactivity disorder (ADHD) is associated with environmental risk factors, including exposure to neurotoxic agents. Here we used a rodent model of developmental manganese (Mn) exposure producing lasting attention deficits to show broad epigenetic and gene expression changes in the prefrontal cortex, and to identify disrupted mTOR and Wnt signaling pathways as a novel mechanism for how developmental Mn exposure may induce lasting attention and catecholaminergic system impairments. Importantly, our findings establish early development as a critical period of susceptibility to lasting deficits in attentional function caused by elevated environmental toxicant exposure. Given that environmental health threats disproportionately impact communities of color and low socioeconomic status, our findings can aid future studies to assess therapeutic interventions for vulnerable populations.

Uncertainty in phosphorus fluxes and budgets across the U.S. long-term agroecosystem research network

Phosphorus (P) budgets can be useful tools for understanding nutrient cycling and quantifying the effectiveness of nutrient management planning and policies; however, uncertainties in agricultural nutrient budgets are not often quantitatively assessed. The objective of this study was to evaluate uncertainty in P fluxes (fertilizer/manure application, atmospheric deposition, irrigation, crop removal, surface runoff, leachate) and the propagation of these uncertainties to annual P budgets. Data from 56 cropping systems in the P-FLUX database, which spans diverse rotations and landscapes across the U.S. and Canada, were evaluated. Results showed that across cropping systems, average annual P budget was 22.4 kg P ha^-1 (range = -32.7 to 340.6 kg P ha^-1 ), with an average uncertainty of 13.1 kg P ha^-1 (range = 1.0 to 87.1 kg P ha^-1 ). Fertilizer/manure application and crop removal were the largest P fluxes across cropping systems and, as a result, accounted for the largest fraction of uncertainty in annual budgets (61 and 37%, respectively). Remaining fluxes individually accounted for <2% of the budget uncertainty. Uncertainties were large enough that determining whether P was increasing, decreasing, or not changing was inconclusive in 39% of the budgets evaluated. Findings indicate that more careful and/or direct measurements of inputs, outputs, and stocks are needed. Recommendations for minimizing uncertainty in P budgets based on the results of the study were developed. Quantifying, communicating, and constraining uncertainty in budgets among production systems and multiple geographies is critical for engaging stakeholders, developing local and national strategies for P reduction, and informing policy. This article is protected by copyright. All rights reserved.

Rift Valley fever MP-12 vaccine elicits an early protective immune response in mice

Rift Valley fever virus (RVFV) is an important mosquito-borne pathogen that causes outbreaks of severe disease in people and livestock throughout Africa and the Arabian Peninsula. The development of an effective veterinary and human vaccine to protect against Rift Valley fever (RVF) disease remains a high priority. The live attenuated RVFV MP-12 is a promising vaccine candidate for the prevention of RVF in both human and domestic ruminants. The aim of this study was to determine the onset of protective immunity elicted in mice by a single dose of this vaccine. Groups of CD-1 mice were vaccinated intraperitoneally with RVFV MP-12 vaccine and challenged on days 2, 5, 6 and 7 post-vaccination (PV) with a lethal dose of virulent RVFV. The mice were observed once daily for terminal morbidity and blood samples were obtained from the retro-orbital sinus complex on days 23 and 28 PV of surviving mice to determine RVFV neutralizing antibody titers. In one test, 2 of 3 mice challenged on day 2 PV survived and all 3 mice challenged at days 5 and 7 PV also survived. A second test of 10 mice per group was performed, and half (5) of those challenged at day 2 PV survived while all (10) survived challenge at day 4 and 6 PV. All surviving animals develop antibody that ranged from 1:80 to 1:1,280 PV. In a separate experiment, RVFV MP-12 vaccinated CD-1 mice, but not challenged developed a low viremia for the first 3 days PV and neutralzing antibody was detected on days 5 through day 28 PV. These findings demonstrated that the RVFV MP-12 vaccine elicited a rapid protective immune response in mice as early as 2 days PV, thus further supporting the effectiveness of this vaccine candidate for preventing RVF among humans and domestic ruminants.

Pedestal fluctuation measurements with charge exchange imaging at the DIII-D tokamak

A new high radial resolution 2D multichannel Charge eXchange Imaging (CXI) diagnostic is under development for deployment at DIII-D. The diagnostic system will measure low-to-intermediate radial wavenumber carbon density fluctuations by observing the n = 8 - 7 (λ = 529.06 nm) C-VI emission line, resulting from charge exchange collisions between heating neutral beam atoms and the intrinsic carbon ion density. The new CXI diagnostic will provide measurements with ΔR ∼ 0.4 cm to access higher k_r instabilities (k_r < 8 cm^-1) predicted to arise in the steep-gradient region of the H-mode pedestal. The CXI system will feature 60 fiber bundles in a 12 × 5 arrangement, with each bundle consisting of four 1 mm fibers. A custom optical system has been designed to filter and image incoming signals onto an 8 × 8 avalanche photodiode array. Additionally, a novel electronics suite has been designed and commissioned to amplify and digitize the relatively low-intensity carbon signal at a 2 MHz bandwidth. Forward modeling results of the active C-VI emission suggest sufficient signal to noise ratios to resolve turbulent fluctuations. Prototype measurements demonstrate the ability to perform high frequency pedestal measurements.

202 Frequency of inter-specialty consensus decisions and adherence to advice following a weekly neurovascular multidisciplinary meeting

Background/Aims

Data are limited on the frequency of ‘consensus’ between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) regarding management of patients with extracranial carotid/vertebral stenoses, and post-MDM ‘adherence’ to advice. This prospective audit/quality improve- ment project collated data at a Neurovascular/Stroke Centre.

Methods

Data from a weekly MDM were prospectively-recorded to document the proportion of extrac- ranial carotid/vertebral stenosis patients in whom ‘consensus management decisions’ were reached by Neurologists/Vascular Surgeons/Stroke Physicians-Geriatricians. Adherence to MDM advice was analysed in patients with asymptomatic, symptomatic and ‘indeterminate symptomatic status [ISS]’ stenoses, including intervals between symptom onset-MDM discussion +/- intervention.

Results

115 patients were discussed (September/2017-February/2020). Consensus regarding manage- ment was 96.5% (111/115) overall; 100% (29/29) with asymptomatic carotid stenosis [ACS], 96.5% (55/57) with symptomatic carotid stenosis [SCS], and 93.1% (27/29) with ISS. Overall adherence to MDM advice was 93% (107/115); 100% (29/29) with ACS, 89.5% (51/57) with SCS, 93.1% (27/29) with ISS. Median interval from index TIA/stroke to intervention was 12.5 days (IQR:9-18d), and MDM discussion-to-intervention was 5.5d (IQR:1-7d) in patients with 50-99% SCS.

Conclusions

High-frequency inter-specialty consensus regarding management/adherence to proposed treatment supports a collaborative, multidisciplinary model-of-care in patients with extracranial arterial stenosis. Service development should shorten intervals between symptoms-MDT discussion-intervention to optimise secondary prevention.

Conceptual design and performance predictions for 2D beam emission spectroscopy turbulence measurements at Wendelstein 7-X

A conceptual design for a 2D beam emission spectroscopy diagnostic system to measure ion gyro-scale plasma turbulence at Wendeslstein 7-X is described. The conceptual design identifies field-aligned viewing geometries and ports for cross-field turbulence measurements in the neutral beam volume. A 2D sightline grid covers the outer plasma region, and the grid configuration provides sufficient k-space coverage in radial and poloidal directions for ion temperature gradient and trapped-electron mode turbulence measurements. Emission intensity estimates, optical transmission losses, and detector noise levels indicate that the measurements will be sensitive to plasma density fluctuations as small as δn/n ≈ 0.5% with a bandwidth of 1 MHz. Implementation challenges include a small beam emission Doppler shift due to nearly radial heating beams and reduced optical throughput due to collection aperture limitations.

