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BACKGROUND: Despite a high community smoking rate, few investigations of tobacco usage among Japanese nurses have been conducted in rural areas, particularly those in the southern islands. AIM: The aim of this research was to investigate the epidemiology of tobacco smoking among a previously understudied group of rural Japanese nurses. DESIGN: A self-reporting questionnaire was adapted from previous investigations and distributed to a complete cross-section of 1162 nurses from a large teaching hospital in southern Japan (response rate: 74.0%). RESULTS: A total of 10.9% (95% Confidence Interval: 9.0-13.2) were current smokers, with a further 2.9% (95% CI: 2.0-4.3) being ex-smokers. When stratified by gender, the prevalence of smoking was 10.8% (95% CI: 8.9-13.1) among females, and 18.7% (95% CI: 6.6-43.0) among males. The median number was 10.0 cigarettes per day for a period of 10.0 years. When stratified by age, the highest smoking prevalence (16.4%) was observed among nurses aged between 45 and 50 years. In relation to career length, the highest smoking prevalence (13.3%) was demonstrated among those who had worked between 6 and 10 years. CONCLUSIONS: Overall, our study suggests that around 11% of rural nurses in southern Japan currently smoke tobacco. When stratified by gender however, the prevalence among male nurses was almost double that of their female counterparts. Although interventions to reduce smoking are clearly needed in this region, interventions will need to consider the underlying social and cultural motivations for tobacco usage among Japanese people, in general. [ABSTRACT FROM AUTHOR]

To investigate factors contributing to the mental health of Vietnamese technical intern trainees in the food manufacturing industry, a questionnaire survey was conducted twice with a six-month interval. A total of 111 technical trainees who participated in two surveys were included in the analysis. We used a mixed-effects model, where items with statistically significant associations in the univariate analysis were fixed effects, factories were random effects, and the outcome was defined as the K6 score at follow-up. The mean K6 score increased from 3.13 (SD 3.5) at baseline to 3.86 (SD 4.1) at follow-up, with 26.1% and 34.2% exhibiting poor mental health (K6≥5) at baseline and follow-up, respectively. Insomnia and years of training experience were significantly associated with the K6 score at follow-up. Those with insomnia had significantly higher K6 score at follow-up. Compared to the first year of training, K6 score at follow-up increased significantly for training in their third year or more. It is important to understand the sleeping conditions of trainees and support them based on their years of training experience.

Introduction: Limited information is available on the biological effects of whole-body exposure to quasi-millimeter waves (qMMW). The aim of the present study was to determine the intensity of exposure to increase body temperature and investigate whether thermoregulation, including changes in skin blood flow, is induced in rats under whole-body exposure to qMMW., Methods: The backs of conscious rats were extensively exposed to 28 GHz qMMW at absorbed power densities of 0, 122, and 237 W/m 2 for 40 minutes. Temperature changes in three regions (dorsal and tail skin, and rectum) and blood flow in the dorsal and tail skin were measured simultaneously using fiber-optic probes., Results: Intensity-dependent temperature increases were observed in the dorsal skin and the rectum. In addition, skin blood flow was altered in the tail but not in the dorsum, accompanied by an increase in rectal temperature and resulting in an increase in tail skin temperature., Discussion: These findings suggest that whole-body exposure to qMMW drives thermoregulation to transport and dissipate heat generated on the exposed body surface. Despite the large differences in size and physiology between humans and rats, our findings may be helpful for discussing the operational health-effect thresholds in the standardization of international exposure guidelines., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ijima, Kodera, Hirata, Hikage, Matsumoto, Ishitake and Masuda.)

