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Objective: To review the historical aspects of compensation system for workers with pneumoconiosis who developed lung cancer., Methods: Materials and papers published on the compensation system as discussed in administrative meetings were utilized., Results: Legal claims for compensation for lung cancer among individuals with pneumoconiosis increased during the period of rapid economic growth in Japan. A possible causal relationship between pneumoconiosis and lung cancer in workers has been discussed by committees of specialists. The Expert Committee on Pneumoconiosis and Lung Cancer in 1978 did not find a causal relationship between them. However, a survey of physicians specializing in pneumoconiosis revealed medical disadvantages among individuals diagnosed with pneumoconiosis who developed lung cancer. The Ministry of Labour announced the risk of work-related lung cancer in patients with advanced pneumoconiosis (class IV or equivalent severity). Since then, numerous lung cancer patients with pneumoconiosis have been adjudicated. In 1997, the International Agency for Research on Cancer (IARC) re-evaluated the carcinogenicity of silica and declared it to be a Group I carcinogen in humans. The Expert Committee on Compensation of Lung Cancer Cases Developing from Pneumoconiosis discussed the IARC evaluation but did not accept this classification. However, the Committee of Occupational Exposure Limits in the Japan Society of Occupational Health upheld the IARC evaluation of silica as a Group I carcinogen. Because the Expert Committee of Medical Disadvantage of Lung Cancer Patients with Pneumoconiosis accepted the increased risk of lung cancer in patients with class III or equivalent severity pneumoconiosis, the Ministry of Labour announced worker compensation for such patients. The Expert Committee of Health Control of Pneumoconiosis Complicated with Lung Cancer reported in 2002 that a meta-analysis revealed no increased risk of lung cancer among workers exposed to crystalline silica; however, there was an increased risk of lung cancer in patients with pneumoconiosis. The Ministry of Labour has added lung cancer to the list of complications from pneumoconiosis and, if necessary, regular medical checkups for lung cancer. After Leaving dust work, the Health Care System provides for workers who are diagnosed With class II or higher pneumoconiosis. Therefore, if an individual with pneumoconiosis develops class II or higher lung cancer, that individual becomes eligible for workers' compensation., Conclusions: The conclusion of the Expert Committee in 2002 and the decision of the Ministry of Labour to add lung cancer to its list of complications of pneumoconiosis are evaluated to be appropriate.

Objectives: This study aimed to review the trends in "occupational health nursing research" conducted in Japan and determine research areas that need strengthening eventually., Methods: All articles published in Ichushi Web since 1903 were searched using the keywords "occupational health nursing" and "research." The 486 papers identified were extracted and categorized according to type and publication year. The research content of 194 original and review papers was categorized according to whether they addressed practical methods and abilities., Results and Discussion: According to publication type, out of the 486 papers, 230 (47.3%) were conference proceedings, whereas 194 (39.9%) were original and review papers. Among practical methods-related papers, 107 (55.2%), 86 (44.3%), and 1 (0.5%) were on general, health, and work environment management, respectively, whereas none addressed work management and occupational health education. Among practical ability-related papers, 125 (64.4%), 23 (11.9%), and 46 (23.7%) were on knowledge, technology, and competency, respectively. The overview of annual trends showed that the papers of all types have increased progressively. While conference proceedings accounted for 80% of the papers until 1992, recent proportions have shown a decrease to < 50%. Conversely, original papers accounted for < 20% of the papers early on, but observed a progressive increase, with recent proportions of > 40%. Regarding content, almost no papers addressed work environment management, work management, and occupational health education. Additionally, practical ability-related papers highlighted that although some research on technologies and competencies has been conducted, some areas remain inadequately addressed., Conclusions: In Japan, occupational health nursing papers have been steadily increasing since the first conference proceeding was published in 1980. Among papers addressing practical methods, those related to general management were most common, of which occupational health management accounted for approximately 80%, indicating efforts aimed at the development of occupational health nursing through research. Moreover, limited papers addressed work environment management, work management, and occupational health education, suggesting the need for future research. Among papers addressing practical ability, > 60% were related to knowledge, with research on competencies was only > 20%, suggesting the need for further research eventually.