Profile of reticulated platelets in the early, subacute and late phases after transient ischemic attack or ischemic stroke

Information regarding the profile of reticulated platelets (RP) in ischemic cerebrovascular disease (CVD) patients is limited. Data from two prospective, observational, case-control studies were combined to compare the %RP using whole blood flow cytometry in patients ≤ 4 weeks of TIA/stroke onset (baseline, N = 210), and 14 ±7 days (14d, N = 182) and ≥ 90 days (90d, N = 145) after starting or changing antiplatelet therapy with healthy controls (N = 34). There were no differences in median %RP between the overall CVD patient population at baseline or 14d vs. controls (P ≥ 0.2). However, the median %RP was significantly higher in CVD patients overall at 90d (P = .036), and in the subgroup of patients with "lacunar" TIA/ischemic stroke at baseline (P = .04) and at 90d (P = .01), but not at 14d (P = .06) vs. controls. There were no significant differences in the median %RP between other TIA/stroke subgroups and controls (P ≥ 0.05). Elevated circulating reticulated platelets, as a marker of increased platelet production/turnover, may occur following an ischemic event in a well-phenotyped TIA/ischemic stroke population overall, but may precede symptom onset at least in the subgroup with small vessel occlusion. These data improve our understanding of the profile of reticulated platelets in CVD patients.

Distribution of Manganese-Substituted Magnetites in Dusts from Taranto, Italy

Elevated exposure to manganese (Mn) in environmental dusts and airborne particulates, particular from ferromanganese alloy steel production and metal working, is associated with a number of negative health outcomes, including Parkinsonism and other nervous system diseases. Manganese contamination and exposure from industrial sources is difficult to identify or quantify, as manganese is naturally abundant in the environment, and means to distinctly identify or fingerprint Mn arising from different industrial and environmental sources are limited. Here, the chemical and mineralogical properties of Mn in dusts from an active steel production facility in Taranto, Italy, were compared with those of indoor and outdoor deposited dust samples and surface soils collected in a series of schools in the nearby town. X-ray absorption spectroscopy revealed distinct chemical forms of Mn in industrial sources from those in typical background soils. Manganese ore from the facility contained abundant Mn(III, IV) oxides, while Mn-substituted magnetites were the most abundant mineral phase in dusts found in areas of the plant where metal was produced or combustion occurred. All school dusts were primarily composed of Mn-substituted magnetites, while most of the soils contained abundant manganese(IV) oxides. Source apportionment of Mn in regional dust and soil samples was estimated using linear combination fitting with representative industrial source materials. Manganese in dusts from the Taranto area community adjacent to the plant was derived primarily from industrially-sourced dusts produced during high temperature coke or steel production rather than re-suspended local soils or ore source material. Soils contained smaller proportion of industrially-derived Mn and are distinct from dusts, indicating that soil is a minor contributor of dust Mn in this area.

Key messages

Manganese speciation gives useful information in investigating Mn toxicology to humans in urban areas. Manganese-substituted magnetites may represent the target compound useful to distinguish toxic and non-toxic Mn-containing elements.

The Latitudes, Attitudes, and Platitudes of Watershed Phosphorus Management in North America

Phosphorus (P) plays a crucial role in agriculture as a primary fertilizer nutrient-and as a cause of the eutrophication of surface waters. Despite decades of efforts to keep P on agricultural fields and reduce losses to waterways, frequent algal blooms persist, triggering not only ecological disruption but also economic, social, and political consequences. We investigate historical and persistent factors affecting agricultural P mitigation in a transect of major watersheds across North America: Lake Winnipeg, Lake Erie, the Chesapeake Bay, and Lake Okeechobee/Everglades. These water bodies span 26 degrees of latitude, from the cold climate of central Canada to the subtropics of the southeastern United States. These water bodies and their associated watersheds have tracked trajectories of P mitigation that manifest remarkable similarities, and all have faced challenges in the application of science to agricultural management that continue to this day. An evolution of knowledge and experience in watershed P mitigation calls into question uniform solutions as well as efforts to transfer strategies from other arenas. As a result, there is a need to admit to shortcomings of past approaches, plotting a future for watershed P mitigation that accepts the sometimes two-sided nature of Hennig Brandt's "Devil's Element."

Body Size Influences Stingless Bee (Hymenoptera: Apidae) Communities Across a Range of Deforestation Levels in Rondônia, Brazil

Developments in understanding bee responses to habitat loss indicate that body size is a trait with important consequences for conservation. Stingless bees (Hymenoptera, Apidae, Meliponini) are a diverse group of eusocial bees providing pollination services in tropical landscapes, exhibiting a large range in body size across species. We tested the effects of deforestation on the body sizes of stingless bee communities by using museum specimens and revisiting a previous effort that sampled stingless bee communities across varying levels of deforestation at 183 sites in Rondônia, Brazil, in 1996-1997. Body size measurements (intertegular distance) from 72 species collected were included as dependent variables in response to forest area, forest edge, and connectivity of forest patches at several spatial scales. We find that stingless bee body size is negatively related to forest cover: mean community body size was larger in areas with greater amounts of deforestation, and smaller in areas with less deforestation. Second, stingless bee species richness was positively associated with forest edge regardless of body size. Lastly, we find that as forest patch isolation increased, the stingless bee community body size also increased. These findings support hypotheses that small stingless bee species might be more negatively affected by deforestation, adding to the growing body of evidence that stingless bees require areas of intact forest in near proximity to other forest patches to conserve these diverse pollinator communities.

Willingness to care for blood-borne virus-infected patients in Thailand

Background

Although stigma and discrimination by nurses against patients infected with human immunodeficiency virus (HIV) or hepatitis C virus (HCV) have been reported, potential determinants of nurses' willingness to care for these patients have not been well studied in Thailand.

Aims

To identify factors associated with Thai nurses' willingness to care for patients infected with HIV or HCV.

Methods

Multivariable logistic regression analysis of data from a questionnaire completed by nurses at a large hospital in Bangkok, Thailand.

Results

Of 626 nurses, 546 (87%) nurses participated. Eleven per cent (59) and 6% (34) had previously experienced HIV- or HCV-infected blood contamination incidents, respectively. Forty-four per cent (240) and 38% (208) reported unwillingness to care for HIV- or HCV-infected patients, respectively. Willingness to care was less common [adjusted odds ratios 0.51 (0.34-0.74) for HIV and 0.62 (0.42-0.89) for HCV] in nurses aged ≥ 40 years and in those who feared HCV [0.63 (0.37-0.99)], but not HIV [0.84 (0.5-1.26)] transmission. Nurses who had confidence in protecting themselves against infection with HIV [1.84 (1.52-2.04)] and HCV [1.87 (1.45-2.18)], and accepting attitudes towards HIV-infected co-workers [1.39 (1.08-1.66)] but not HCV-infected co-workers [1.16 (0.83-1.5)], were more willing to care for HIV- and HCV-infected patients.

Conclusions

Around 4 in 10 Thai nurses in our sample were unwilling to care for HIV- or HCV-infected patients. Minimizing the risk of nosocomial transmission and improving the public perception of infected individuals may help improve nurses' willingness to care for such patients, in Thailand or elsewhere.

A century of the Archives of Environmental & Occupational Health

With this issue, the Archives of Environmental & Occupational Health celebrates 100 years of continuous publication since its foundation as the Journal of Industrial Hygiene in 1919. During its first century, the Archives established an extraordinary legacy in the development of no less than three fields of research and practice: (1) occupational medicine, (2) industrial hygiene, and (3) air pollution studies and regulation. Its contribution to American environmental protection standards in air quality was particularly important, as the journal served as a major outlet for crucial air pollution research during the early years of the new United States Environmental Protection Agency. Its pages also chart the development of occupational health as an independent field, as well as the later emergence of modern environmental health as a related co-discipline. As the Archives moves into its second century of continuous publication, the journal will continue shaping the fields of environmental and occupational health; building on the solid foundation of evidence-based research from which humankind continues to benefit.