Background/aim: The widespread use of fifth-generation 5G millimeter-waves (MMW) generates concern about potential adverse health effects. The latest international guidelines for MMW exposure adopt an absorbed power density (APD) of 200 W/m 2 to avoid a local temperature rise of 5°C in human tissues as an operational adverse health effect threshold. However, because APD is estimated by simulations using human tissue models, it is unknown whether a similar value can be confirmed for living tissues. The aim of this study was to investigate the relationship between APD and skin temperature rise in vivo, and to validate the estimated values., Materials and Methods: The rat dorsal skin was locally exposed to a 26.5 GHz quasi-MMW (qMMW) for 18 min using a patch antenna. The qMMW exposure intensities estimated by dosimetry were set to 0-500 W/m 2 of APD. The temperatures in the dorsal skin and rectum were simultaneously measured during exposure., Results: The qMMW-induced local temperature increase at different sites. The dorsal skin temperature increased by approximately 11.3°C at a maximum intensity of 500 W/m 2 , but the rectal temperature increased by only 0.6°C, indicating highly localized effects of exposure to rats. A significant correlation was observed between APD and skin temperature rise. The relationship provided a linear regression model, and a temperature rise of less than 5°C was estimated in the skin exposed to 200 W/m 2 of APD., Conclusion: These results suggest that the operational threshold for the MMW exposure guidelines is valid under the present experimental conditions using rats., (Copyright © 2023, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Objectives: To evaluate the effects of sarcopenia and excess visceral fat accumulation on early urinary function after I-125 low-dose-rate brachytherapy for prostate cancer., Methods: We retrospectively reviewed consecutive patients who underwent brachytherapy for prostate cancer. Pre-treatment computed tomography was used to measure skeletal muscle index at the L3 level to assess sarcopenia and visceral fat area at the umbilical level. The International Prostate Symptom Score and the University of California Los Angeles Prostate Cancer Index were used to assess quality of life during the 24 months after brachytherapy. Logistic regression analysis was used to examine whether sarcopenia and excess visceral fat accumulation had clinically significant effects on post-treatment quality of life., Results: Among 246 patients, 92 (37.4%) were stratified into the sarcopenia group and 141 (57.3%) into the excess visceral fat accumulation group. The sarcopenia group had significantly lower University of California Los Angeles Prostate Cancer Index urinary function than the non-sarcopenia group 24 months post-brachytherapy. The excess visceral fat accumulation group had significantly poorer International Prostate Symptom Score total, storage, and voiding scores than the non-excess accumulation group 12 months post-brachytherapy. In the multivariate analysis, sarcopenia had a clinically significant adverse effect on the University of California Los Angeles Prostate Cancer Index urinary function at 12 months. Excess visceral fat accumulation had a clinically significant adverse effect on the International Prostate Symptom Score voiding and storage scores at 12 months., Conclusions: Sarcopenia and excess visceral fat accumulation negatively affect urinary function early after I-125 low-dose-rate brachytherapy for prostate cancer., (© 2022 The Authors. International Journal of Urology published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Urological Association.)

Aim: The aim of this study was to identify factors that influence changes in resilience among workers with mental health disorders, leading to effective treatment and support., Methods: Among the new patients at an institution, 81 who were working and had the ICD-10 diagnoses F3 and F4 were included. Resilience was measured at the initial visit and 3 months later using the S-H resilience test. Univariate and multiple regression analyses were conducted using the change in resilience between the two measurements as the objective variable, and treatment and attendance at work as explanatory variables., Results: There were no significant differences in resilience abilities between pre- and postmeasurement for the subjects as a whole. However, tests for the subgroups of diagnostic category, attendance at work, and treatment showed that resilience improved significantly in the mood disorder group, the leaving employment group, and the group receiving additional treatment. The results of the multiple regression analysis showed that treatment type (with or without additional treatment) had an effect on the degree of change in resilience, and among these "inpatient treatment" and "re-work program" were suggested to have an effect., Conclusion: The resilience of workers with mental health disorders was found to improve even after only 3 months of treatment, depending on the content of the treatment. We believe the significance of this study is the quantitative indication of the transition of resilience, which has not been made concrete until now., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