In Japan, a study on mental health in workplace has expanded from tertiary to secondary and primary preventions of mental health disorders among employees. Recent movements suggest a trend of bringing numerous topics outside the industrial health, including those with perspectives from categories generally known as primordial prevention, such as enhancement of working life quality or improvement of work environment.First, according to the aforementioned trends, the present paper made an effort to organize the terms and concepts related to mental health disorders, which included the foundation for research and practice in this area as well as the outcomes of discussions on the tertiary and secondary preventions.Second, the primary models of work-related stress, along its impact on mental health, and the scales for assessing workers' mental health issues were discussed, which have been used in numerous studies since the 1990s. The introduction of those models and scales contributed immensely to the expansion of this field's research areas. However, a number of significant factors, most of which have social or cultural implications, can influence the connection between stress at workplace and health problems. Therefore, conducting large-scale study or systematic reviews targeting domestic cases exclusively is necessary to obtain evidence for establishing highly versatile measures against mental health problems in Japan.Third, in this regard, several noteworthy large-scale research projects in Japan are highlighted as a hope for encouraging such studies in this field. However, the occupational health practitioners' effort to understand the actual workplace situations where they attend to and to put the understanding into practice has been and will remain an indispensable attribute for them in the future.

Objective: The Health Promotion Act was revised in 2018 and prohibits smoking inside taxis and buses. However, there is no regulation for smoking in the business vehicles of companies or private cars. This paper examined exposure to secondhand smoke in vehicles with digital dust monitors., Material and Methods: A cigarette was smoked inside of a five-seat car, and particulate matter 2.5 (PM 2.5 ) concentrations were measured at front and rear seats., Results: The concentration of PM 2.5 reached 3,400 μg/m 3 with all windows closed and decreased to approximately 3,000 μg/m 3 when driver's window and passengers' windows were opened by 10 cm. However, the PM 2.5 concentration did not decrease to levels below 1,500 μg/m 3 with all windows fully opened., Discussion and Conclusion: To prevent exposure to secondhand smoke, smoking should not be allowed inside any vehicle when non-smokers are present.

Objectives: The objective of this study was to summarize a combined competency domains and items set for occupational hygienists in Japan since there is a lack of such a set due to the existence of several national certification specialists in the field of occupational hygiene., Methods: A literature search, Kitagawa Jiro's (KJ) method study, Delphi method study, and a questionnaire survey were utilized. The domains, roles, knowledge, and skills included in the home pages and reports of representative organizations in the USA, UK, and Japan, and those in papers found through Google Scholar were compared and rearranged to about 150 items. From these, occupational hygiene competency domains and items were discussed and selected by five occupational hygiene specialists using the KJ method and prioritized by 13 occupational hygiene specialists using the Delphi method. Additionally, responses of 53 union members of occupational hygiene specialists from a university were obtained by a questionnaire survey., Results: Ten occupational competency domains and 147 items were identified through the literature search, 10 domains and 135 items through the KJ method, six domains and 63 items through the Delphi method, and lastly, five domains and 51 items were identified through the questionnaire survey. The five domains included (1) discovering problems and potential developments and making decisions, (2) solving problems and promoting developmental occupational hygiene, (3) communicating with stakeholders and recovering in an emergency, (4) empowering organizations to which you belong, and (5) educating and facilitating workers., Conclusions: Although the 53 subjects in the questionnaire survey were predominantly 20 to 30 years old and more than half of the 13 Delphi method participants were relatively old veterans, there was a positive correlation between the evaluation of 63 items by both methods. These results suggest that the occupational hygiene competency set of five domains and 51 items obtained in this study is a combined competency set that is representative of Japan.