Temporal evaluation of estrogenic endocrine disruption markers in smallmouth bass (Micropterus dolomieu) reveals seasonal variability in intersex

A reconnaissance project completed in 2009 identified intersex and elevated plasma vitellogenin in male smallmouth bass inhabiting the Missisquoi River, VT. In an attempt to identify the presence and seasonality of putative endocrine disrupting chemicals or other factors associated with these observations, a comprehensive reevaluation was conducted between September 2012 and June 2014. Here, we collected smallmouth bass from three physically partitioned reaches along the river to measure biomarkers of estrogenic endocrine disruption in smallmouth bass. In addition, polar organic chemical integrative samples (POCIS) were deployed to identify specific chemicals associated with biological observations. We did not observe biological differences across reaches indicating the absence of clear point source contributions to the observation of intersex. Interestingly, intersex prevalence and severity decreased in a stepwise manner over the timespan of the project. Intersex decreased from 92.8% to 28.1%. The only significant predictor of intersex prevalence was year of capture, based on logistic regression analysis. The mixed model of fish length and year-of-capture best predicted intersex severity. Intersex severity was also significantly different across late summer and early spring collections indicating seasonal changes in this metric. Plasma vitellogenin and liver vitellogenin Aa transcript abundance in males did not indicate exposure to estrogenic endocrine disrupting chemicals at any of the four sample collections. Analysis of chemicals captured by the POCIS as well as results of screening discrete water samples or POCIS extracts did not indicate the contribution of appreciable estrogenic chemicals. It is possible that unreported changes in land-use activity have ameliorated the problem, and our observations indicate recovery. Regardless, this work clearly emphasizes that single, snap shot sampling for intersex may not yield representative data given that the manifestation of this condition within a population can change dramatically over time.

Extracting the turbulent flow-field from beam emission spectroscopy images using velocimetry

The 2D turbulent E × B flow-field is inferred from density fluctuation images obtained with the beam emission spectroscopy diagnostic on DIII-D using the orthogonal dynamic programming velocimetry algorithm. A synthetic turbulence model is used to test the algorithm and optimize it for measuring zonal flows. Zonal flow measurements are found to require a signal-to-noise ratio above ∼10 and a zonal flow wavelength longer than ∼2 cm. Comparison between the velocimetry-estimated flow-field and the E × B flow-field using a nonlinear gyrokinetic GENE simulation finds that the flow-fields have identical spatial structure and differ only by the mean turbulence phase velocity, which is spatially uniform in this flux tube simulation.

A four-season longitudinal study of enterohaemorrhagic Escherichia coli in beef cow-calf herds in Mississippi and Nebraska

Our objective was to describe the probability of detecting seven serogroups of enterohaemorrhagic Escherichia coli (EHEC-7) of public health importance in faecal samples from beef cow-calf herds and to test for factors associated with their detection. Fresh faecal samples (n = 85) from two Mississippi and two Nebraska herds were collected in each of four seasons. Samples were tested for each EHEC-7 serogroup by a molecular screening assay. Separate management groups within herds were sampled, and group-level factors were recorded. To measure the effects of factors on faecal shedding of EHEC-7, separate multivariable logistic regression models were used, accounting for the random effect of clustering by group within farm. Statistical significance was set α = 0.05. Fifty-nine samples (4.3%) were positive for EHEC O26, and Nebraska samples were more likely to be positive than Mississippi samples (OR = 12.4, 95% CI: 1.1, 139.2). Forty-four samples (3.2%) were positive for EHEC O45. Odds for detection were greater in the summer than all other seasons combined (OR = 4.2, 95% CI: 1.3, 14.0), and odds decreased if a precipitation event occurred (OR = 0.07, 95% CI: 0.006, 0.8). EHEC O103 was detected in 66 samples (4.9%) with increased probability to be detected at increased temperature. EHEC O111 was detected in 71 samples (5.2%), and 43 samples (3.2%) were positive for EHEC O145. Both EHEC O111 and O145 were associated separately with season, with greater probability for detection in the summer. Eighteen (1.3%) and 68 (5.0%) samples were positive for EHEC O121 and EHEC O157, respectively. We failed to detect significant explanatory factors associated with probability to detect EHEC O121 or O157. Factors that vary by time and place, such as precipitation, ambient temperature, region and season, are uniquely associated with the probability to detect EHEC-7 in fresh faeces collected from cow-calf herds.

Preventing heat illness in the anticipated hot climate of the Tokyo 2020 Summer Olympic Games

Amid the effects of global warming, Tokyo has become an increasingly hot city, especially during the summertime. To prepare for the upcoming 2020 Summer Olympics and Paralympics in Tokyo, all participants, including the athletes, staff, and spectators, will need to familiarize themselves with Tokyo’s hot and humid summer conditions. This paper uses the wet-bulb globe temperature (WBGT) index, which estimates the risk of heat illness, to compare climate conditions of sports events in Tokyo with the conditions of the past three Summer Olympics (held in Rio de Janeiro, London, and Beijing) and to subsequently detail the need for establishing appropriate countermeasures. We compared WBGT results from the past three Summer Olympics with the same time periods in Tokyo during 2016. There was almost no time zone where a low risk of heat illness could be expected during the time frame of the upcoming 2020 Tokyo Olympics. We also found that Tokyo had a higher WBGT than any of those previous host cities and is poorly suited for outdoor sporting events. Combined efforts by the official organizers, government, various related organizations, and the participants will be necessary to deal with these challenging conditions and to allow athletes to perform their best, as well as to prevent heat illnesses among staff and spectators. The sporting committees, as well as the Olympic organizing committee, should consider WBGT measurements in determining the venues and timing of the events to better avoid heat illness and facilitate maximum athletic performance.

Treatment resistance in potentially malignant disorders-'Nature' or 'Nurture'…?

BACKGROUND

Contemporary potentially malignant disorder management is based upon provisional histological diagnosis followed by interventional surgery to excise or ablate 'high-risk' mucosal lesions. Although the majority of patients achieve disease-free status post-treatment, others develop further or persistent disease unresponsive to intervention.

METHODS

A detailed, retrospective clinico-pathological review of treatment resistant potentially malignant lesions, from a 590 patient cohort treated by CO₂ laser surgery and followed for a mean of 7.3 years, was undertaken. Clinical outcome was determined at study census date (31 December 2014).

RESULTS

A total of 87 patients (15%) exhibited PMD disease resistant to treatment: 34 (6%) became disease free following further treatment, whilst 53 (9%) had persistent disease despite intervention. Disease-free patients were younger, changed lesion appearance from erythroleukoplakia to leukoplakia (P = .004), developed further lesions at new sites, demonstrated reduction in dysplasia severity with time and required multiple treatments to achieve disease-free status (P = .0005). In contrast, persistent disease patients were older, male, often presented with proliferative verrucous leukoplakia (PVL) on gingival and alveolar sites, displayed less severe dysplasia initially and underwent laser ablation rather than excision (P = .027).

CONCLUSION

Despite clinico-pathological profiling of treatment resistant patients, the precise inter-relationship between the inherent nature of potentially malignant disease and the external influence of treatment intervention remains obscure.

Profiling cancer risk in oral potentially malignant disorders-A patient cohort study

BACKGROUND

Oral potentially malignant disorders harbour variable and unpredictable risk for squamous carcinoma development. Whilst current management strategies utilise histopathological diagnoses, dysplasia grading and targeted intervention for "high-risk" lesions, clinicians are unable to predict malignant potential.