The objective of this study was to verify whether the assessment of poor sleep based on two sleep scales could predict suicidal ideation in Japanese dayworkers. A longitudinal survey was conducted among 446 Japanese dayworkers working at a company in Japan. Questionnaires were administered in 2013 (baseline) and 2014 (follow-up). To evaluate suicidal ideation, we used Question 19 of the Self-rating Depression Scale, categorizing participants who chose response options "some/a good part/most of the time" as suicidal ideation (+), and those who chose option "never or only a little of the time" as suicidal ideation (-). Two sleep scales, the Pittsburgh Sleep Quality Index (PSQI) and the 3-Dimensional Sleep Scale (3DSS), were selected as potential predictors of suicidal ideation. Only participants who were suicidal ideation (-) at baseline were included in the analysis, and suicidal ideation (+) individuals at follow-up were considered to have developed suicidal ideation during the interval between baseline and follow-up surveys. Data from 293 participants (236 men, 57 women) were analyzed. Twenty-two participants (7.5%) became suicidal ideation (+) at follow-up. Multiple logistic regression analysis showed that only sleep quality of the 3DSS subscale significantly predicted suicidal ideation, even after adjusting for depressive symptoms. That is, assessment of poor sleep did not predict suicidal ideation when based on the PSQI, but did when based on the 3DSS. Assessment of sleep quality based on the 3DSS may prove more useful in predicting worker suicidal ideation in industrial settings with limited facilities than PSQI., Supplementary Information: The online version contains supplementary material available at 10.1007/s41105-022-00404-6., Competing Interests: Conflict of interestAll authors declare that they have no conflicts of interest., (© The Author(s) 2022.)

Purpose: To evaluate the oncological outcomes and genitourinary and gastrointestinal adverse events in acute and late-phases of iodine-125 low-dose-rate brachytherapy for localized prostate cancer., Material and Methods: We retrospectively evaluated 334 patients treated for localized prostate cancer with low-dose-rate brachytherapy. Bio-chemical relapse-free survival, cause-specific survival, and overall survival were evaluated using Kaplan-Meier method and log-rank test. Incidence of adverse events was calculated using National Cancer Institute common terminology criteria for adverse events, version 5. Logistic regression was used to identify independent predictors of acute and late-phase genitourinary and gastrointestinal adverse events., Results: National Comprehensive Cancer Network's low-, intermediate-, and high-risk groups included 133 (39.8%), 163 (48.8%), and 38 (11.3%) patients, respectively. The 5-year cause-specific survival rate was 100%. The 5-year bio-chemical relapse-free survival rates for the low-, intermediate-, and high-risk groups were 98.3%, 95.8%, and 100%, respectively. One patient had a ≥ grade 3 acute adverse event. The 5-year cumulative ≥ grade 1, ≥ grade 2, and ≥ grade 3 genitourinary adverse event rates were 27.9%, 14.4%, and 0.5%, respectively. The 5-year cumulative ≥ grade 1, ≥ grade 2, and ≥ grade 3 gastrointestinal adverse event rates were 3.1%, 1.5%, and 0.5%, respectively. A high pre-treatment international prostate symptom score and non-use of α1-blockers were associated with an increased risk of acute genitourinary adverse events., Conclusions: Low-dose-rate brachytherapy had good oncological outcomes, with acceptable adverse event rates. Pre-treatment urinary function and use of α1-blockers may be useful in predicting and preventing acute genitourinary adverse events., Competing Interests: The authors report no conflict of interest., (Copyright © 2022 Termedia.)

The Japan "Ordinance on Safety and Health of Work under High Pressure", which is the law regulating health conditions for workers under high pressure environments, was amended in 2014. The revised regulations have highlighted other difficulties and new problems, but they have not yet written an appropriate amendment based on the aspect of occupational and environmental health. Health management for occupational divers and caisson workers in accordance with the new regulations has not determined the best approach to reducing related disorders and will cause other legal problems. This paper presents some issues in the new regulations for hyperbaric workers, which directly or indirectly involve occupational health physicians. Health checkups and work limitations should be done in consideration of the occupational characteristics of the undersea and hyperbaric environment. Regular examinations using specific studies are useful to diagnose the early stages of chronic conditions for workers, and are also useful for determining the hiring suitability for hyperbaric workers. Work limitations should be decided by the conditions that induce serious accidents or disorders that result from exposure to hyperbaric environments, and depend on the obstacles for work due to sequelae of decompression sickness. The new regulations need to be properly revised, based on scientific evidence, to include health management for workers in undersea and hyperbaric environments.