Objectives: To investigate the systems and actual practices of occupational safety and health risk management in China., Methods: First, we gathered basic information through a literature review using an academic search engine (Japan Medical Abstracts society, Pubmed, and Google Scholar), as well as a general search on the Internet. Next, we conducted field surveys at a graduate school for public health, providers of occupational health services (e.g. medical examinations, working environment measurements), and local workplaces of a Japanese construction machinery company in China. This information was analyzed in terms of legal framework, professional staff, working environment measurements, medical examinations, occupational diseases, and occupational health service providers., Results: Health and safety-related matters have become codified in Chinese workplaces as a result of safety laws and measures to prevent occupational diseases. While the country does have safety and hygiene officers, they lack official frameworks for occupational physicians and nursing professionals. The employers are not obligated to appoint medical professionals. While general medical examinations are not provided for under Chinese law, businesses are obligated to bring in external providers of occupational safety to perform special medical exams and working environment measurements. Occupational diseases are on the rise; pneumoconiosis comprises roughly 80% of cases. In addition, occupational health technical service providers have specialized staff and are not permitted to perform medical examinations or other services without government accreditation., Discussion/conclusion: There are great disparities in specialist knowledge about health and hygiene between company staff and external organizations, thus running the risk of corporate health and safety policies existing only on paper. This issue demands greater utilization of public health physicians in Chinese workplaces and support from Japanese professionals who understand how occupational safety and health risk management operate in China.

Objectives: In Japan, so-called "medical examinations for those engaged in specified work" involve the same tests as those in general medical examinations, regardless of the type of work engaged in. The role of these medical examinations and "medical examinations with specified items for those engaged in harmful work operations" is also unclear. Therefore, questions have been raised about the appropriateness of the work covered by this medical examination. However, its legal system is complex and difficult to interpret. This study clarifies the changes in the type of work and their criteria covered by this medical examination., Methods: We investigated laws and regulations, notifications, papers, and publications related to the history of medical examinations for those engaged in specified work., Results: In 1947, Article 48 of the former ordinance on industrial safety and health stipulated that those engaged in work involving the handling of harmful substances that require special safety and health management shall undergo so-called "medical examinations for those engaged in specified work." Quantitative criteria for this work were indicated in a notification in 1948 in the form of tentative reference values, and they have not changed significantly since then. As a result, many of the standards used to determine who is subject to medical examinations for those engaged in specified work have exceeded allowable concentrations., Conclusion: The work covered by medical examinations for those engaged in specified work and its criteria have hardly been modified in approximately 70 years. In view of the changes in social environment and improvement in management methods for harmful work, it is necessary to rearrange the purposes and roles of the medical examinations with specified items for those engaged in harmful work operations and medical examinations for those engaged in specified work and to reconsider the method of the medical examinations for those engaged in specified work.

Objective: Previous studies reported that presenteeism costs the enterprises more than absenteeism. It becomes more important for corporate management to evaluate the outcomes of health promotion initiatives for their employees using work performance scales in Japan. We previously developed a Japanese version of Work Limitations Questionnaire (WLQ-J), a presenteeism scale developed by Lerner D. et al., and conducted an internet survey to examine the reliability and validity of WLQ-J with 710 employees from an IT company and a medical institution as subjects and reported the study results (Ida et al, 2012). The objective of the present study is to examine the reliability and validity of WLQ-J with employees from more companies and industries than those included in the previous study., Methods: We analyzed for 4,440 employees from 14 companies and 9 industries as subjects, who were selected from a total of 4,712 employees who answered both WLQ-J and Brief Job Stress Questionnaire (BJSQ) on the internet or paper survey conducted from September 2014 to January 2015., Results: The subjects' average age was 40.3±11.8 years (33.2±9.5 years in the previous study), with the percentage of males and females being 77.9% and 21.1%, respectively. The factor structure of WLQ-J accorded with that of the original version of WLQ. This supports the factorial validity of WLQ-J. In addition, sufficient internal consistency was recognized by Cronbach's alpha of the whole scale (0.87 for the present study and 0.97 for the previous study) and the subscales (0.77-0.94 for the present study and 0.88-0.95 for the previous study). The four subscale scores of WLQ-J were significantly correlated with the stress response of BJSQ with correlation coefficients of 0.28-0.64 for the present study and 0.39-0.60 for the previous study (p < 0.01 for both studies). Moreover, criterion-related validity of WLQ-J was also supported by the significant dose-response relationship between the subscale scores of WLQ-J and stress response of BJSQ (p < 0.01 for the previous study and p < 0.001 for the present study)., Conclusions: The present study demonstrated the reliability and validity of WLQ-J in a population of employees from more companies and industries than those in the previous study, with its average age and percentage of males and females close to those of the whole Japanese industries. This suggests that WLQ-J is available as a stable scale for presenteeism in different populations in Japan.

