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1.  Declining Rates of Tobacco Use in the Japanese Medical Profession, 1965–2009 
Journal of Epidemiology  2013;23(1):4-11.
Although there has been a downward trend in smoking rates among medical doctors in recent years, rates have been higher among Japanese doctors when compared internationally.
We extensively reviewed all published English- and Japanese-language articles that reported the smoking rates of Japanese doctors.
A total of 36 articles were examined, most of which had been conducted as postal surveys, usually by a national, prefectural, or local medical association. Sample sizes ranged from 17 to 11 773, and response rates ranged from 33% to 91%. National surveys conducted between 1965 and 2009 suggest that there has been a statistically significant (P < 0.0001) decline in smoking rates among Japanese doctors (from around 68% to 16% among males and from 19% to 5% among females).
Overall, the published data reveal a significant decline in smoking rates among Japanese doctors since 1965, especially among men. Although less than one-fifth of Japanese male doctors now smoke, more work needs to be done in tobacco control to help further reduce the burden of smoking, especially in medical schools.
PMCID: PMC3700230  PMID: 23149752
smoking; tobacco; physician; doctor; Japan
2.  Tobacco use among Australian dental hygiene students is declining, but more still needs to be done 
Tobacco Induced Diseases  2013;11(1):22.
While health care professionals have a responsibility to prevent and control the use of tobacco for improved health outcomes, it appears that some dental hygiene students continue to smoke. A survey of Australian dental hygiene students found that up to 16.3% smoke, although this prevalence rate decreased with each year of study. As future role models, it is essential that smoking cessation counselling is embedded in the dental curriculum to not only discourage their own habits, but so that they may promote the importance of being tobacco free to the wider population.
PMCID: PMC4015873  PMID: 24148282
Smoking; Tobacco; Students; Dental hygiene; Prevention
3.  Musculoskeletal disorders and symptom severity among Australian dental hygienists 
BMC Research Notes  2013;6:250.
Recent literature has identified that musculoskeletal disorders (MSD) are a significant occupational health issue for both dentists and dental hygienists. Research on the occupational health of dental hygienists is lacking in Australia, which is of particular concern given that it is a rapidly growing field in this country. The aims of this research are to investigate the prevalence of MSD and correlating regions of pain among Australian dental hygienists. A self-reporting questionnaire was distributed to all registered dental hygienists in Australia. The questionnaire was a modified version of a validated tool, used previously among health practitioners and students.
A total of 624 dental hygienists responded to the questionnaire, achieving a response rate of 42%. MSD were frequently reported by dental hygienists in the neck (85%), shoulder (70%), and lower back (68%). Of those reporting pain, over two thirds reported that the pain lasted for longer than two days, for all body regions. Logistic regression analysis revealed that there is a correlation between reports of MSD in the neck, shoulder and lower back regions.
Overall, this study suggests that MSD are a reasonably common problem for Australian dental hygienists, and that they often need to seek medical treatment for these problems. It is concerning that there is a correlation between reports of MSD in the neck, shoulder and lower back regions; further studies are needed to establish the epidemiological patterns of MSD in this profession.
PMCID: PMC3704656  PMID: 23822098
Musculoskeletal disorders; Dental hygienist; Occupational health
4.  Influenza Vaccination Uptake among the Working Age Population of Japan: Results from a National Cross-Sectional Survey 
PLoS ONE  2013;8(3):e59272.
Influenza vaccination rates among Japanese people of working age (20–69 years) is currently suboptimal, and the reasons for this have not been clearly elucidated. This study examined factors associated with vaccination intention among the working age population in Japan during September 2011, one-month prior to influenza vaccination becoming available.
Methodology/Principal Findings
A web-based survey of intention to be vaccinated against influenza in the coming season was undertaken among 3,129 Japanese aged 20 to 69 years. Multinomial logistic regression analysis was used to explore the associations between vaccination intent and other variables. Influenza vaccination intent was associated with having been vaccinated in the previous year (Odds Ratio (OR): 3.81; 95% Confidence Interval (CI): 3.75–3.86), the number of children per household (one compared with zero; OR: 1.37; 95%CI: 1.11–1.65), and household income ($50,000 to <$100,000 compared with $0 to <$50,000; OR: 1.30; 95%CI: 1.07–1.54). Smoking was inversely associated with influenza vaccine uptake (current smokers compared with non-smokers; OR: 0.79; 95%CI: 0.61–0.98). A history of either the survey respondent or a household member having being medically diagnosed with influenza in the previous year was not statistically associated with future influenza vaccination intent.