The global spread of 5th generation (5G) wireless systems causes some concern about health effects of millimeter waves (MMW). To investigate biological effects of local exposure to 5G-MMW on human body, a novel 60 GHz band exposure setup was developed, and its performance was validated. A spatial synthetic beam-type exposure setup using two dielectric lens antennas was proposed to achieve high intensity 60 GHz irradiation to the target area of human skin. Variety distributions and intensities of electromagnetic fields at the exposed area, which is modified by incident angles of the combined beams, were simulated using finite-difference time-domain methods. The exposure performance we estimated was verified by temperature elevations of surface in a physical arm-shaped silicone phantom during the MMW exposure. The interference fringes generated in the exposed area due to the combined two-directional beam radiations were observed both in the simulation and in the phantom experiment but eliminated by applying an orthogonalizing polarized feeding structure. Under these exposure conditions, the local temperature changes, which could evoke warmth sensations, were obtained at the target area of the human forearm skin, which means the achievement of exposure performance we intended., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hikage, Ozaki, Ishitake and Masuda.)

Unmarried people often have disorderly lifestyles, and sleep problems (e.g., insomnia, short sleep duration, social jetlag) are becoming more complex due to the modern 24-h society. To improve health promotion measures for unmarried people, this study examined the relationship between marital status and sleep assessed as a multifactorial structure (phase, quality, quantity) in Japanese day workers. A cross-sectional survey was conducted with employees at five workplaces in Japan. Participants indicated their marital status, and the 3-Dimensional Sleep Scale measured sleep condition. We used scale cutoff values to define poor sleep phase, quality, and quantity (scores below the cutoff). "All poor sleep" and "all good sleep" were defined as when all scores were below or above the cutoff, respectively. Data from 786 participants (578 men, 208 women) were analyzed. Multivariate analysis showed that being unmarried was significantly related to poor sleep phase, quality, and quantity, with increased odds ratios. In unmarried participants, odds ratios (OR) were highest for poor sleep quantity in men (OR: 2.15) and poor sleep phase in women (OR: 2.73). All poor sleep showed the highest odds ratio for both unmarried men (OR: 2.74) and women (OR: 6.13), while unmarried men showed significantly decreased odds ratios for all good sleep (OR: 0.51). The finding that being unmarried was more closely associated with poor sleep quality and quantity in men, and more closely associated with poor sleep phase in women, could greatly contribute to creating measures to promote improved sleep in unmarried people., Supplementary Information: The online version contains supplementary material available at 10.1007/s41105-021-00357-2., Competing Interests: Conflict of interestYuuki Matatsumoto, Naohisa Uchimura, and Tatsuya Ishitake declare that they have no conflicts of interest., (© The Author(s), under exclusive licence to Japanese Society of Sleep Research 2021.)

Nitrogen (N 2 ) accumulation in the blood and tissues can occur due to breath-hold (BH) diving. Post-dive venous gas emboli have been documented in commercial BH divers (Ama) after repetitive dives with short surface intervals. Hence, BH diving can theoretically cause decompression illness (DCI). "Taravana," the diving syndrome described in Polynesian pearl divers by Cross in the 1960s, is likely DCI. It manifests mainly with cerebral involvements, especially stroke-like brain attacks with the spinal cord spared. Neuroradiological studies on Ama divers showed symptomatic and asymptomatic ischemic lesions in the cerebral cortex, subcortex, basal ganglia, brainstem, and cerebellum. These lesions localized in the external watershed areas and deep perforating arteries are compatible with cerebral arterial gas embolism. The underlying mechanisms remain to be elucidated. We consider that the most plausible mechanisms are arterialized venous gas bubbles passing through the lungs, bubbles mixed with thrombi occlude cerebral arteries and then expand from N 2 influx from the occluded arteries and the brain. The first aid normobaric oxygen appears beneficial. DCI prevention strategy includes avoiding long-lasting repetitive dives for more than several hours, prolonging the surface intervals. This article provides an overview of clinical manifestations of DCI following repetitive BH dives and discusses possible mechanisms based on clinical and neuroimaging studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Kohshi, Denoble, Tamaki, Morimatsu, Ishitake and Lemaître.)