Objectives: Anti-cancer drugs are harmful to healthy persons. In recent years, occupational exposure to anti-cancer drugs has become a major concern to health care workers. To address this issue, a smear method was developed to measure widely using anti-cancer drugs depositing on the floors, safety cabinet surfaces, and tables in hospital., Methods: Ten kinds of widely used anti-cancer drugs, paclitaxel, vincristine, docetaxel, vinorelbine, irinotecan, methotrexate, oxaliplatin, cyclophosphamide, gemcitabine and fluorouracil were collected by smearing material surfaces with methanol impregnated cellulose filter paper and/or polypropylene nonwoven. The collected anti-cancer drugs are extracted in 5 ml of 0.01% (v/v) hydrazine/methanol solution by sonication. The extracted solution was filtered and concentrated to prepare 1ml of sample solution. Then, the anti-cancer drugs in the sample solution were simultaneously measured by LC/MS., Results: The anti-cancer drugs excepting fluorouracil spread on P-tile surface were measured with recoveries of 37-101% and standard deviations (SD) of 1.8-19%. All 10 of the anti-cancer drugs on a stainless steel plate surface were measured with the recoveries of 35-111% and SD of 1.3-11%., Conclusions: Using this smear method, 9 or 10 kinds of widely used anti-cancer drug residues in hospital, possibly exposed to health care workers, were grasped.

Objective: The purpose of this study was to examine the support activities provided for occupational health nurses aimed at improving psychosocial working environments, related knowledge and skills, and learning environments as well as associations among these factors. In addition, we aimed to create correlated factor models to describe the support activities in order to identify ways to promote these activities among occupational health nurses., Methods: An anonymous mail-based questionnaire survey was conducted of occupational health nurses who were members of the Japan Society for Occupational Health and belonged to enterprises or independent health insurance societies. Among 356 returned questionnaires (response rate: 46.4%), all the main items were answered in 329 (valid response rate: 92.4%), and these questionnaires were analyzed. Factor analysis was performed for the seven items pertaining to support activities for the improvement of psychosocial working environments and models of each factor of the support activities were developed using covariance structure analysis., Results: In the factor analysis, [Clarifying a stress-related situation and providing advice] and [Facilitating workplace involvement] were identified as support-related factors. The mean implementation rates for these approaches were approximately 50 to 80%, and less than 40%, respectively. [Clarifying a stress-related situation and providing advice] was associated with skills of "providing superiors with explanations to enhance their understanding" and "collecting and analyzing stress survey results by department", and knowledge of "personal stress questionnaires" and "common stress factors in working environments". The above-mentioned knowledge and skills were associated with self-learning of "examining and reporting daily activities for the improvement of working environments" and "reviewing related papers". [Facilitating workplace involvement] was associated with skills of "indirectly supporting discussions led by key persons in working environments" and "giving feedback regarding occupational stress survey results to superiors", and knowledge of "tools for the improvement of working environments" and "appropriate methods to use stress questionnaires". In addition, such knowledge and skills were associated with self-learning and learning environments of "participating in seminars to learn effective methods to use group-work approaches" and "receiving support and advice from mentors of universities and research institutions"., Discussion: The features of occupational health nurse support for the improvement of psychosocial working environments were revealed by this study. The implementation rates suggest that it is particularly necessary to promote [Facilitating workplace involvement]. It will be necessary to encourage the acquisition of associated knowledge and skills in order to promote occupational health nurse support for the improvement of psychosocial working environments.

Objective: Bacteria on the facepiece of a dust respirator were measured just after use and after 24-hours storage at a room temperature after being worn, and bacteria disinfection methods other than ethanol were examined., Methods: The existence of bacteria on a facepiece of a mask that had been worn for about one hour in a laboratory was investigated. In order to eliminate bacteria before use on the next day, five methods of bacteria disinfection were investigated: wiping with a facial tissue impregnated with ethanol as a control; wiping with a facial tissue wetted with tap water; wiping with a dry facial tissue after wiping with one wetted with tap water; wiping with a dry facial tissue after wiping with one wetted with distilled water; and wiping with a dry facial tissue two times. The tests were carried out using silicone rubber sheets plated with bacteria collected from human skin. The disinfection methods that were as effective as facial paper wetted with ethanol, were then assayed on the facepiece of the dust respirator., Results: Bacteria were detected on the facepiece immediately after it had been worn. Bacteria were also detected on the facepiece after it had been stored at 25°C for 24-hours after being worn. The methods of wiping with a dry facial tissue after wiping with either tap water or distilled water were almost as statistically effective as wiping with ethanol wetted facial paper. Bacteria on the facepiece were decreased by wiping with a dry facial tissue after wiping with one wetted with tap water., Discussion: Colonies of bacteria were detected on a facepiece that had been stored 24 hours after being worn, which suggests that bacteria disinfection just after a respirator has been worn should be recommended. It is very important that the water on the facepiece should be removed after wiping with a wet facial tissue.

