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OBJECTIVES: To develop and validate a global occupational health and safety management system (OHSMS) model for Japanese companies. METHODS: In cooperation with a Japanese company, we established a research team and gathered information on occupational health and safety (OHS) practices in nine countries where the target company operated manufacturing sites. We then developed a model hypothesis via research team meeting. The model hypothesis was introduced to local factories in Indonesia and Thailand as trial sites. We evaluated the roles of the company headquarters, the implementation process, and any improvements in OHS practices at the sites. Based on the results, a global OHSMS model was formalized for global introduction. RESULTS: The model consisted of both headquarters and site roles. These roles were well-functioning, and OHS at the sites improved. Two issues concerning the functioning of the headquarters were identified: the need to establish a reporting system to the headquarters and the need to support the improvement of specialized human resources. By improving the model hypothesis to address these issues, the model was formalized for global introduction. CONCLUSIONS: The global OHSMS model was based on the use of methods and specialized human resources relevant to each region and their common objectives, as well as evaluation indicators based on the minimum requirements of the company headquarters. To verify the effectiveness of this model, the experiment should be extended to other countries.

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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.

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We collected information necessary for conducting occupational health activities in Thailand with regard to occupational safety and health management systems (OSHMS). Based on an information collection check sheet developed in our previous research, we conducted a literature research and visited four local business bases, one ISO certification body and two higher educational institutions. The legal framework concerning occupational health in Thailand consists of the Occupational Safety, Health and Environment Act of 2011 and 13 ordinances from the Ministry of Labor under that act. The original OSHMS standards for Thailand have been published, and the number of companies, especially large ones, introducing systems conforming to these standards has increased in recent years. For occupational health specialists, there are training programs for specialized occupational health physicians, professional safety officers and occupational nurses. Professional safety officers also play a central role in occupational health in the workplace. In Thailand, it is necessary to ensure compliance with related acts and regulations, and to conduct voluntary activities that satisfy workplace conditions as based on the OSHMS standards. Additionally, to improve occupational health performance, it is essential to use high-quality external services and/or occupational health professionals. Headquarters of Japanese companies have considered taking countermeasures such as recommending active use of professional safety officers, as well as issuing global standards.

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OBJECTIVES: To consider the appropriate occupational health system for Japanese enterprises in Indonesia with information on the regulations and development of the specialists. METHODS: In this study, we used the information-gathering checklist developed by Kajiki et al. Along with literature and internet surveys, we surveyed local corporations owned and operated by Indonesians, central government agencies in charge of medical and health issues, a Japanese independent administrative agency supporting subsidiaries of overseas Japanese enterprises, and an educational institution formulating specialized occupational physician training curricula. RESULTS: In Indonesia, the Ministry of Manpower and the Ministry of Health administer occupational health matters. The act No. 1 on safety serves as the fundamental regulation. We confirmed at least 40 respective regulations in pertinent areas, such as the placement of medical and health professionals, health examinations, occupational disease, and occupational health service agencies. There are some regulations that indicate only an outline of activities but not details. Occupational physicians and safety officers are the two professional roles responsible for occupational health activities. A new medical insurance system was started in 2014, and a workers' compensation system was also established in 2017 in Indonesia according to the National Social Security System Act. DISCUSSION: Although safety and health laws and regulations exist in Indonesia, their details are unclear and the quality of expert human resources needed varies. To conduct high-quality occupational health activities from the standpoint of Japanese companies' headquarters, the active promotion of employing highly specialized professionals and cooperation with educational institutions is recommended.

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OBJECTIVE: Expatriate workers and their families may encounter difficulties and uncertainties when visiting local hospitals. These problems include differences in the medical system, higher healthcare costs, and language problems. Occupational health staff in companies need to know about the healthcare system, including emergency transportation arrangements, to reduce anxiety in workers and families attending hospitals. This study was designed to create a checklist to allow occupational health staff to collect information from overseas hospitals efficiently and effectively. METHODS: We used documentary searches and the knowledge and experience of researchers to identify the support requirements of expatriate workers and drafted a checklist for information collection from overseas hospitals. The validity of the checklist was assessed in two stages. First, we interviewed health specialists caring for expatriate workers and their families and then tested the draft in international hospitals. We revised the draft based on our findings and again tested the new version in different overseas hospitals, enabling us to create a final version of the checklist. RESULTS: Our checklist contains 12 major categories: reception, administration, inpatient wards, available tests, outpatient clinics, emergency services, pediatrics, gynecology, dentistry, general health check-ups, vaccination services, and precautions against infection. These categories cover a total of 51 subcategories, each of which is further divided into a total of 131 smaller categories. DISCUSSIONS: Occupational health staff can use this checklist to gather information in order to provide comprehensive and effective support for expatriate workers attending hospitals. We recommend that the staff gather all possible information from hospital websites before visiting and use the visiting time to gather information available only on site. In order to gather as much information as accurately as possible, the staff are recommended to visit the facilities related to the checklist categories, that is, Japanese language reception, outpatient services, inpatient wards, emergency services, pediatrics, gynecology, general health check-up centers, and cardiac catheterization labs, and obtain information directly from doctors, nurses, and specialists working at the hospitals.