METHODS

Detailed, retrospective clinico-pathological analysis of potentially malignant lesions undergoing malignant transformation, from a 590 patient cohort treated by interventional laser surgery and followed for a mean of 7.3 years, was undertaken. Clinical outcome was documented at study census date (31 December 2014).

RESULTS

A total of 99 patients (16.8%) developed cancer: 71 (12%) seen "unexpectedly" upon excision and 28 (4.8%) progressing to malignancy at a median of 87.3 months post-surgery. Thirty "unexpected" excisions were micro-invasive (42.3%) arising primarily in severely dysplastic precursors (75%) at ventro-lateral tongue and floor of mouth sites (54.5%); 1 patient (1.4%) had a cancer-related death, whilst 58 (81.7%) were disease free. A total of 19 of 28 "progressive" cancers (67.9%) arose at new sites, with erythroleukoplakia a significant predictor of malignancy (P = .0019). Nine (32.1%) developed at the same precursor site, with 6 (77.7%) on the ventro-lateral tongue and floor of mouth. Three (10.7%) were micro-invasive, 9 patients (32.1%) died from metastatic disease and 12 (42.9%) were disease free (P < .001).

CONCLUSION

Squamous carcinoma may arise at the site of a precursor lesion as transformation or new-site development via field cancerisation. Whilst interventional surgery facilitates early diagnosis and treatment of occult disease, thus reducing risk from same-site transformation, new-site cancer is a significant long-term risk for patients with potentially malignant disorder.

Efficacy of oral brush biopsy in potentially malignant disorder management

BACKGROUND

Oral potentially malignant disorders (PMD) harbour unpredictable risk for squamous cell carcinoma development. Current management requires tissue biopsy for histopathology characterisation, dysplasia grading and targeted intervention to "high-risk" lesions, although evidence-based guidelines are limited and diagnoses subjective. This study investigated the use of adjunctive oral brush biopsy techniques during the management of PMD in a UK hospital population.

METHODS

Retrospective review of a 310 PMD patient cohort presenting to Maxillofacial Surgery in Newcastle upon Tyne with new, single-site lesions between December 2009 and May 2014. Patients underwent Orcellex^® brush biopsy and liquid-based cytology examination in addition to conventional biopsy techniques, with management proceeding along established care pathways. Patient demographics, cytology data, most significant histopathology diagnoses and clinical outcome were all documented at the study census date (31.12.15).

RESULTS

A total of 170 male & 140 female patients (age range 18-91 years), exhibiting primarily leukoplakia (86.5%) at floor of mouth and ventrolateral tongue sites (44.9%), were identified. Management comprised: observation (49.7%), laser surgery (44.9%), antifungal treatment (3.5%) and Head & Neck clinic referral following cancer diagnosis (1.9%). Clinical outcomes were as follows: disease free (51.3%), persistent PMD (42.3%) and malignant transformation (6.4%). Histology and cytology diagnoses strongly correlated (r = .305). Treatment modality, lesion site, histology and cytology diagnoses were the best predictors of clinical outcome.

CONCLUSIONS

Orcellex^® brush cytology provides reliable diagnoses consistent with conventional histopathology and offers less invasive, adjunctive assessment appropriate for long-term monitoring of patients in specialist clinics.

A randomized controlled trial to evaluate the effects of dietary fibre from distillers grains on enterohemorrhagic Escherichia coli detection from the rectoanal mucosa and hides of feedlot steers

Feeding high levels (≥40% dry matter) of distillers grains may increase the risk for cattle to carry enterohemorrhagic Escherichia coli (EHEC) O157. The mechanism for the increased risk is not known nor whether non-O157 EHEC are similarly affected. Our objective was to test whether the fibre content or other components of modified distillers grains plus solubles (MDGS) affects the probability for cattle to carry EHEC serogroups of public health importance. A 2 × 2 plus 1 factorial treatment arrangement within a randomized block design was utilized. Within each of four blocks, 25 feedlot pens (n = 8 steers/pen) were assigned randomly to (i) corn-based control diet; (ii) 20% dry matter (DM) MDGS; (iii) 40% DM MDGS; (iv) corn bran added to corn-based diet to match fibre of 20% MDGS or (v) 40% MDGS. Rectoanal mucosa swabs (RAMS) were collected on day (d)0, d35, d70 and d105; hide swabs were collected on the last feeding day. Samples were tested for EHEC by a molecular screening assay. The effects of fibre source and fibre level on EHEC carriage were tested using multilevel logistic regression (generalized linear mixed models; α = 0.05). EHEC O45 RAMS detection was associated with fibre level, source and sampling day. EHEC O103 RAMS detection increased by feeding 40% MDGS but not the corresponding corn bran diet. Hide contamination by EHEC O45 or O103 was less likely in cattle fed MDGS compared to corn bran diets. EHEC O111 RAMS detection decreased by feeding 40% MDGS but not by feeding the corresponding corn bran diet. Detection of EHEC O157 or O145 was not associated with dietary factors. Feeding 40% MDGS increased the probability for carriage of some EHEC serogroups but decreased probability of others, which indicated that EHEC serogroups have different risk factors associated with feeding MDGS and little association with dietary fibre.

The effect of loupes on neck pain and disability among dental hygienists

BACKGROUND

Musculoskeletal disorders represent a significant occupational health issue in dental hygiene, with high prevalence rates documented. Despite this fact, there have been few advancements in the application of ergonomic principles in the dental hygiene profession. While the use of loupes is often promoted as an ergonomic solution, there is little published research to support this claim.

OBJECTIVES

The aim of the present study, therefore, was to investigate the effect of the use of loupes on neck pain and disability in dental hygienists.

METHODS

The study was conducted using an exploratory pre-test post-test design, comparing musculoskeletal measures in dental hygienists wearing loupes with final year dental hygiene students who do not wear loupes. Pre- and post-test measures included the Neck Pain and Disability Scale and a standardised physical assessment using previously validated measures. Statistical analysis was conducted as a series of mixed ANOVAs with time and treatment as the independent variables.

RESULTS

While the analyses revealed no significant interactions between time and treatment (p <  0.05), there were general trends of improvement or deterioration for outcome measures. Improvements over time were noted in the treatment group for cervical range of motion and deep neck muscle endurance; however deteriorations were noted for forward head posture and cervical kinaesthetic sense.

CONCLUSIONS

Overall, despite no statistically significant differences being detected, this study suggests that wearing loupes appears to have both positive and negative outcomes with regards to physical well-being. As such, further studies are required to more precisely determine the effects of loupes on MSD among dental hygienists, particularly long-term. Dental hygienists with existing neck pain exploring ergonomic equipment may reflect on the findings and consider the potential benefits and risks of wearing loupes.

Harnessing interactive technologies to improve health outcomes in juvenile idiopathic arthritis

BACKGROUND

Children and adolescents with Juvenile Idiopathic Arthritis (JIA) typically have reduced physical activity level and impaired aerobic and anaerobic exercise capacity when compared to their non-JIA counterparts. Low intensity exercise regimens appear to be safe in children with JIA and may results in improvements in overall physical function. Poor adherence to paediatric rheumatology treatment may lead to negative clinical outcomes and possibly increased disease activity. This includes symptoms such as pain, fatigue, quality of life, longer term outcomes including joint damage, as well as increase of healthcare associated costs. Low adherence to medications such as methotrexate and biological-drugs remains a significant issue for paediatric rheumatologists, with alarming reports that less than half of the children with JIA are compliant to drug-therapy.