Overall, this suggests that intention to be vaccinated among working age Japanese is associated with a past history of influenza vaccination, having children, and the household's income. As such, consideration of these factors should now form the cornerstone of strategies to encourage increased uptake of vaccination against influenza in future years.
PMCID: PMC3595249  PMID: 23555010
5.  Wearing face masks in public during the influenza season may reflect other positive hygiene practices in Japan 
BMC Public Health  2012;12:1065.
Although the wearing of face masks in public has not been recommended for preventing influenza, these devices are often worn in many Asian countries during the influenza season. In Japan, it is thought that such behavior may be an indicator of other positive hygiene practices. The aim of this study, therefore, was to determine if wearing a face mask in public is associated with other positive hygiene practices and health behaviors among Japanese adults.
We initially recruited around 3,000 Japanese individuals ranging from 20 to 69 years of age who were registered with a web survey company. Participants were asked to recall their personal hygiene practices during the influenza season of the previous year. Logistic regression analysis was then used to examine the associations between wearing a face mask in public and personal hygiene practices and health behaviors.
A total of 3,129 persons responded to the survey, among whom 38% reported that they had worn a face mask in public during the previous influenza season. Wearing a face mask in public was associated with various self-reported hygiene practices including: frequent hand washing (adjusted Odds Ratio [OR]: 1.67; 95% Confidence Interval [95%CI]: 1.34-1.96), occasional hand washing (OR: 1.43; 95%CI: 1.10-1.75), frequently avoiding crowds (OR: 1.85; 95%CI: 1.70-1.98), occasionally avoiding crowds (OR: 1.65; 95%CI: 1.53-1.76), frequent gargling (OR: 1.68; 95%CI: 1.51-1.84), occasional gargling (OR: 1.46; 95%CI: 1.29-1.62), regularly avoiding close contact with an infected person (OR: 1.50; 95%CI: 1.33-1.67), occasionally avoiding close contact with an infected person (OR: 1.31; 95%CI: 1.16-1.46), and being vaccinated of influenza in the last season (OR: 1.31; 95%CI: 1.17-1.45).
Overall, this study suggests that wearing a face mask in public may be associated with other personal hygiene practices and health behaviors among Japanese adults. Rather than preventing influenza itself, face mask use might instead be a marker of additional, positive hygiene practices and other favorable health behaviors in the same individuals.
PMCID: PMC3536629  PMID: 23227885
Face mask; Health behavior; Hygiene practices; Influenza
6.  Tobacco smoking among doctors in mainland China: a study from Shandong province and review of the literature 
Tobacco Induced Diseases  2012;10(1):14.
Tobacco control represents a key area in which doctors can make a significant positive impact on their patients’ lives. Despite this fact, however, doctors in certain regions of China are known to smoke tobacco at rates similar to or even exceeding those seen within the general population.
This study sought to investigate the smoking habits of doctors at a teaching hospital in Shandong province, as well as providing a brief review of smoking research that has been conducted among doctors elsewhere in China.
An anonymous questionnaire survey was distributed to doctors working at a university teaching hospital in 2008, as part of a larger study of occupational health issues in the healthcare profession.
The overall smoking prevalence rate of doctors in this study was 36.3% with significant differences observed between the genders (males: 46.7% and females: 5.3%). Age and total career length were also correlated with smoking habit, although no significant associations were found with department of employment.
Overall, our study suggests that smoking rates among doctors in Shandong province are higher than those documented in many other countries, a finding which is consistent with previous research conducted in some other Chinese provinces. Addressing this issue from an intrinsic cultural perspective will clearly need to form the cornerstone of tobacco control efforts within the Chinese medical community in future years.
PMCID: PMC3519549  PMID: 23006640
China; Chinese; Doctor; Physician; Smoking; Tobacco; Medical
7.  Occupational health issues in marine and freshwater research 
Marine and freshwater scientists are potentially exposed to a wide variety of occupational hazards. Depending on the focus of their research, risks may include animal attacks, physiological stresses, exposure to toxins and carcinogens, and dangerous environmental conditions. Many of these hazards have been investigated amongst the general population in their recreational use of the environment; however, very few studies have specifically related potential hazards to occupational exposure. For example, while the incidence of shark and crocodile attacks may invoke strong emotions and the occupational risk of working with these animals is certainly real, many more people are stung by jellyfish or bitten by snakes or dogs each year. Furthermore, a large proportion of SCUBA-related injuries and deaths are incurred by novice or uncertified divers, rather than professional divers using aquatic environments. Nonetheless, marine and freshwater research remains a potentially risky occupation, and the likelihood of death, injury and long-term health impacts still needs to be seriously considered.
