Objectives: The author conducted an ecological study to examine prefectural differences in ENMR and the related factors in Japan, using two new indicators; birth weight (BW) adjusted ENMR and expected ENMR by BW distribution. Method: Correlate analysis of data from national vital statistics and some indicators of medical care services among 47 prefectures edited by the Ministry of Health and Welfare, Japan were conducted. BW-adjusted ENMR and expected ENMR by BW, as well as other indicators, were prepared for statistical analysis. Result: Crude and BW-adjusted ENMRs were significantly correlated with ENMRs for low birth weight (LBW) and very low birth weight (VLBW) early neonates (p<0.01). The number of Obstetrics and Gynecology (OB/GYN) physicians was negatively correlated with BW adjusted ENMR. Conclusion: Crude and BW-adjusted ENMRs were affected mainly by LBW and VLBW early neonate specific ENMR, but not by the rate of LBW. The variation of ENMR among prefectures in Japan is attributable to the number of OB/GYN physicians. The present findings suggest that emphasis should be laid upon enhancement of regional perinatal care systems.
Japan ; Low Birth Weight ; OB GYN ; Related ; Upper case double-you

We report a 30-year-old man with an extensive cerebral contusion. He presented with severe left upper and lower limb paralysis and mild right lower limb palsy. He was diagnosed with severe sleep apnea syndrome and was treated with nighttime nCPAP (nasal Continuous Positive Airway Pressure). Four years after the injury, he was able to walk with Lofstrand crutches. However, he gradually began to have difficulty standing, walking and driving his wheelchair because his spasticity developed markedly. He received ITB (intrathecal baclofen) therapy and noted a reduction in spasticity. He was once again able to drive his wheelchair and to walk with support. In addition, his respiratory function didn't show any deterioration. Spasticity is a common complication after cerebral or spinal cord injury, for which treatment has been difficult. ITB therapy can dramatically reduce spasticity, but has been demonstrated that it may also depress respiratory function in patients with respiratory insufficiency. This case suggests that ITB therapy may reduce spasticity without affecting respiratory function even in patients with a respiratory disorder.

In this study, we aim to compare the criteria for sensitizers among national organizations in various countries and international organizations, and to specify whether each Pollutant Release and Transfer Register (PRTR)-designated chemical substance is a sensitizer by each organization. The definition of sensitizing chemicals and the designation of respective sensitizers according to the PRTR law, Japan Society for Occupational Health (JSOH), American Conference of Governmental Industrial Hygienists (ACGIH), European Union (EU), and Deutsche Forschungsgemeinshaft (DFG) were studied. Of the 435 PRTR-designated chemical substances, 15 are listed as sensitizers according to the PRTR law, 16 as sensitizers of the airway and 21 as sensitizers of the skin by JSOH, 12 as sensitizers (no discrimination) by ACGIH, 19 (airway) and 85 (skin) by EU, and 15 (airway) and 43 (skin) by DFG. Only 9 substances were designated as sensitizers by all these organizations. The variation in the designation of sensitizers is accounted for by the differences in the classification criteria and grouping of chemical substances. JSOH limits the definition of sensitizers to substances that induce allergic reactions in humans and uses only human data. Other organizations utilize not only human evidence but also appropriate animal tests. In addition, EU designates an isocyanate as a sensitizer except those for which there is evidence showing that they do not cause respiratory sensitivity. The worldwide enforcement of the globally harmonized system (GHS) of classification and labeling of chemicals could promote not only the consistent designation of sensitizers among national and international organizations, but also the development of testing guidelines and classification criteria for mixtures.