Decompression illness (DCI) is well known in compressed-air diving but has been considered anecdotal in breath-hold divers. Nonetheless, reported cases and field studies of the Japanese Ama, commercial or professional breath-hold divers, support DCI as a clinical entity. Clinical characteristics of DCI in Ama divers mainly suggest neurological involvement, especially stroke-like cerebral events with sparing of the spinal cord. Female Ama divers achieving deep depths have rarely experienced a panic-like neurosis from anxiety disorders. Neuroradiological studies of Ama divers have shown symptomatic and/or asymptomatic ischaemic lesions situated in the basal ganglia, brainstem, and deep and superficial cerebral white matter, suggesting arterial insufficiency. The underlying mechanism(s) of brain damage in breath-hold diving remain to be elucidated; one of the plausible mechanisms is arterialization of venous nitrogen bubbles passing through right to left shunts in the heart or lungs. Although the treatment for DCI in Ama divers has not been specifically established, oxygen breathing should be given as soon as possible for injured divers. The strategy for prevention of diving-related disorders includes reducing extreme diving schedules, prolonging surface intervals and avoiding long periods of repetitive diving. This review discusses the clinical manifestations of diving-related disorders in Ama divers and the controversial mechanisms., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

Decompression illness (DCI), a syndrome following inadequate reduction in environmental pressure, has two forms: decompression sickness and arterial gas embolism after pulmonary barotrauma. Recompression therapy using oxygen, a kind of hyperbaric oxygen therapy, has been considered the gold standard treatment for DCI, although there is no randomized controlled trial evidence for its use. We evaluated the effectiveness of recompression therapy in treating DCI by reviewing the reported therapeutic results of serious DCI, especially neurological disorders. Early or ultra-early recompression therapy did not dramatically improve clinical recovery from DCI symptoms, including spinal cord disorders. In contrast, early first aid normobaric oxygen inhalation highly improved or stabilized clinical conditions of DCI. Based on these clinical results, the international committee for hyperbaric and diving medicine has stated that cases of mild DCI may be managed without recompression therapy. Further work is needed to clarify the clinical utility of recompression therapy for spinal injury as a common symptom of DCI. We also point out that the Japanese decree "Ordinance on Safety and Health of Work under High Pressure", which describes work under hyperbaric environments, has some serious issues and should be amended on the basis of scientific evidence.

Hyperbaric medicine includes two different medical fields: hyperbaric oxygenation (HBO) as emergency and intensive care, and diving medicine. Recent topics in hyperbaric therapy include radiation oncology and regenerative medicine. Of special interest are clinical studies of radiotherapy after HBO that were conducted at some institutes to evaluate its therapeutic effects for cancer patients. A few studies have shown that HBO improves memory disturbance following traumatic brain injury and hypoxic and ischemic events. There is a great possibility that HBO enhances the therapeutic effects of radiotherapy and potentiates regenerative medicine. Randomized controlled trials, however, have indicated the re-examination of its viable treatment effects in some conditions, including decompression illness, carbon monoxide poisoning, and serious soft tissue infection. As recent trends in the treatment of decompression illness have changed on the basis of clinical series, the laws related to diving and caisson work should be amended in the future.

Background/aim: The factors associated with longitudinal changes in health-related quality of life (HRQOL) are unclear. In this study we aimed to evaluate the longitudinal changes and predictors of HRQOL after 125 I low-dose-rate brachytherapy (LDB) for localised prostate cancer (PCA)., Patients and Methods: We evaluated 180 patients with localised PCA treated with LDB. The HRQOL was evaluated at 3 weeks before LDB and at 1, 3, 6, 12, 18, 24, 36, and 48 months after LDB using the International Prostate Symptom Score, Medical Outcome Study 8-Items Short Form Health Survey (SF-8), and University of California Los Angeles Prostate Cancer Index (UCLA-PCI)., Results: All HRQOL scores, except for UCLA-PCI sexual function and SF-8 mental component summary (MCS), were improved to baseline after an early transient deterioration. In contrast, the sexual function did not return to baseline after early deterioration. Meanwhile, the MCS scores showed no significant decline after implantation and trended upward. The prostate V100 and baseline UCLA-PCI sexual function scores predicted a clinically significant decrease in sexual function in the late post-implantation period., Conclusion: Most aspects of the HRQOL of PCA patients who underwent LDB improved to baseline. The results that V100 and baseline sexual function were predictors of late post-LDB may provide more accurate information for patients with preserved sexual function before treatment and for their partners., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

We present a pulmonary sarcoidosis patient with specific elevation of serum Krebs von den lungen-6 (KL-6) levels, who was successfully treated with inhaled corticosteroids. Pulmonary sarcoidosis was initially identified as a chest radiograph abnormality during a routine medical examination, and subsequently confirmed by a high serum level of soluble interleukin 2 receptor. The patient was started on high-dose inhaled budesonide because of high serum levels of angiotensin-converting enzyme (ACE) and KL-6. Following treatment, radiographic findings improved, ACE levels normalized, and serum KL-6 levels markedly decreased. No recurrence was detected at 100 months with a budesonide dosage of 800 μg/day. This case demonstrates the efficacy of highdose inhaled corticosteroids for the initial treatment of pulmonary sarcoidosis.