MAIN BODY

The recent advances in interactive technology resulting in a variety of wearable user-friendly smart devices may become a key solution to address important questions in JIA clinical management. Fully understanding the impact that arthritis and treatment complications have upon individual children and their families has long been a challenge for clinicians. Modern interactive technologies can be customised and accessed directly in the hands or wrists of children with JIA. These secured networks could be accessible 'live' at anytime and anywhere by the child, parents and clinicians. Multidisciplinary teams in paediatric rheumatology may benefit from adopting these technologies to better understand domains such as patient biological parameters, symptoms progression, adherence to drug-therapy, quality of life, and participation in physical activities. Most importantly the use of smart devices technologies may also facilitate more timely clinical decisions, improve self-management and parents awareness in the progression of their child's disease. Paediatric rheumatology research could also benefit from the use of these smart devices, as they would allow real-time access to meaningful data to thoroughly understand the disease-patterns of JIA, such as pain and physical activity outcomes. Data collection that typically occurs once every 1 or 3 months in the clinical setting could instead be gathered every week, day, minute or virtually live online. Arguably, few limitations in wearing such interactive technologies still exist and require further developments.

CONCLUSION

Finally, by embracing and adapting these new and now highly accessible interactive technologies, clinical management and research in paediatric rheumatology may be greatly advanced.

A consensus for occupational health management of healthcare workers infected with human immunodeficiency virus, hepatitis B virus, and / or hepatitis C virus

Occupational health management plays an important role in the prevention of provider-to-patient transmission in healthcare workers infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and/or hepatitis C virus (HCV). Therefore, the Japan Society for Occupational Health's Research Group on Occupational Health for Health Care Workers has proposed a consensus for the management of healthcare workers infected with HIV, HBV, and/or HCV based on recent evidence for each concerned group. The consensus recommends that: (1) employers in medical institutions should establish a policy of respecting the human rights of healthcare workers, management strategies for occupational blood exposure, and occupational health consultation; (2) occupational health staff should appropriately assess the risk of provider-to-patient transmission of HIV, HBV, and/or HCV infection and rearrange their tasks if necessary. When conducting risk assessment, occupational health staff should obtain informed consent and then cooperate with the physician in charge as well as infection control experts in the workplace; (3) healthcare workers infected with HIV, HBV, and/or HCV should disclose their employment to their treating physician and consult with their doctor regarding the need for special considerations at work; and (4) supervisors and colleagues in medical institutions should correctly understand the risks of HIV, HBV, and HCV infection and should not engage in any behavior that leads to discrimination against colleagues infected with HIV, HBV, and/or HCV.

Psychosocial factors and colleagues' perceptions of return-to-work opportunities for workers with a psychiatric disorder: a Japanese population-based study

Background

This study examined associations between psychosocial factors and the perception that adequate employment opportunities might not be provided for people with limited work capacity due to psychiatric disorders.

Methods

We conducted an online, cross-sectional survey of 3,710 employed individuals aged 20 to 69 years in Japan. Our survey included the Brief Job Stress Questionnaire and investigated participants’ perception of opportunities in their workplace for individuals with a psychiatric disorder returning to work (colleagues’ negative perception) and psychosocial factors (job demand, job control, and workplace social support). Multiple logistic regression analysis was used to evaluate potential associations between psychosocial factors and colleagues’ negative perception.

Results

Colleagues’ negative perception was associated with low workplace social support (middle tertile: Odds Ratio [OR]: 1.26, 95% Confidence Interval [CI]: 1.12–1.40; low tertile: OR 1.45, 95% CI: 1.32–1.58; p for trend <0.01); low levels of job control (middle tertile: OR 1.22, 95% CI: 1.06–1.38; low tertile: OR 1.64, 95% CI: 1.46–1.81; p for trend <0.01); and no previous experience working with a person with a psychiatric disorder (OR 1.74, 95% CI: 1.60–1.88).

Conclusions

Psychosocial factors may affect colleagues’ perceptions of individuals with a psychiatric disorder returning to work in Japan. Greater consideration of psychosocial factors in the workplace may be necessary to facilitate people with a psychiatric disorder successfully returning to work in Japan, as elsewhere.

Nurses' willingness to care for patients infected with HIV or Hepatitis B / C in Vietnam

OBJECTIVES

This study examined the factors associated with nurses' willingness to care for patients infected with human immunodeficiency virus (HIV) or hepatitis B or C virus (HBV/HCV) in Vietnam.

METHODS

A cross-section of 400 Vietnamese nurses from two hospitals were selected using stratified random sampling, to whom a self-administered questionnaire was administered which included demographic items, previous experience with patients infected with HIV or HBV/HCV, and their attitudes toward these patients. Data was analyzed using descriptive statistics and multiple logistic regression.

RESULTS

The lifetime prevalence of needlestick or sharps injury whilst caring for a patient infected with HIV or HBV/HCV was 9 and 15.8%, respectively. The majority of participants expressed a willingness to care for patients infected with HIV (55.8%) or HBV/HCV (73.3%). Willingness to care for HIV-infected patients was positively associated with being 40-49 years of age and confidence in protecting themselves against infection. Regarding HBV/HCV infection, willingness to care was positively associated with individual confidence in protecting themselves against infection.

CONCLUSIONS

This study revealed that Vietnamese nurses were somewhat willing to care for patients infected with HIV or HBV/HCV, and this was associated with individual confidence in protecting themselves against infection and with negative attitudes towards HIV and HBV/HCV. Establishing a positive safety culture and providing appropriate professional education to help reduce the stigma towards infected patients offers an effective way forwards to improve quality of care in Vietnam, as elsewhere.

NURSES’ ATTITUDES TOWARDS CO-WORKERS INFECTED WITH HIV OR HEPATITIS B OR C IN VIETNAM

Stigma and discrimination experienced by nurses infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) potentially undermine their positions. The aim of this study was to determine the factors associated with nurses’ attitudes towards accepting co-workers with HIV, HBV, or HCV. The study design was descriptive and cross-sectional. Four hundred Vietnamese nurses participated in this study using stratified random sampling at two public hospitals in Hanoi, Vietnam. A self-administrated questionnaire was used to obtain data. Descriptive statistics and multivariable logistic regression was performed to analyze data. Nine percent of nurses had experienced a needle-stick or sharps injury (NSI) from a patient infected with HIV, and 15.8% of respondents reported having a previous NSI from a patient infected with HBV or HCV. Some nurses reported that they could not accept contact between patients and nurses infected with HIV (25.2%) and HBV or HCV (12.7%). Older age and a belief that colleagues should disclose their infection status were associated with positive attitudes towards HIV-, HBV-, or HCV-positive colleagues. Fear of transmission was associated with negative attitudes towards HIV-positive co-workers. Infected employees disclosure of their status may help their colleagues to be more accepting by providing appropriate workplace adjustments for infected employees. HIV is generally a more stigmatized infection, and therefore attitudes towards HIV-positive co-workers might be affected by fear of transmission. Providing education to recognize infectious risk may be effective in improving nurses’ attitudes in Vietnam, as elsewhere.

Lung, gastric and colorectal cancer mortality by occupation and industry among working-aged men in Japan

We examined occupational and industrial differences in lung, gastric, and colorectal cancer risk among Japanese men of working age (25–64 years) using the 2010 Japanese national survey data for occupation and industry-specific death rates. Poisson regression models were used to estimate the age-adjusted incident rate ratios by lung, gastric, and colorectal cancers, with manufacturing used as the referent occupation or industry. Unemployed Japanese men and those in manufacturing had an 8–11-fold increased risk of lung, gastric and colorectal cancer. The highest mortality rates for lung and colorectal cancer by occupation were “administrative and managerial” (by occupation) and “mining” (by industry). For gastric cancer, the highest mortality rate was “agriculture” (by occupation) and “mining” (by industry). By occupation; Japanese men in service occupations, those in administrative and managerial positions, those in agriculture, forestry and fisheries, and those in professional and engineering categories had higher relative mortality risks for lung, gastric, and colorectal cancers. By industry; mining, electricity and gas, fisheries, and agriculture and forestry had the higher mortality risks for those cancers. Unemployed men had higher mortality rates than men in any occupation and industry for all three cancers. Overall, this study suggests that for Japanese men, occupations and industries may be a key social determinant of health.