Objectives: Whole-body vibration (WBV) with high level acceleration is found in the workplaces of construction and mining, and has been reported to be associated with low back pain (LBP) experienced by operators of heavy vehicles as an occupational health problem. Because the work conditions with exposure to WBV include bending and twisting of the low back and other factors, the causal relationship between WBV and LBP has not yet been affirmed. A review suggesting the dose-response relationship between WBV with low acceleration and LBP has been published, although there is little evidence supporting the causal relationship. Therefore, we reviewed the dose-response relationship between WBV with low acceleration and LBP., Methods: We examined original articles which reported a dose-response relationship between WBV and LBP in addition to review articles with almost the same aims., Results and Discussion: Studies which examined imaging findings such as CT and MRI, objective indicators of LBP, do not confirm the causal relationship. Although many studies demonstrated a positive relationship between working periods and incidence of LBP, there were very few reports which recognized a dose-response relationship for the vibration acceleration below 1.0 m/s(2) in which the 8-h energy-equivalent, combined frequency-weighted vibration of three diagonal, that is x, y and z, axes (root-sum-of-squares), Asum(8) was used as an index of vibration exposure., Conclusion: This paper reject the hypothesis of a dose-response relationship between WBV with low acceleration and LBP, concluding there is no evidence linking low level exposure to WBV with LBP for the Japan Society for Occupational Health to recommend 0.35 m/s(2)/as of Asum(8) as a tentative occupational exposure limits for WBV.

Objectives: DISCUSSION is continuing about whether or not to update the Occupational Exposure Limit for Whole Body Vibration exposure (OELWBV) which was established in 1975 as a part of the Recommendation of Occupational Exposure Limits (OEL), issued by the Japan Society for Occupational Health. The objectives of this study were to clarify the necessity of the update and the adverse health effects of whole-body vibration by reviewing the literature and to help to compile a for detailed revisions., Subjects and Methods: Mainly referring to our preceding review, the current OELWBV exposure was examined. The relatedness of adverse health effects, principally back symptoms and occupational exposure to whole-body vibration (WBV) was examined by reviewing review papers, the original English papers referred to in those papers, and original English and Japanese references from 2002 to 2010 retrieved through a MEDLINE search., Results: The results show the necessity of updating the present OELWBV as soon as possible. The overwhelming majority of the literature consists of epidemiological studies showing the relatedness of WBV to back symptoms. Thirty epidemiological studies out of 28 literatures clearly show the presence of a relationship between WBV and back symptoms. Various indices of exposure to WBV and back symptoms show the dose response relationships. Among these, a few studies used A(sum)(8) (equivalent 8-hour r.m.s. acceleration value for the combined frequency-weighted vibration of three diagonal, that is x, y and z, axes) as the exposure index. All of these studies reported some dose-response relationship between WBV exposure and back symptoms., Discussion: Despite the clear presence or absence of a relationship between WBV and back symptoms, 0.5 m/s(2) seems to be the unconfirmed threshold of risk. Focusing on data of A(sum)(8), we suggest that the risk increases over the magnitude of 0.30 m/s(2). To clarify this, further epidemiological studies and others should focus on A(sum)(8) around 0.30 m/s(2)., Conclusions: The present OEL of WBV should be examined from the viewpoint of the risks of back symptoms referring to the epidemiological studies that show the larger risks of back symptoms in comparison with unexposed referent workers. We conclud that when updating the present OELWBV, A(sum)(8) should be taken into account for back symptoms, referring to the findings of epidemiological studies.