Diving accident in breath-hold (BH) divers (Ama) is a stroke-like neurological condition involving the brain. Ama divers are at a risk of ischemic brain injuries which are situated in watershed or terminal zones of cerebral arteries, and/or corticomedullary junctional area of cerebral arteries. The underlying mechanisms of brain damage in BH diving remains to be elucidated. After repetitive BH dives, nitrogen (N2) bubbles may be formed in the venous side of tissues and flow into the right atrium. N2 bubbles passing through the heart or the lungs is the most likely contributing factor. The pathophysiology of diving accident in BH diving is unclear, and more studies for stroke are needed to further elucidate its nature. (Received 29 July, 2019; Accepted 10 January, 2020; Published 1 May, 2020).

Objectives: The aim of this study is to clarify factors that support the work engagement of nurses, who bear the burden of extended day shifts, by focusing on the advantages of the variable shift system and workday break activities., Methods: Nurses who were working under a variable shift system were asked to complete a self-report questionnaire to examine the workload, work engagement, work stressors, stress-coping strategies, and stress-coping break time activities, as well as the advantages and disadvantages of the variable shift system. Nine break activities were classified into the following four categories: social activities, rest/relaxation, entertainment, and cognitive activities. The advantages or disadvantages of the variable shift system were scored by developing composite variables using principal component analysis. These variables were used to perform a multiple regression analysis with work engagement as the dependent variable., Results: The advantage score was the variable most strongly correlated with work engagement. In contrast, "Quantitative workload" was negatively correlated with work engagement. Among break activities, in the social activities category correlations were observed in "Both conversation and Email/SNS" and "Conversation only". Although in fact most nurses chose conversation as one of the break options, more than half of the nurses selected rest/relaxation as their ideal break activity., Conclusion: Our study suggested that the variable shift system supported the work engagement of nurses who worked extended day shifts. The results also suggested that it would be useful to arrange the employee lounge environment so that employees could freely choose between "conversation" or "taking a rest" depending on the circumstances.

Background: Cognitive dysfunction due to delirium or dementia is a common finding in acutely ill geriatric patients, but often remains undetected. A brief and sensitive clinical identification method could prevent errors or complications while evaluating the mental status of elderly patients., Aims: To evaluate the usefulness and clinical implications of the revised simplified short-term memory recall test (STMT-R) in geriatric patients admitted in the emergency department; with age, gender, dementia history, serum albumin, underlying diseases and clinical outcome used as comparative factors., Methods: Mini-mental state examination and STMT-R scores were initially compared and a positive correlation was observed (r = 0.66, p < 0.001). Subsequently, 885 inpatients aged over 50 years underwent STMT-R evaluation between October 2014 and September 2015. We considered as cognitive dysfunction STMT-R scores ≤ 4 of a maximum score of 8., Results: Among enrolled patients, 52.2% were female and the mean age was 78.9 years. There were 159 patients who were unable to complete the test (incomplete testing group). We observed cognitive dysfunction in 460 patients, while 266 did not have cognitive dysfunction. There were significant differences between those with and without cognitive dysfunction in terms of age, dementia history, underlying respiratory diseases, and hospital outcome., Conclusion: Cognitive dysfunction at admission can have a negative effect on the hospital outcomes of elderly patients. Age, a history of dementia and underlying respiratory diseases may also influence cognitive functional decline.

