Outbreak of Salmonella Braenderup Infection Originating in Boxed Lunches in Japan in 2008

There have been only 2 reports of a large-scale foodborne outbreak arising from Salmonella enterica serotype Braenderup infection worldwide. On August 9, 2008, an outbreak originating in boxed lunches occurred in Okayama, Japan. We conducted a cohort study of 786 people who received boxed lunches from a particular catering company and collected 644 questionnaires (response rate:82%). Cases were defined as those presenting with diarrhea (≧4 times in 24h) or fever (≧38℃) between 12 am on August 8 and 12 am on August 14. We identified 176 cases (women/men:39/137);younger children (aged＜10 years) appeared to more frequently suffer severe symptoms. Three food items were significantly associated with higher risk of illness;tamagotoji (soft egg with mixed vegetables and meat) (relative risk (RR):11.74, 95% confidence interval (CI):2.98-46.24), pork cooked in soy sauce (RR:3.17, 95% CI:1.24-8.10), and vinegared food (RR:4.13, 95% CI:1.60-10.63). Among them, only the RR of tamagotoji was higher when we employed a stricter case definition. Salmonella Braenderup was isolated from 5 of 9 sampled cases and 6 food handlers. It is likely that unpasteurized liquid eggs contaminated by Salmonella Braenderup and used in tamagotoji caused this outbreak

Factors Affecting Appropriate Management of Patients with Sexually Transmitted Infections in Japan

Physicians should educate patients with sexually transmitted infections (STIs) on measures to prevent reinfection and should also undertake human immunodeficiency virus (HIV) testing after diagnosis of STIs. These preventive measures are important, but it is not known to what extent these procedures are followed in Japan. We conducted a cross-sectional study to investigate the proportion of patients with STIs who received appropriate management from physicians, namely recommendation of HIV testing, encouragement of condom use and examination and/or treatment of sexual partners, to elucidate the factors affecting institution of each measure. From a mailshot of 566 physicians, 409 (72.3%) responded, with 176 diagnosing an STI in 967 patients. The proportions applying the 3 measures were low (recommendation of HIV testing:27.0;encouragement of condom use:64.8%;examination of sexual partners:17.5%), and were related to the sex of the patients and numbers of patients diagnosed by the physicians. Female patients received better care than male patients, particularly with respect to recommendation of HIV testing (odds ratio:2.82). Physicians who diagnosed more than 20 STI patients tended not to provide appropriate management. These findings suggest the necessity for better physician management of patients for effective prevention of STIs

Comparative study of the work load between one-man buses and two-man buses.

The differences in physiological and safety conditions of one-man buses and two-man buses were examined from the view point of occupational fatigue. This survey consisted of a work load study which included a time study, study of subsidiary behavior, auditory task, memory test, Galvanic Skin Response (GSR) and physiological function tests and a self-administered questionnaire which involved items concerning safety and subjective fatigue complaints. The visual and postural restrictions in the one-man bus were greater than in the two-man bus. The mental capacity of the one-man bus drivers was found to be less. Greater mental fatigue and stress were observed in the one-man bus. More subjective fatigue complaints were observed in the one-man bus. More cases of near accidents were observed in the one-man bus. From these results it was concluded that the one-man bus caused bus drivers a greater mental and physical work load.</p

トクシマシ イシカイ ノ COPD タイサク

In the national project Health Japan 21 （2nd edition） put forward in April 2013, the Ministry of Health, Labour, and Welfare specified chronic obstructive pulmonary disease （COPD） as a targeted lifestyle-related disease, in addition to cancer, heart diseases, and diabetes, and concluded that the establishment of COPD management systems is an important issue to maintain Japanese people’s healthy lives, as the number of deaths from this disease is likely to rapidly increase in the future. In Tokushima Prefecture, the mortality rate associated with COPD has been stably high over the past years ; the nation’ s highest in 2010 and third highest in 2011. In some regions of the western area, particularly mountainous regions, and southern area of the prefecture, the standardized mortality rate among males is double the national mean, highlighting the necessity of rapidly taking countermeasures. Under such circumstances, the Tokushima City Medical Association regarded COPD management as a priority item when developing annual projects this year, and organized the COPD Management and Smoking Cessation Promotion Committee in May. The medical association also presented a tentative plan to conduct association-led individualized COPD assessment at its own expense to the local government of Tokushima, with a view to materializing COPD assessment projects to clarify, evaluate, and analyze the actual situation, including surveys on citizens’ recognition of COPD and those conducted by family doctors to examine the statuses of their patients, involving the local government in the future. During deliberations to examine the feasibility of this plan, the local government proposed a new COPD assessment plan based on the conventional mass pulmonary cancer examination system, in order to deal with those at a high risk of COPD ; following some revisions, the new plan was adopted. The plan consisted of the following steps : > Targeting those meeting the 3 diagnostic criteria specified in the pulmonary cancer interview sheet for COPD assessment : 1） age of 60 or over ; 2） previous smoking habit ; 3） presence of at least one of the subjective COPD symptoms （chronic coughing, sputum, and shortness of breath during activity）. > Providing these patients with a free-consultation coupon to undergo assessment in a registered primary medical examination institution. > Conducting airway obstruction evaluation in primary medical examination institutions using the mass COPD screening interview sheet （COPD-PSTM） and spirometry. > Conducting insurance-covered medical examinations, such as the respiratory function test, chest XP, and CT scans, in secondary medical examination institutions （chest physicians） to establish a definite diagnosis. > Reporting the results of these examinations to family doctors. > If treatment is necessary, developing initial pharmacotherapy plans as part of the standardized treatment of COPD for approximately 3 months, which are implemented by family doctors. In consideration of the rapidly aging Japanese population, the number of potential COPD patients aged 40 and over is expected to reach nearly 7 million soon. In order to deal with such a large number of COPD patients, it is primary care physicians’ duty to provide early diagnosis and treatment, and local medical associations are charged with promoting spirometry through their activities as part of COPD assessment projects, aiming to establish cooperative systems to manage the disease between primary care physicians providing treatment during the stable period and chest physicians providing it during the exacerbation period. As future perspectives, spirometry-promoting seminars to be held in clinical environments are being considered ; participation in these seminars will be a requirement for registered primary COPD examination institutions, and those who have completed such programs will be Tokushima City Medical Association-certified COPD specialists （tentative name）. It is expected that these approaches to carry out the nation’s first COPD assessment projects will improve clinical environments in communities, such as support for smoking cessation, medical professionals’ knowledge of COPD, and the standardization of diagnosis and treatment

Relationship between health services and medical costs -Evaluation of the effect of health services provided by the health insurance scheme of employees-

With the rapid increase in medical costs, insured employees and employers have had to pay higher premiums in Japan. As a result, many health insurance schemes are providing health services not only to improve the health condition of the employees but also to reduce medical costs. A questionnaire study on health services provided by employees' health insurance schemes was carried out, and the relationship between the activities of health services and medical costs was analyzed.The schemes provided different kinds of health services such as physical fitness programs, information services, and gymnastic facilities. The highest correlation was found between the mean age of the insured employees, and the second highest correlation was found between the total costs for health services and the medical expenditure. The items of health services relating to medical expenditure differed according to the mean age of insured employees. The health services among the schemes for younger employees were effective in reducing medical costs, while no significant correlation between health services and medical expenditure was observed among the schemes for elder employees