Objectives and Results: Globalization has progressed tremendously resulting in far-reaching changes in the work environment. In Japan, occupational health and safety (OSH) activities are performed under and improved by regulations. However, this system is not likely to satisfy the unceasing diversification of social demand for OSH in recent years. The US adopts a self-imposed OSH system with responsibility carried by employers under a system of minimum regulation. This paper introduces the systematic training for occupational physicians in schools of public health in the US, which is creating a base of OSH professionals who can meet social demand., Discussion: To satisfy the diverse demand for recent OSH, it is essential to improve the basic skills of occupational physicians and other OSH professionals by offering systematic training in Japan. Some examples of systematic training for occupational physicians in schools of public health in the US are discussed with the goal of improving Japan's future OSH.

Objective: By publishing the scientific opinion entitled "Use of the benchmark dose (BMD) approach in risk assessment: Guidance of the Scientific Committee," the European Food Safety Authority (EFSA) recommended that the BMD approach, as an alternative to the traditionally used no-observed-adverse-effect level approach, be used as the method of choice for the determination of the reference point for deriving health-based guidance values and margins of exposure, and described the BMD approach as being extensively applicable to all chemicals, even to dose-effect assessment of epidemiological data. When the BMD approach was first proposed, the approach was expected to estimate the dose causing a low but measurable target organ effect. We examined whether the BMD approach can be applied to epidemiological endpoints with clinical standards., Methods: Comparisons between the BMD approach recommended by the EFSA and classical BMD approach (hybrid method) were conducted using epidemiological data with clinical standards., Results: The 95% lower confidence limit of the EFSA-based BMD tended to be considerably lower than that of the hybrid method. The former approach is easily applicable to dose-response data in published papers, though it is difficult to adjust for possible confounders. The cutoff values, calculated by the hybrid method, of epidemiological endpoints are nearly concordant with the clinical standards., Conclusions: By using the BMD approach recommended by the EFSA, human health safety may be better guaranteed because of the lower reference points for hazardous substances. However, its application to epidemiological data does not always reflect toxicological implications in light of the clinical standard.

It is well known that the amplitude and latency of P300 in event-related brain potentials (ERPs) evoked by performing the oddball paradigm reflect the extent of individuals' selective attention. The purpose of this study was to examine whether P300 is a reliable measure for evaluating mental fatigue. In addition to the measurement of auditory ERPs derived from Fz, Cz and Pz, the concentrations of lactic acid, cortisol in plasma and the reaction time of the oddball paradigm, which are believed to reflect fatigue, were measured. In an attempt to cause mental fatigue, 12 healthy college students (8 males, 4 females; 19.5 +/- 0.5 yr; mean +/- S.D.) were forced to perform a continuous addition task using the Uchida-Kreperin test paper for about 2 h. Before the task, the latencies of P300 in Fz, Cz and Pz were 295.6 +/- 8.7 msec, 298.8 +/- 8.5 msec and 297.5 +/- 7.2 msec (mean +/- S.D.), respectively, and after the task they were 312.6 +/- 11.2 msec, 314.6 +/- 10.1 msec and 315.8 +/- 8.7 msec, respectively. A significant difference in the latency before and after the task was detected (p<0.01). In all subjects, the latency of P300 was prolonged in all recording positions, Fz, Cz and Pz. In a control experiment where the continuous addition task was not loaded, a significant change of the latency was not detected. The amplitude of P300 didn't change significantly in all recording positions after the task. In the control experiment, the amplitude of P300 did not change significantly. On the other hand, the changes in the concentrations of lactic acid and cortisol and the reaction time were not induced by the continuous addition task. The prolongation of the latency of P300 would originate from a decline in brain function. In this study, a prolongation of the latency of P300 after the task was detected in all subjects. It is well known that the value of P300 changes with modification of the recording condition, therefore a recording of P300 under the same conditions is required for qualitative evaluation.