Objectives　The final evaluation of the Japanese government's Healthy Parents and Children 21 project in 2014 noted an increase in low birth weight infants as an aspect that worsened. In order to reduce the number of low birth weight infants, miscarriages, and stillbirths in Kurume City, we conducted a survey aimed at researching new measures, including the search for new risk factors of birth complications.Methods　The participants of this study were 2,986 pregnant women who submitted a pregnancy notification form in 2014. We excluded women who moved away from Kurume city or for whom birth weight records could not be obtained. Information from the pregnancy notification form was linked to birth weight records to examine the relationships between low birth weight infants, miscarriages, stillbirths, and pregnancy attributes. Variables that were shown to be related in an initial univariate analysis were analyzed further in a multiple logistic regression analysis with low birth weight, miscarriage, or stillbirth as the response variables.Results　A multiple logistic regression analysis showed that being 35 years or older (odds ratio [OR]: 1.41), height less than 158 cm (OR: 1.45), non-pregnant body mass index (BMI) less than 18.5 (OR: 1.48), and detection of physical abnormalities by a physician during the pregnancy (OR: 2.20) were independent maternal factors that were significantly associated with low birth weight. Being aged 35 years or older (OR: 2.05) and smoking (OR: 3.42) were independent factors that were significantly associated with miscarriage and stillbirth. In addition, the cessation of alcohol use (OR: 0.51) significantly reduced this risk.Conclusion　Because some biological factors such as "age" and "non-pregnant BMI" are invariable, we encourage pregnant women to get checkups to detect abnormalities early or to attend birthing classes that offer mental support, especially for pregnant women over 35 years. We want to tell young generations that pregnant women over 35 are at an increased risk of having low birth weight infants, miscarriages, and stillbirths, and those pregnant women with a lower BMI have an increased risk of low birth weight infants. "Maintenance of appropriate body weight," "smoking," "alcohol," socioeconomic issues such as "lack of systems for seeking advice and support staff," and "financial concerns" can be improved with health education from public health nurses and multidisciplinary support interventions. At the Children Care Support Center in Kurume city, professionals work together to provide continuous support to families during pregnancy, childbirth, and parenting. As a result, we may be able to contribute to reducing the number of low birth weight infants, miscarriages, and stillbirths.

We investigated whether long-term exposure to low-frequency noise generated by wind power facilities is a risk factor for sleep disorders. We performed an epidemiological study of the living environment and health effects of such noise by surveying 9,000 residents (≥20 years of age) living in areas with operational wind power facilities. Sleep disorders were assessed using the Athens Insomnia Scale. To assess environmental noise in residential areas near wind turbines, infrasound and low-frequency sound exposure levels were measured at 50 community centers of a town. The prevalence of sleep disorders was significantly higher among residents who reported subjectively hearing noise (by approximately twofold) than among those who did not. Moreover, the reported prevalence of sleep disorders was significantly higher (by approximately twofold) among residents living at a distance of ≤1,500 m from the nearest wind turbine than among residents living at a distance of ≥2,000 m, suggesting a dose-response relationship. The attitudes of residents towards wind power facilities strongly affected their responses regarding sleep disorder prevalence. It is highly likely that audible noise generated by wind power facilities is a risk factor for sleep disorders. Obtaining a satisfactory consensus from local residents before installing wind power facilities is important as for more amenable their attitudes towards such facilities.

The diagnosis of decompression illness (DCI), which is based on a history of decompression and clinical findings, can sometimes be confounded with other vascular events of the central nervous system. The authors report three cases of divers who were urgently transported to a hyperbaric facility for hyperbaric oxygen treatment of DCI which at admission turned out to be something else. The first case, a 45-year-old experienced diver with unconsciousness, was clinically diagnosed as having experienced subarachnoid hemorrhage, which was confirmed by CT scan. The second case, a 49-year-old fisherman with a hemiparesis which occurred during diving, was diagnosed as cerebral stroke, resulting in putaminal hemorrhage. The third case, a 54-year-old fisherman with sensory numbness, ataxic gait and urinary retention following sudden post-dive onset of upper back pain, was diagnosed as spinal epidural hematoma; he also showed blood collection in the spinal canal. Neurological insults following scuba diving can present clinically with confusing features of cerebral and/or spinal DCI. We emphasize the importance of considering cerebral and/or spinal vascular diseases as unusual causes of neurological deficits after or during diving., Competing Interests: The authors of this paper declare no conflicts of interest exist with this submission., (Copyright© Undersea and Hyperbaric Medical Society.)