PMCID: PMC3317851  PMID: 22429712
Exposure; Hazard; Injury; Occupational health; Research; Risk
8.  A systematic review of musculoskeletal disorders among school teachers 
Musculoskeletal disorders (MSD) represent one of the most common and most expensive occupational health problems in both developed and developing countries. School teachers represent an occupational group among which there appears to be a high prevalence of MSD. Given that causes of MSD have been described as multi-factorial and prevalence rates vary between body sites and location of study, the objective of this systematic review was to investigate the prevalence and risk factors for MSD among teaching staff.
The study involved an extensive search of MEDLINE and EMBASE databases in 2011. All studies which reported on the prevalence and/or risk factors for MSD in the teaching profession were initially selected for inclusion. Reference lists of articles identified in the original search were then examined for additional publications. Of the 80 articles initially located, a final group of 33 met the inclusion criteria and were examined in detail.
This review suggests that the prevalence of self-reported MSD among school teachers ranges between 39% and 95%. The most prevalent body sites appear to be the back, neck and upper limbs. Nursery school teachers appear to be more likely to report suffering from low back pain. Factors such as gender, age, length of employment and awkward posture have been associated with higher MSD prevalence rates.
Overall, this study suggests that school teachers are at a high risk of MSD. Further research, preferably longitudinal, is required to more thoroughly investigate the issue of MSD among teachers, with a greater emphasis on the possible wider use of ergonomic principles. This would represent a major step forward in the prevention of MSD among teachers, especially if easy to implement control measures could be recommended.
PMCID: PMC3250950  PMID: 22087739
9.  Examining the dimensions and correlates of workplace stress among Australian veterinarians 
Although stress is known to be a common occupational health issue in the veterinary profession, few studies have investigated its broad domains or the internal validity of the survey instrument used for assessment.
We analysed data from over 500 veterinarians in Queensland, Australia, who were surveyed during 2006-07.
The most common causes of stress were reported to be long hours worked per day, not having enough holidays per year, not having enough rest breaks per day, the attitude of customers, lack of recognition from the public and not having enough time per patient. Age, gender and practice type were statistically associated with various aspects of work-related stress. Strong correlations were found between having too many patients per day and not having enough time per patient; between not having enough holidays and long working hours; and also between not enough rest breaks per day and long working hours. Factor analysis revealed four dimensions of stress comprising a mixture of career, professional and practice-related items. The internal validity of our stress questionnaire was shown to be high during statistical analysis.
Overall, this study suggests that workplace stress is fairly common among Australian veterinarians and represents an issue that occupies several distinct areas within their professional life.
PMCID: PMC2797516  PMID: 19995450
10.  Exposure rate of needlestick and sharps injuries among Australian veterinarians 
Needlestick and sharps injuries (NSI) represent an important occupational health issue in veterinary practice. Little is known about the distribution and correlates of NSI among Australian veterinarians.
A questionnaire-based NSI survey was mailed to 1094 veterinarians registered with the Veterinary Surgeons Board of Queensland during 2006.
A total of 664 surveys were returned from 1038 eligible participants (response rate 64.0%) with 56.8% being male, around one-third in the >50 years age group and about half aged 31-50 years. Just over two-fifths were working in small animal practice only. Around three quarters (75.3%) reported suffering at least one NSI in the previous 12 months, while 58.9% reported suffering from at least one contaminated NSI during the previous 12 months, which crudely extrapolates to an exposure rate of 75.3 and 58.9 NSI per 100 person-years respectively. Risk factors for contaminated NSI were female gender, working in small or mixed animal practice, being less experienced, seeing more patients per week and working longer hours per week. The most common causative devices were syringes (63.7%), suture needles (50.6%) and scalpel blades (34.8%).
The exposure rate of NSI is high for Queensland veterinarians and clearly remains a major occupational health problem. Current guidelines and strategies to reduce NSI in veterinary practice should be promoted, but appear to be adapted from human health care. Studies to understand why veterinarians have such high NSI rates are required to not only identify risk factors for NSI, but also to determine attitudes and beliefs about NSI. From these studies specific strategies for veterinarians can be designed and trialed to develop evidence-based guidelines and policies that are effective in decreasing the exposure rate of NSI in veterinary practice.
PMCID: PMC2744915  PMID: 19712488
11.  The historical decline of tobacco smoking among Australian physicians: 1964–1997 
Tobacco Induced Diseases  2008;4(1):13.