Large Metasurface Aperture for Millimeter Wave Computational Imaging at the Human-Scale

We demonstrate a low-profile holographic imaging system at millimeter wavelengths based on an aperture composed of frequency-diverse metasurfaces. Utilizing measurements of spatially-diverse field patterns, diffraction-limited images of human-sized subjects are reconstructed. The system is driven by a single microwave source swept over a band of frequencies (17.5–26.5 GHz) and switched between a collection of transmit and receive metasurface panels. High fidelity image reconstruction requires a precise model for each field pattern generated by the aperture, as well as the manner in which the field scatters from objects in the scene. This constraint makes scaling of computational imaging systems inherently challenging for electrically large, coherent apertures. To meet the demanding requirements, we introduce computational methods and calibration approaches that enable rapid and accurate imaging performance.

Attitudes of nurses toward HIV-infected colleagues in Japan

BACKGROUND

Nurses may be unwilling to accept HIV-infected colleagues who can continue to work with patients if the provider-to-patient transmission risks have been appropriately assessed.

AIMS

To assess the factors associated with nurses' willingness to accept HIV-infected colleagues as coworkers.

DESIGN

Descriptive and cross-sectional.

METHODS

An anonymous online survey targeting Japanese nurses working in hospitals or clinics (n = 992). Logistic regression analysis was used to evaluate factors associated with their willingness to accept HIV-positive colleagues before or after a risk assessment.

RESULTS

Respondents who avoided contact with, and expressed discriminatory views about, HIV-infected colleagues were less willing to accept them. After undertaking an appropriate risk assessment, a high level of knowledge regarding HIV transmission increased the likelihood of acceptance towards HIV-infected colleagues.

CONCLUSIONS

The use of risk assessment may increase nurses' willingness to accept HIV-infected colleagues, particularly among co-workers with a high level of knowledge about HIV.

Upper Body Musculoskeletal Disorders among Australian Occupational Therapy Students

Although upper body musculoskeletal disorders (MSDs) represent an increasingly important issue for university students, few if any studies have targeted the occupational therapy faculty. Given this dearth of information, it was considered necessary to investigate a cross-section of Australian occupational therapy students by means of an established questionnaire survey. Completed replies were obtained from 95.7%, 100% and 97.7% (n = 44, 55 and 48) of students in the first, second and fourth years of a large occupational therapy school in northern Queensland, Australia.

The 12-month period prevalence of MSDs was as follows: neck (67.4%), shoulder (46.3%) and upper back (39.5%). Three-quarters of all students (75.5%) reported an MSD occurring in at least one of these body regions. Over half (56.5%) reported an MSD over 2 days' duration in the past year. Almost 40% (39.5%) reported an MSD that had affected their daily life, while one-quarter (25.2%) needed some type of treatment.

Logistic regression indicated that students aged over 21 years were almost four times more likely to report shoulder-related MSD (OR 3.7, 95%CI: 1.4–10.2). Year of study in the occupational therapy course was another important MSD correlate, with adjusted odds ratios ranging from 3.3 at the upper back (OR 3.3, 95%CI: 1.2–9.6) to 10.9 at the neck (OR 10.9, 95%CI: 3.2–43.8). Computer usage also incurred a certain degree of risk, with students who spent over 5 hours per week on the computer having an increased risk of MSD at the neck (OR 5.0, 95%CI: 1.3–21.5) and shoulder (OR 4.7, 95%CI: 1.4–18.3).

Overall, this study suggests that Australian occupational therapy students have a large burden from MSDs in the upper body region, even more so than other student groups and some working populations. Since the distribution of MSD risk is not uniform among them, interventions to help reduce these conditions need to be carefully targeted. Further longitudinal investigations would also be useful in determining the mechanisms and contributory factors for MSDs among this unique student population.

An international review of tobacco smoking research in the nursing profession, 1976-2006

Tobacco smoking represents a contentious issue in the nursing profession, and one that has now become an important topic in nursing research. Despite this fact, the epidemiological quality of research varies widely, and it has been difficult to accurately determine the true incidence of smoking among nurses. Given these inconsistencies, we conducted a state-of-the-art review to identify international trends in tobacco usage among nurses, to ascertain how the epidemiological quality of research has improved over the past 30 years, and also to elucidate the directions in which nursing research has evolved. A total of 73 English-language studies that met the inclusion criteria were located and analysed. Overall, our review suggests that, while tobacco smoking among nurses appears to be decreasing in many countries during recent years, the international trend is far from uniform, and some developed nations still report high smoking rates among their nursing staff. From a methodological perspective, the relative epidemiological quality of smoking research has also fluctuated over time, making it difficult to compare the results of one study to the next. Despite these caveats, tobacco smoking remains a key topic in nursing research, as well as a critically important occupational-health issue for the entire nursing profession. In order to make the next generation of tobacco research data as comparable as possible, future scholars should consider devising and implementing a standardised format for conducting international tobacco smoking research within the nursing profession.

Domoic acid disrupts the activity and connectivity of neuronal networks in organotypic brain slice cultures

Domoic acid is a neurotoxin produced by algae and is found in seafood during harmful algal blooms. As a glutamate agonist, domoic acid inappropriately stimulates excitatory activity in neurons. At high doses, this leads to seizures and brain lesions, but it is unclear how lower, asymptomatic exposures disrupt neuronal activity. Domoic acid has been detected in an increasing variety of species across a greater geographical range than ever before, making it critical to understand the potential health impacts of low-level exposure on vulnerable marine mammal and human populations. To determine whether prolonged domoic acid exposure altered neuronal activity in hippocampal networks, we used a custom-made 512 multi-electrode array with high spatial and temporal resolution to record extracellular potentials (spikes) in mouse organotypic brain slice cultures. We identified individual neurons based on spike waveform and location, and measured the activity and functional connectivity within the neuronal networks of brain slice cultures. Domoic acid exposure significantly altered neuronal spiking activity patterns, and increased functional connectivity within exposed cultures, in the absence of overt cellular or neuronal toxicity. While the overall spiking activity of neurons in domoic acid-exposed cultures was comparable to controls, exposed neurons spiked significantly more often in bursts. We also identified a subset of neurons that were electrophysiologically silenced in exposed cultures, and putatively identified those neurons as fast-spiking inhibitory neurons. These results provide evidence that domoic acid affects neuronal activity in the absence of cytotoxicity, and suggest that neurodevelopmental exposure to domoic acid may alter neurological function in the absence of clinical symptoms.

Hand Dermatitis Risk Factors Among Clinical Nurses in Japan

The purpose of this study was to establish hand dermatitis (HD) risk factors among Japanese nurses. A questionnaire was administered to 1,162 clinical nurses, from whom 860 replies were received (response rate of 74.0%). Their overall HD prevalence was 53.3%. Several risk factors were identified: using latex gloves (odds ratio [OR] 1.9), allergies in adulthood (OR 2.7), urticaria as an adult (OR 1.5), atopic dermatitis as an adult (OR 2.7), any allergies to latex products (OR 5.2), skin irritation following contact with latex (OR 4.1), contact dermatitis following contact with latex (OR 3.5), family history of hay fever (OR 1.6), and family history of atopic dermatitis (OR 1.9). The use of hand cream was associated with a 50% reduction in HD risk (OR 0.5). In this study, we found that Japanese clinical nurses suffer a significant occupational burden from HD. As such, it is essential that hospital managers consider interventions to reduce this troublesome occupational disease among clinical nurses in Japan, as elsewhere.