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OBJECTIVES: This study aimed to develop an information gathering check sheet to efficiently collect information necessary for Japanese companies to build global occupational safety and health management systems in overseas business places. METHODS: The study group consisted of 2 researchers with occupational physician careers in a foreign-affiliated company in Japan and 3 supervising occupational physicians who were engaged in occupational safety and health activities in overseas business places. After investigating information and sources of information necessary for implementing occupational safety and health activities and building relevant systems, we conducted information acquisition using an information gathering check sheet in the field, by visiting 10 regions in 5 countries (first phase). The accuracy of the information acquired and the appropriateness of the information sources were then verified in study group meetings to improve the information gathering check sheet. Next, the improved information gathering check sheet was used in another setting (3 regions in 1 country) to confirm its efficacy (second phase), and the information gathering check sheet was thereby completed. RESULTS: The information gathering check sheet was composed of 9 major items (basic information on the local business place, safety and health overview, safety and health systems, safety and health staff, planning/implementation/evaluation/improvement, safety and health activities, laws and administrative organs, local medical care systems and public health, and medical support for resident personnel) and 61 medium items. We relied on the following eight information sources: the internet, company (local business place and head office in Japan), embassy/consulate, ISO certification body, university or other educational institutions, and medical institutions (aimed at Japanese people or at local workers). CONCLUSIONS: Through multiple study group meetings and a two-phased field survey (13 regions in 6 countries), an information gathering check sheet was completed. We confirmed the possibility that this check sheet would enable the user to obtain necessary information when expanding safety and health activities in a country or region that is new to the user. It is necessary in the future to evaluate safety and health systems and activities using this information gathering check sheet in a local business place in any country in which a Japanese business will be established, and to verify the efficacy of the check sheet by conducting model programs to test specific approaches.

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BACKGROUND: Although drug-eluting stents (DES) are widely used today, bare metal stents (BMS) are still frequently employed. We investigated the utilization and clinical outcomes of BMS implantation since we first began using DES. METHODS: The clinical course following percutaneous intervention with de novo implantation of BMS was studied beginning in July 2004, when sirolimus-eluting stents (SES) were first used in our hospital, to August 2006. Outcomes following BMS and SES implantation were compared. RESULTS: BMS implantation was carried out in 160 lesions and SES implantation in 242 lesions. Follow-up coronary angiography was performed for 208 lesions (78 lesions in which BMS were implanted and 130 lesions in which SES were implanted) within 1 year. There were no significant differences in patient characteristics between the SES and BMS groups. Regardless of the reason for BMS implantation, the rates of in-stent restenosis and target lesion revascularization were higher in the BMS group than in the SES group. However, the rate of in-stent restenosis and target lesion revascularization of BMS in lesions with a diameter of 4.0mm or greater was 0%. CONCLUSIONS: In order to reduce the risk of in-stent restenosis and target lesion revascularization, we recommend implantation of BMS with a diameter of 4.0 mm or greater or SES unless it is contraindicated.

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OBJECTIVES: The long-term outcome of patients with diabetes who underwent stent placement has not been assessed comprehensively. METHODS: Analysis of angioplasty procedures performed between January 1994 and December 1998 identified 140 diabetics (156 lesions) and 169 non-diabetics (187 lesions) who underwent successful stent placement. Follow-up was completed in 286 patients (93%) with a mean follow-up period of 2.8 +/- 1.3 years. Cardiac death, nonfatal myocardial infarction, coronary artery bypass grafting and repeat percutaneous transluminal coronary angioplasty were considered as adverse cardiac events. The primary clinical endpoint was event-free survival at 1 and 3 years. The primary angiographic endpoint was restenosis rate at follow-up angiography (follow-up rate 75% of 257 lesions). RESULTS: The diabetics were older (66 +/- 8 vs 62 +/- 11 years, p < 0.0005) with more risk factors such as hypertension (69% vs 57%, p < 0.05) and multivessel disease (69% vs 51%, p < 0.005). Final balloon size was smaller in diabetics than in non-diabetics (3.26 +/- 0.61 vs 3.39 +/- 0.53 mm, p < 0.05). Restenosis rate was significantly higher in diabetics than in non-diabetics (36% vs 24%, p < 0.05), but the target lesion revascularization in diabetics was not statistically different compared with non-diabetics (22% vs 16%). Long-term event-free survival was not significantly different between diabetics and non-diabetics (69.9% vs 74.8% at 1 year, 57.3% vs 66.0% at 3 years). CONCLUSIONS: Diabetics have an increased risk for angiographical restenosis after successful stent placement compared to non-diabetics. However, diabetics who underwent stent placement had a favorable clinical long-term outcome similar to non-diabetics.

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BACKGROUND: The Tranilast Restenosis Following Angioplasty Trial showed that oral administration of 600 mg/day of tranilast for 3 months markedly reduced the restenosis rate after percutaneous transluminal coronary angioplasty (PTCA) for de novo lesions. METHODS: We conducted the second multicenter, randomized, double-blinded placebo-controlled trial. A total of 297 patients with 329 lesions were randomly assigned to treatment with tranilast or a placebo for 3 months after successful PTCA for both de novo and restenotic lesions. Angiographic follow-up examination was done at 3 months, and angiograms were interpreted with a quantitative approach. RESULTS: Two hundred thirty-nine lesions (72.6%) in 216 of the patients (72.7%) met the criteria and were included in the assessment of restenosis. Lesion restenosis was defined as a loss of 50% or more of the initial gain, and the restenosis rates were 18.8% in the tranilast group (n = 112) and 44.1% in the placebo group (n = 127; P =.00005). The restenosis rate, defined as a percent stenosis of > or = 50% at follow-up examination, was also significantly lower in the tranilast group (25.9% versus 41.9%; P =.012). The numbers of restenotic lesions were 38 (33.9% of 112) in the tranilast group and 30 (23.6% of 127) in the placebo group. In restenotic lesions, the lesion restenosis rate was significantly lower in the tranilast subgroup (18.4% versus 53.3% with the first restenosis criterion; P =.004). CONCLUSION: The oral administration of tranilast for 3 months markedly reduced the restenosis rate after PTCA, even in restenotic lesions.

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