Physicians occupy an important position as tobacco control exemplars and their own smoking habits are known to influence how effective they may be in such a role.
A comprehensive review of all published manuscripts describing tobacco usage rates and tobacco control activities in the Australian medical profession between 1964 and 1997.
Some of the earliest surveys revealed that around one-quarter of Australian physicians were smoking in the mid twentieth century, a rate which rapidly declined in the 1970s and 1980s, with reductions beyond that achieved by the general population.
Overall, our review suggests that not only do contemporary Australian physicians smoke at very low rates when compared internationally, but that an active professional community can also make a real difference to the lifestyle choices of its own members.
PMCID: PMC2646683  PMID: 19114012
12.  Too many Japanese university students are still smoking tobacco 
Tobacco Induced Diseases  2008;4(1):10.
Although campus-wide smoking bans are slowly spreading throughout Japan, the uptake of these measures has been suboptimal and many Japanese university students continue to smoke. Educational facilities are in an ideal position to set positive examples for tobacco control, and the time is now right for more Japanese universities to actively encourage their students as health promotion advocates and role models for healthy behavior.
PMCID: PMC2596093  PMID: 19017385
13.  The historical decline of tobacco smoking among United States physicians: 1949–1984 
Tobacco use became an ingrained habit in the United States (US) following the First World War and a large proportion of physicians, similar to the general population, were smokers. The period from 1949 to 1984 was a pivotal era of change however, as the medical profession, like the society it served, became increasingly aware of the dangers that tobacco incurred for health.
An extensive review targeted all manuscripts published in academic journals between 1949 and 1984 that related to tobacco smoking among US physicians. The study was undertaken in 2007–08 with an internet search of relevant medical databases, after which time the reference lists of manuscripts were also examined to find additional articles.
A total of 57 manuscripts met the inclusion criteria. From a research perspective, the methodology and coverage of smoking surveys ranged from detailed national investigations, to local medical association surveys, and journal readership questionnaires. From a historical perspective, it can be seen that by the 1950s many US physicians had begun questioning the safety of tobacco products, and by the 1960s and 1970s, this had resulted in a continuous decline in tobacco use. By the 1980s, few US physicians were still smoking, and many of their younger demographic had probably never smoked at all.
Although the quality and coverage of historical surveys varied over time, a review of their main results indicates a clear and consistent decline in tobacco use among US physicians between 1949 and 1984. Much can be learned from this pivotal era of public health, where the importance of scientific knowledge, professional leadership and social responsibility helped set positive examples in the fight against tobacco.
PMCID: PMC2556033  PMID: 18822167
14.  An international review of tobacco smoking in the medical profession: 1974–2004 
BMC Public Health  2007;7:115.
Tobacco smoking by physicians represents a contentious issue in public health, and regardless of what country it originates from, the need for accurate, historical data is paramount. As such, this article provides an international comparison of all modern literature describing the tobacco smoking habits of contemporary physicians.
A keyword search of appropriate MeSH terms was initially undertaken to identify relevant material, after which the reference lists of manuscripts were also examined to locate further publications.
A total of 81 English-language studies published in the past 30 years met the inclusion criteria. Two distinct trends were evident. Firstly, most developed countries have shown a steady decline in physicians' smoking rates during recent years. On the other hand, physicians in some developed countries and newly-developing regions still appear to be smoking at high rates. The lowest smoking prevalence rates were consistently documented in the United States, Australia and the United Kingdom. Comparison with other health professionals suggests that fewer physicians smoke when compared to nurses, and sometimes less often than dentists.
Overall, this review suggests that while physicians' smoking habits appear to vary from region to region, they are not uniformly low when viewed from an international perspective. It is important that smoking in the medical profession declines in future years, so that physicians can remain at the forefront of anti-smoking programs and lead the way as public health exemplars in the 21st century.
PMCID: PMC1906758  PMID: 17578582
15.  Glutaraldehyde exposure and its occupational impact in the health care environment 
Despite the search for effective and less toxic substitutes, glutaraldehyde (GA) remains one of the few substances capable of high-level instrument disinfection in modern health care. Workers commonly affected include operating room nurses, radiographers, x-ray technicians and cleaners. Widespread hospital usage combined with its well-known irritant properties, has ensured an increase in occupationally-related illnesses during recent years. Operating room nurses, laboratory workers and x-ray technicians frequently contact GA in both the liquid and vapor form. Workplace exposure is usually dependent on job tasks, ventilation levels and the use of protective equipment. GA is a relatively potent irritant and sensitizer, with a well-documented history of symptoms following occupational exposure. Although mechanisms for GA toxicity have been postulated, research on the toxicological, teratogenic, and carcinogenic potential of this chemical has shown inconsistent results. Reducing workplace exposure to its lowest possible level represents the most important hazard reduction strategy. This may be achieved by keeping GA containers tightly sealed when not in use, maintaining adequate ventilation levels and the rigid adherence to appropriate personal protective equipment. Substitution with automated cold sterilization machines may be another appropriate measure, while banning unnecessary practices such as GA fogging and its use as a surface disinfectant may also be helpful in reducing occupational exposure in the health care environment.