The purpose of this paper is to provide information for the development of health and welfare services being offered by health insurance societies (HIS). We analyzed examples of coordinated activities by HISs, the organizations under them (affiliated groups), and regional community self-regulating groups (communities), looking for the shape and direction such coordinated activities should take in the future. We chose 6 cases from public information available from August, 2000 to January, 2001 and visited the parties involved to conduct follow up surveys on the nature of their coordinated activities. Based on a survey conducted by the National Federation of Health Insurance Societies in March, 1999 (Survey of the Current Status of Health and Welfare Services), 36 HISs that were thought likely to be acting in coordination with the community were mailed questionnaires. Of these HISs, 7 that were found to actually be carrying out such coordinated activities were contacted in a telephone survey. We categorized the form and direction of coordinated activities into the following 5 category types: individualized, shared use of facilities, human exchange, shared health management information, and general coordination. The personnel, facilities and institutional capabilities of the affiliated groups are important resources for HISs to carry out health and welfare services, both in general and for coordinated services in the community. In areas where affiliated groups are lacking in resources, communities and other agencies have to actively seek out and make use of external resources. The coordination of services by affiliated groups and the community allows both to make the best use of the capabilities each has and effectively enables them to mutually compensate for their weak points.

Job stress in employees in hospitals has been recognized as a key issue in the workplace. In this paper, characteristics of job stress in the medical profession, especially in doctors and nurses, and the effectiveness of stress management are overviewed. The important points in stress management in hospitals are summarized as follows: 1) improvement of work environment, 2) assurance of participation and autonomy, 3) education or training to reduce job stress (ex. coping behavior, self-care, relaxation), 4) career development, 5) total support among medical professions. Some reports have demonstrated that the establishment of constant meetings is an effective method of reducing job stress and improving mental health in the medical profession, but few prospective intervention studies have been carried out. Further research is necessary to evaluate the effectiveness of stress reduction and to develop effective intervention programs for medical professions in hospitals.

In order to evaluate occupational exposure conditions, it is necessary to determine the 8-hr time-weighted average (8-hr TWA) of exposure concentrations and compare the 8-hr TWA value with the permissible exposure limit, but 8-hr sampling is difficult for the outside laboratories because of trip time. For working environment measurement, because sampling duration in a unit work area may be one hour, the measurement can be conducted in several work areas in a day. If exposure conditions can be evaluated with the 1-hr TWA values, sampling to determine the exposure concentration would be efficient and able to be completed during the work area sampling. From this point of view, methods for evaluating exposure conditions with 1-hr or more TWA values are proposed in this paper.

This paper describes handling stress in the workplace from the viewpoint of work conditions and ergonomics. The term expressed in Japanese as "sagyokanri" corresponds to the term "work conditions and ergonomics" in English, which is used internationally in the field. Therefore, "sagyokanri" means considering how to handle work and stress by using ergonomics. The Japanese Journal of Ergonomics is quoted in this discussion of the definition of stress and the lack of countermeasures taken with respect to work conditions and ergonomics as they relate to stress. Finally, it touches on the SACL (Stress Arousal Checklist), one method of evaluating stress which is not very familiar to those in the occupational health field in Japan.

In recent years, job stress and stress management have emerged as key issues in health promotion in the workplace in all of the post-industrialized countries. In the EU, the European Survey on Working Conditions has reveals that stress and musculo-skeletal disorders are the main health risks at work. In the US, NORA (national occupational research agenda) identifies 21 research priorities, in which "organization of work" is included as a job stress related factor. In this paper, trends and characteristics in occupational stress management in western countries, especially in the EU are overviewed. Presently, most stress management activities are oriented towards secondary or tertiary prevention, and are worker-oriented. But in future, priority strategy for intervention should be primary prevention, and focused on the organization as the generator of risk. In the group of countries paying a lot of attention to work stress, health policies or legal framework at the national level and a variety of activities for stress prevention at the company level are well integrated. By analyzing various stress management cases or projects, key factors for a successful approach to stress prevention are extracted as follows: 1. A stepwise and systematic approach, 2. clear determination of aims, tasks, responsibilities, planning and financial means, 3. An adequate diagnosis of risk analysis, 4. A combination of work-directed and worker-directed measures, 5. A participative approach, 6. Top management support. Costs-benefit assessment should be introduced to evaluate the effectiveness of stress prevention and to promote more integrated approaches in the workplace.

