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1.  Reference value and annual trend of white blood cell counts among adult Japanese population 
This study was initiated to establish the reference values (the 95 % lower limit in particular) for white blood cell (WBC) counts in peripheral blood of general Japanese population. Additional attempts were made to examine whether the reference range had changed in the past 100 years, and which factors had induced such change in WBC counts.
Data employed were WBC counts of >100 thousand apparently healthy Japanese men, collected in 2002 and in 2010, respectively. Information on smoking habits was collected simultaneously.
The distribution of WBC counts was essentially normal. Arithmetic mean (AM) WBC was 6,248 cells/mm3 in 2002 and 6,162 cells/mm3 in 2010. Based on the 2010 observation, 3 × 103 WBCs/mm3 (after rounding of the figure) was identified as the 95 % lower limit of the reference value for the population. No clear age dependency was detected. Smoking induced elevation in WBC, whereas WBC returned to the level of never smokers after quitting for 3 or more years.
Historical review disclosed a secular trend of decrease in WBC in the past 100 years, so that about 8 % of never-smoking men would be considered leukocytopenic according to the conventional cutoff of 4 × 103 cells/mm3 as a screening level. Decreased smoking rates and improved general hygiene are discussed as possible factors for WBC count reduction. Thus, WBC count of 3 × 103 cells/mm3 is recommended as the 95 % lower limit of the reference value for screening cases with reduced WBC counts.
PMCID: PMC3590320  PMID: 23054993
Annual trend; Japanese; Leukocyte counts; Men; Reference value; White blood cell counts
2.  Activities of occupational physicians for occupational health services in small-scale enterprises in Japan and in the Netherlands 
Occupational health service (OHS) for small-scale enterprises (SSEs) is still limited in many countries. Both Japan and the Netherlands have universal OHS systems for all employees. The objective of this survey was to examine the activities of occupational physicians (OPs) in the two countries for SSEs and to investigate their proposals for the improvement of service.
Questionnaires on types and sizes of the industries they serve, allocation of service hours (current and desired), sources of information for occupational health activities etc. were mailed in 2006 to 461 and 335 Japanese and Dutch OPs, respectively, who have served in small- and medium-scale enterprises. In practice, 107 Japanese (23%) and 106 Dutch physicians (32%) replied, respectively.
Results and Conclusions
Total service time per month was longer for OPs in the Netherlands than OPs in Japan. Japanese OPs spent more hours for health and safety meetings, worksite rounds, and prevention of overwork-induced ill health (14–16% each). Dutch OPs used much more hours for the guidance of absent workers (48%). Thus, service conditions were not the same for OPs in the two countries. Nevertheless, both groups of OPs unanimously considered that employers are the key persons for the improvement of OHS especially in SSEs and their education is important for better OHS. The conclusions should be taken as preliminary, however, due to study limitations including low response rates in both groups of physicians.
PMCID: PMC2836247  PMID: 20130904
Education; Employer; Occupational physician; Occupational health services; Small-scale enterprises

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