PMCID: PMC2723614  PMID: 21432369
glutaraldehyde; occupational exposure; health care environment; toxicology; disinfection
16.  HIV/AIDS prevention in China: A challenge for the new millennium 
China’s first HIV infection was officially reported in 1985 and by the end of 1996, there may have been up to 200,000 people affected nationwide. In 2001, this figure probably exceeded 600,000. By 2003, the predicted number of HIV cases had reached 1.5 million. At least 80,000 individuals now have fullblown AIDS. China may soon have the largest HIV-infected population in the world, possibly 6 million cases by 2005. With infection rates rising at about 30% per year, it is feared this figure might exceed 10 million by 2010. Although the Chinese government was initially slow to accept the problem, in the late 1990s definite changes began occurring. In 2003 Premier Wen Jiabao publicly shook the hand of an AIDS patient and his government promised to introduce a range of free HIV-related services. Large preventive education campaigns are now underway. Unfortunately, there will still be many obstacles in controlling the epidemic and preventing further spread of this disease. Without doubt, China faces a serious predicament in the new millennium, and one which will pose numerous challenges for preventive medicine.
PMCID: PMC2723251  PMID: 21432150
HIV; AIDS; China; prevention; public health
17.  Work environment and hand dermatitis among nurses in a Chinese teaching hospital 
The aim of this study was to investigate the effects of the working environment on hand dermatitis (HD) prevalence among nurses in a Chinese teaching hospital.
We utilised a previously validated, self-reporting survey which was translated into Chinese.
The prevalence of HD among nurses was 18.3%, although this rate varied between departments, ranging from 9.4% in gynaecology to 26.7% in intensive care (P for Trend=0.3167). Logistic regression indicated that wet work was the most important HD risk factor, with a 9-fold increase (OR 9.0, 95% CI 1.2–74.9, P=0.0342). Allergic disease was also related to HD, with a 4.6-fold increase noted (OR 4.6, 95% CI 1.4–15.0, P=0.0096).
Overall, the prevalence of HD among Chinese hospital nurses appears to be less than that of their foreign counterparts. Nevertheless, the burden of this disease does seem to vary with respect to depertment of employment within the hospital.
PMCID: PMC2723576  PMID: 21432330
work environment; hand dermatitis; China; nurse; wet work
18.  Sociodemographic Factors and Prejudice toward HIV and Hepatitis B/C Status in a Working-Age Population: Results from a National, Cross-Sectional Study in Japan 
PLoS ONE  2014;9(5):e96645.
In many countries, HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) infected individuals may face discrimination and mistreatment from coworkers. Effective interventions to reduce workplace discrimination are therefore needed to protect these vulnerable populations. The current study investigated potential associations between sociodemographic factors and prejudice toward HIV and HBV/HCV infected colleagues within a Japanese working population.
An online anonymous, nationwide internet survey was administered to a cross-section of approximately 3,000 individuals in Japan. The survey comprised 14 questions focusing on demographics (five items), basic HIV or HBV/HCV knowledge (eight items), and potential prejudice toward HIV or HBV/HCV infected colleagues (one item). The sociodemographic characteristics evaluated were sex, age, educational level, employment status, and individual income; with multiple logistic regression used for the analysis.
In total, 3,055 individuals were recruited for the HIV related survey and 3,129 for the HBV/HCV related survey. Older age was significantly and positively associated with prejudice toward HIV infected colleagues (p<0.01) and negatively associated with prejudice toward HBV/HCV infected colleagues (p<0.01). Statistically significant associations were not observed between other sociodemographic characteristics and potential prejudice toward HIV and HBV/HCV infected coworkers.
Overall, this study suggests that age may be associated with prejudice toward HIV and HBV/HCV infected colleagues among the working age population of Japan. As such, policy makers should consider the age of participants when formulating efforts to reduce prejudice toward HIV and HBV/HCV infected workers.
PMCID: PMC4008599  PMID: 24792095

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