The management of job stress is reviewed in consideration of gender and age. Although these two factors are very important in the management of job stress, it is very difficult to decrease job stress from the point of view of these broad aspects. That there are presence of only a few articles in Japan and overseas describing these two factors in job stress reflects the difficulty. We reviewed articles including large scale but unpublished papers, and found some characteristics of stress according to gender and generation. In this paper we have discussed gender and generation gaps in the stress of life, the gender gap in job stress. We have also reviewed several measures for decreasing job stress in male and female workers on the basis of reviewed articles. We have proposed measures for controlling job stress in each gender and generation. It is essential to study and control job stress taking gender and generation into consideration.

High short-term exposure to toxic chemicals can occur during a workday, even if the daily average exposure is lower than the permissible exposure limit, because the exposure concentration varies from minute to minute. To protect workers from acute health effects due to high short-term exposure, the Japan Society for Occupational Health recommends that the maximum value for 15-min time-weighted average (15-min TWA) exposure during a workday should not exceed 1.5 times the occupational exposure limit for 8-hr TWA, and the American Conference of Governmental Industrial Hygienists issues the threshold limit value-short-term exposure limit (TLV-STEL), that is a 15-min TWA exposure which should not be exceeded at any time during a workday. A workday (8 hr) consists of thirty two 15-min periods. If the thirty-two 15-min TWAs are measured, the short-term exposure situation can be appropriately evaluated by comparing the highest measured value with the standard value (e.g. TLV-STEL), but such continuous monitoring consumes a lot of cost and time. In this paper, we propose a method for evaluating short-term exposure by using three or more measured values. This evaluation method corresponds to two different types of selection of sampling periods. One is a random selection of three or more 15-min periods among the 32 periods. If this selection is adopted, a comparison between the 98.44 percentile of the within-day distribution of 15-min TWAs and the standard value can be made by using one-sided tolerance factors, KI, KII and KIII, and the exposure situation is classified into four exposure classes at 95% and 50% confidence levels. Another is a random selection among high exposure periods. If this selection is adopted, a comparison between the specific percentile of the distribution and the standard value can be made with modified one-sided tolerance factors, and the exposure class is determined similarly. This method can provide a precise evaluation of exposure, so that it is useful in the industrial hygiene field.

The purpose of this paper is to clarify some patterns of utilization of an external employee assistance program (EAP) we have conducted for other public and private facilities in the Tokyo Kenbikyoin Foundation between April, 1986 and December, 1996. The subjects were 26 men and 12 women in 7 facilities under the following conditions: (1) Employees who have already had their own psychiatrists at the first interview of the external EAP; (2) Facilities utilize the EAP for two or more employees who met the first criterion. As a result, utilization patterns differed depending on medical staff's attitude toward the external EAP. There was a significant difference according to sex. The rate for men was 54% in worksites where medical staff understood this external program (worksite A1) and 93% in worksites where they did not (worksite A2-3, B). As to expectations for the program, there were more consultations for organizational measurements (63%) in worksite A1, while less organizational matters (27%) and more personal complains about their psychiatrists in the worksite A2-3, and B. These results suggest that the involvement of medical staff is the key to utilizing the external EAP effectively.

Ionizing radiation-induced cancer risk has been estimated mainly from the Radiation Effects Research Foundation study of atomic bomb survivors who were exposed to a high instant radiation dose. With the development of nuclear industries, the cancer risk has recently been estimated directly from epidemiological studies of radiation workers who were exposed to low-level protracted doses, though the results still remain controversial due to the lack of statistical power. The present article is to review, summarize and comment on epidemiological papers on radiation workers in various job types published up to 1994.

This paper grouped together recent ILO conventions relevant to occupational safety and health (OSH) in order to clarify their characteristics and form an overview. There are 13 such conventions adopted by ILO during the period 1960-1993. Each of these conventions have distinct goals to cover respective areas of OSH, which was contrasted with each other. Conventions are subject to ratification, thus the ratification status of Japan was statistically compared to that of ILO and OECD member states. As at June 1993, Japan ratified three of such conventions, which was slightly higher than the average number ratified by all ILO member states and ranked 11th among 24 OECD member states. The relative ratification status of Japan on ILO Conventions fared better with those relevant to OSH than others. ILO Conventions are inter-related by reference and note, thus ratification of basic conventions such as C. 155 (Occupational Safety and Health Convention) and C. 148 (Working Environment Convention), neither of which is ratified by Japan, should be prioritized to further promote ratification status in the OSH area.