Occupational therapy students' technological skills: Are 'generation Y' ready for 21st century practice?

BACKGROUND/AIM

Technology is becoming increasingly integral to the practice of occupational therapists and part of the everyday lives of clients. 'Generation Y' are purported to be naturally technologically skilled as they have grown up in the digital age. The aim of this study was to explore one cohort of 'Generation Y' occupational therapy students' skills and confidence in the use of technologies relevant to contemporary practice.

METHODS

A cross-sectional survey design was used to collect data from a cohort of 274 students enrolled in an Australian undergraduate occupational therapy programme.

RESULTS

A total of 173 (63%) students returned the survey. Those born prior to 1982 were removed from the data. This left 155 (56%) 'Generation Y' participants. Not all participants reported to be skilled in everyday technologies although most reported to be skilled in word, Internet and mobile technologies. Many reported a lack of skills in Web 2.0 (collaboration and sharing) technologies, creating and using media and gaming, as well as a lack of confidence in technologies relevant to practice, including assistive technology, specialist devices, specialist software and gaming.

CONCLUSIONS

Overall, the results suggested that this group of 'Generation Y' students were not universally skilled in all areas of technology relevant to practice but appear to be skilled in technologies they use regularly. Recommendations are therefore made with view to integrating social networking, gaming, media sharing and assistive technology into undergraduate programmes to ensure that graduates have the requisite skills and confidence required for current and future practice.

Assessing the Impact of Nationwide Smoking Cessation Interventions among Employed, Middle-Aged Japanese Men, 2005-2010

Background

A variety of tobacco control interventions have become available in Japan over the past decade, however, the magnitude to which they have impacted on smoking rates may have varied by socioeconomic status such as job content, particularly for middle-aged men who were formerly long-term smokers. We conducted a longitudinal study to investigate the differences between smoking cessation strategies among a national sample of middle-aged Japanese employed men between 2005 and 2010.

Methods

Data was extracted from a previous longitudinal survey of middle-aged and elderly people that had been conducted by the Ministry of Health, Labour and Welfare. In 2005, 16,738 Japanese men aged 50–59 years were recruited and sent a questionnaire in each year of the study. We analyzed data for individuals who reported being current smokers at baseline. Cox’s discrete time proportional hazard regression analysis was used to examine potential associations between smoking cessation and socioeconomic factors.

Results

Of the 6187 employed, male smokers who participated in 2005, 31% subsequently quit smoking during the 5-year follow-up period. Those working in manufacturing, transportation, or security were less likely to have quit smoking than those working in management. Having no marital partner, never having been married, or those experiencing psychological distress were significantly less likely to have quit smoking during this time.

Conclusions

Although almost one-third of middle-aged, male smokers quit their habit between 2005 and 2010; the uptake of this national strategy appears to have been far from uniform across Japanese society. Socioeconomic factors such as occupation, marital status and psychological distress were negatively correlated with quitting, suggesting that these groups should be more aggressively targeted in further interventions.

Occupational health in fairy tales

Myths and folklore, as expressions of popular beliefs, provide valuable information on medical knowledge in earlier times. Fairy tales have often recounted occupational maladies throughout the ages and also provide some insight into the toxic effects of certain metals, such as mercury. Much historical information can be gleaned from unexpected sources, and as such, fairy tales should be more carefully scrutinized by contemporary researchers with an interest in the historical origins of workplace injury and disease.

Barriers to the acceptance of work colleagues infected with Hepatitis B and Hepatitis C in Japan

Background:

Healthcare workers infected with Hepatitis B (HBV) or Hepatitis C virus (HCV) may undertake patient care activities if provider-to-patient transmission risks have been assessed in terms of viral load and clinical procedures. The present study investigated potential barriers to the acceptance of colleagues infected with HBV/HCV in healthcare settings after appropriate risk assessment.

Methods:

We conducted an anonymous, internet-based survey of Japanese nurses. Multivariate logistic analysis was used to assess factors associated with willingness to accept colleagues infected with HBV/HCV after risk assessment.

Results:

In total, 992 nurses responded to the survey, with 16% indicating that colleagues infected with HBV/HCV should not have patient contact after risk assessment. Willingness to accept HBV/HCV-infected colleagues was negatively associated with attitudes regarding the avoidance of contact with HBV/HCV-infected colleagues (OR: 0.49; 95% CI: 0.28-0.85). Previous professional contact with HBV/HCV patients (OR: 1.73; 95% CI: 1.36-2.12), experience of accidental injection from or personal exposure to HBV/HCV patients (OR: 2.00; 95% CI: 1.42-2.61), knowledge of HBV/HCV (OR: 2.00; 95% CI: 1.52-2.49), and female sex (OR: 1.60; 95% CI: 1.17-2.09) were positively associated with a willingness to accept HBV/HCV-infected colleagues.

Conclusions:

This study suggests that attitudes regarding the avoidance of contact with HBV/HCV-infected colleagues may be barriers to accepting these colleagues even after risk assessment has been performed. To protect the employment of nurses infected with HBV/HCV, employers should provide comprehensive education for nurses to reduce stigma and improve understanding about the management of staff infected with infectious diseases, such as HBV or HCV.

Co-worker perceptions of return-to-work opportunities for Japanese cancer survivors

PURPOSE

This study examined workplace factors and perceptions of Return-to-Work (RTW) opportunities for colleagues with cancer-related symptoms and/or treatment side effects in Japan.

METHODS

We conducted an online, cross-sectional survey of 3710 employed Japanese individuals of working age. Colleagues' perceptions of RTW opportunities for cancer survivors were examined (using a Japanese questionnaire), along with workplace factors such as job demand, job control and workplace social support (using the Brief Job Stress Questionnaire). Associations between workplace factors and RTW opportunities were evaluated using multiple logistic regression analysis, with participants stratified in tertiles (low, middle and high) according to their levels of workplace social support and job control.

RESULTS

Colleagues' perceptions of inadequate RTW opportunities were associated with low workplace social support (middle tertile: Odds Ratio [OR] 1.22, 95% Confidence Interval [CI]: 1.08-1.36; low tertile: OR 1.43, 95%CI: 1.30-1.57; p for trend <0.01); low levels of job control (middle tertile: OR 1.27, 95%CI: 1.06-1.50; low tertile: OR 1.91, 95%CI: 1.64-2.21; p for trend <0.01); and no prior experience working with a cancer survivor (OR 2.08, 95%CI: 1.83-2.31).

CONCLUSIONS

This study suggests that workplace factors and prior experience of working with a cancer survivor may affect a colleagues' perception of RTW opportunities in Japanese workplaces. Consideration of workplace social factors (workplace support and job control), as well as increased openness and awareness of the particular needs of cancer survivors, is therefore essential to facilitate successful RTW in Japan, as elsewhere.Copyright © 2016 John Wiley & Sons, Ltd.

Reluctance to care for patients with HIV or hepatitis B / C in Japan

Background

Healthcare workers are faced with various professional dilemmas in the workplace, including at times, a reluctance to care for particular patients. This study investigated personal attitudes and factors influencing Japanese nurses’ reluctance to care for patients infected with HIV, Hepatitis B Virus (HBV), or Hepatitis C Virus (HCV).

Methods

Participants completed an anonymous online survey focusing on potential attitudes towards hypothetical patients, awareness of infection risk and their confidence in using precautions to prevent infection. Statistical associations were analyzed using Poisson regression models.

Results

Regarding personal attitudes, 41 % and 18 % of nurses agreed or somewhat agreed that they would be reluctant to care for a hypothetical patient infected with HIV or HBV / HCV, respectively. Reluctance to care for patients with HIV or HBV / HCV was positively associated with prejudicial attitudes and negatively associated with confidence in personal safety precautions. Hypothetical reluctance to care for patients with HBV / HCV was negatively associated with actual previous experience caring for HBV / HCV patients. Older age among nurses (≥50 years) was positively associated with an increased reluctance to care for hypothetical patients with HIV.

Conclusions

Overall, this study suggests that anxiety arising from perceived infection risk and having a prejudicial attitude might affect the acceptance of infected patients, while personal confidence in universal precautions probably mitigates this situation. Improving nurses’ confidence in using universal precautions therefore represents a positive measure that can help reduce prejudice and improve the quality of healthcare services in Japan, as elsewhere.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-0822-2) contains supplementary material, which is available to authorized users.

Occupational differences in suicide mortality among Japanese men of working age

BACKGROUND

Although suicide rates among Japanese men of working-age have steadily increased over the past two decades, the distribution by occupation and industry is not uniform. Little is known regarding occupation and industry differences in relation to suicide risk. This study examined differences in suicide risk among Japanese men of working age (25-59 years) during 2010.

METHODS

We analysed the Japanese government's 2010 national survey data regarding occupation and industry-specific death rates. Poisson regression models were formulated for each occupation and industry to estimate the relative risk of death by suicide. Potential interactions between age and occupation/industry were also examined.

RESULTS

Suicide incidence was highest among workers in the fields of agriculture and mining. When compared with referent groups (sales for occupation and wholesale and retail for industry), the age-adjusted relative risk of suicide was highest for administrative and managerial workers (Incident Relative Risk [IRR]: 3.91, 95% Confidence Interval [95%CI]: 3.16-4.85), service industries (IRR: 3.63, 95%CI: 2.93-4.51) and agriculture (IRR: 3.53, 95%CI: 2.84-4.38) occupations, and for mining (IRR: 23.9, 95%CI: 19.4-29.4), fisheries (IRR: 6.26, 95%CI: 5.03-7.80), electricity and gas (IRR: 5.86, 95%CI: 4.71-7.30) and agricultural industries (IRR: 4.73, 95%CI: 3.78-5.91).

LIMITATIONS

Bias resulting from misclassification of deceased individuals' occupation or industry was a potential limitation of this study. Furthermore, detailed information regarding occupation-related factors, such as employment status, had not been recorded in the initial survey.

CONCLUSIONS

These findings help elucidate Japanese occupations and industries with a higher suicide risk, most likely due to economic changes or workplace factors relating to stress and depression.

Socioeconomic status and self-reported health among middle-aged Japanese men: results from a nationwide longitudinal study

OBJECTIVE

To examine potential associations between socioeconomic factors and self-rated health among a national sample of Japanese men aged 50-59 years between 2005 and 2010, including the 2008 global financial crisis.

DESIGN

Prospective cohort study.

SETTING

Randomly selected 2515 census areas from a total of 1.8 million census areas in Japan.

PARTICIPANTS

This study utilised data from a national, longitudinal survey conducted by the Ministry of Health, Labour and Welfare. Starting in 2005, 16,738 Japanese men aged 50-59 years were recruited and sent a questionnaire each year. We analysed data for the 6-year period (2005-2010) from participants who had worked for over 20 years in the same industry (n=9727).

MAIN OUTCOME MEASURES

We focused on worsening self-rated health status by occupation, education and employment contract.

RESULTS

Working in the manufacturing industry was associated with worsening self-rated health scores when compared to those working in management (HR=1.19; 95% CI 1.04 to 1.37). A relationship between education level and worsening self-rated health was also identified as follows: junior high school (HR=1.49; 95% CI 1.31 to 1.69), high school (HR=1.29; 95% CI 1.17 to 1.42), and vocational college (HR=1.25; 95% CI 1.07 to 1.46), when compared with those holding university-level qualifications. Precarious employment (HR=1.17; 95% CI 1.00 to 1.37) was also associated with worsening self-rated health status in the current study.

CONCLUSIONS

This study suggests that working in manufacturing for more than 20 years and having lower education levels may have a significant impact on the self-rated health of middle-aged Japanese men. This may reflect a progressive decline in Japanese working conditions following the global financial crisis and/or the impact of lower socioeconomic status.

A Socio-Demographic Examination of Adults Responding to Governmental Vaccination Recommendations during the Japanese Rubella Outbreak of 2013

Background

In 2013 a rubella outbreak occurred among Japanese people of working-age which resulted in 14,357 reported cases. The Japanese government subsequently recommended voluntary vaccination or rubella antibody testing for young women (15–49 years of age) who were planning to conceive and for adult men, children, and other persons in potential contact with pregnant women at home. However, the expense and time involved for vaccination, antibody testing and visiting a clinic may represent a major barrier to voluntary compliance among this busy demographic. The aim of the current study was, therefore, to examine potential relationships between the social background of Japanese working-age individuals affected by the 2013 voluntary vaccination campaign.

Methods

A web-based survey of 1,889 Japanese men and women aged 20–49 years was conducted in early 2014. Statistical analyses were used to explore the associations between social background and testing for rubella antibody and / or vaccination uptake during the previous year.

Results

Twenty-four percent of respondents who were planning a pregnancy had been tested for rubella antibody or vaccinated in 2013. However, among those without a current desire for pregnancy, 3% of men and 7% of women, respectively, were tested or vaccinated. Regardless of whether they were planning to conceive, testing for rubella antibodies or vaccination was statistically associated with having acquaintances who had been vaccinated, understanding the government recommendations, and being able to confirm their lack of rubella vaccination history using Maternal and Child Health Handbook records in both men and women.

Conclusion

To help eliminate rubella in Japan, additional initiatives need to target Japanese individuals who cannot envisage a direct benefit from vaccination. The results of this study suggest that disseminating the government recommendation to all potentially affected subpopulations, along with maintaining life-time vaccination records might offer a solution to encourage vaccination uptake among working-age adults in Japan, as elsewhere.

Escherichia coli O157:H7--Discerning Facts from Fiction: An Integrated Research and Extension Project for Multiple Audiences

The O157:H7 (EcO157) epidemiology of Shiga-toxin-producing Escherichia coli (STEC) in cattle is complex, and myths about pre-harvest control are perpetuated. The objectives of this project were to identify perpetuated misinformation and inform four audiences about evidence-based risks and pre-harvest control of EcO157 by addressing: (i) EcO157 epidemiology and pre-harvest control; (ii) how food safety policy is created; and (iii) how to present accurate information about EcO157. An environmental scan using a daily Internet search helped identify themes for education. A literature review of pre-harvest control measures contributed to the development of educational materials (fact sheets, website, web presentations and conferences). Conference 1 was a webinar with 315 registrants, 10 countries including 41 US states and four Canadian provinces. Most participants felt confident in using their new knowledge, more than half felt confident enough to answer EcO157 questions from the public and many would recommend the recorded version of the webinar to colleagues. Conference 2 was live in the Washington, DC, area with most participants employed by the US government. All agreed that they better understood pre-harvest control, how food safety policy was made, and were confident they could create an effective message about STEC pre-harvest control. Videos were posted and received 348 Internet visitors within 2 months. Conference 3 was a webinar with a live audience and Twitter feeds, targeting people who give nutrition advice. Almost all ranked the programme good to excellent and relevant to their work. About 25% indicated that they would share: 'grass-fed beef is not safer than grain-fed', 25% would share information on effectiveness of cattle vaccines, and 14% would share information on message mapping. Across all conferences, major changes in knowledge included the following: there is no additional risk of EcO157 shedding from grain-fed versus grass-fed cattle, pre-harvest vaccination is efficacious, and production systems (pasture versus confinement) do not affect EcO157 shedding rates.