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Background In adults, high-dose remifentanil during surgery has been reported to increase postoperative opioid consumption, but this has not been well documented in children. Multimodal analgesia is recommended in the perioperative period for adolescent idiopathic scoliosis (AIS), but no report has examined opioid consumption under epidural analgesia, which is one of the most common types of analgesia. Aims To investigate the association between intraoperative remifentanil dosage and postoperative opioid consumption in AIS in the setting of combined epidural analgesia for postoperative multimodal analgesia. Methods In this retrospective cohort study, patients aged 10-18 years who underwent surgery for scoliosis and epidural analgesia for postoperative pain between July 2012 and April 2019 were included. The primary endpoint was the association between intraoperative cumulative weight-adjusted remifentanil dosage and logarithmic transformation of cumulative weight-adjusted fentanyl consumption in the intensive care unit (ICU). Nonopioid analgesics were investigated as secondary endpoints. An epidural catheter was inserted by the surgeon intraoperatively, and a local anesthetic was administered at the end of the surgery. Multivariate linear regression analysis with adjustment for confounders was performed for all analyses. Results In total, 142 patients were included, and the median intraoperative remifentanil dosage for all patients was 0.27 (interquartile range, 0.24-0.34) µg/kg/min. No association was observed between cumulative weight-adjusted intraoperative dosage of remifentanil and fentanyl, even after adjusting for potential confounders (slope = -1.25; 95% confidence interval [CI], -4.35 to 1.85; P = 0.43). No association was observed between nonopioid analgesic use and intraoperative remifentanil dosage. Conclusion No association was noted between remifentanil dosage during surgery for AIS and postoperative opioid consumption with epidural analgesia. However, this study has limitations due to its retrospective design; thus, further prospective studies are warranted.

Objectives: Although musculoskeletal pain is considered to be a major contributor to chronic pain in Japan, there are few epidemiological studies on chronic musculoskeletal pain in workers. Presenteeism, defined as attendance at work in spite of the need to rest due to poor health, related to chronic pain causes a decrease in labor productivity, and its economic loss is said to be four times greater than that of Absenteeism. In this study, we examined the relationship between the actual state of musculoskeletal pain in workers and chronic musculoskeletal pain and labor productivity, with the goal of obtaining useful information to improve labor productivity. Methods: A questionnaire was distributed to 3,406 workers, of whom 2,055 were analyzed to determine the prevalence of chronic musculoskeletal pain and the affected body parts, and the influence of work-related factors and the degree of labor productivity loss due to chronic musculoskeletal pain. Results: 34.0% of subjects had chronic musculoskeletal pain. The most commonly reported pain site was “neck and shoulder”. Chronic musculoskeletal pain was significantly more common in people working overtime and in physical workers. Labor productivity was significantly lower in the group with chronic musculoskeletal pain than in the group without musculoskeletal pain, and it was significantly lower in the “neck and shoulder” and “lower back” groups than in the group without chronic musculoskeletal pain. Conclusions: Thirty-four percent of workers were engaged in work while experiencing chronic musculoskeletal pain. These workers had significantly decreased labor productivity. Efforts to improve conditions for workers with chronic musculoskeletal pain in each work type and working condition may improve labor productivity.

This study aimed to identify risk factors for chronic musculoskeletal pain (CMSP) and sought to examine the effect of fear-avoidance beliefs (FABs) on work productivity in workers with CMSP. We performed a longitudinal study using self-administered questionnaires given to employees in three different industries between April 2016 and March 2017. The questionnaire concerned background characteristics, work-related factors and musculoskeletal pain, the Work Functioning Impairment Scale (WFun), and the Japanese version of the Tampa Scale for Kinesiophobia (TSK-J). We performed logistic regression analysis to evaluate factors affecting CMSP and a multi-way analysis of variance to analyze the relationship between FABs and CMSP and the effect of FABs on the ability to function at work. Age (odds ratio [OR] = 1.02, 95% confidence interval [CI]: 1.00-1.03), mean working hours (OR = 1.18, 95% CI: 1.04-1.33), and changes in working hours (OR = 1.18, 95% CI: 1.02-1.37) were significantly associated with CMSP. Regarding FABs, we found that the stronger the FAB, the greater the WFun score, and that an increase in FABs resulted in a significant increase in WFun scores. This study demonstrated that long or increased working hours may be risk factors for CMSP, and that stronger FABs in those with CMSP are associated with decreased ability to function at work. In addition, measures to reduce FABs in workers with CMSP may be effective.

Ten to twenty percent of the population of Japan has chronic pain. Although studies have confirmed a relationship between sleeping hours and chronic pain, it remains unclear whether there is an association between working hours and chronic pain, especially chronic musculoskeletal pain (CMP), in workers. A self-administered questionnaire that sought information regarding background characteristics and work-related factors was sent to 118 enterprises; finally, 1,747 participants were included in the analysis and were classified into CMP (n = 448) and non-CMP (n = 1299) groups. Logistic regression analysis revealed that age (odds ratio [OR] = 1.02, 95% confidence interval [CI]: 1.01-1.03), sex (reference: female, OR = 0.68, 95% CI: 0.52-0.88), working hours (OR = 1.11, 95% CI: 1.03-1.20), and sleeping hours (OR = 0.84, 95% CI: 0.75-0.95) were significantly associated with CMP. Participants were categorized into four groups according to working hours (long: ≥ 9 hours/day [long-work], short: < 9 hours/day [short-work]) and sleeping hours (long: ≥ 7 hours/day [long-sleep], short: < 7 hours/day [short-sleep]). Furthermore, logistic regression analysis showed that the CMP OR was 2.02 (95% CI: 1.46-2.78) times higher in 'long-work plus short-sleep workers' and 1.47 (95% CI: 0.94-2.30) times higher in 'long-work plus long-sleep workers' than in 'short-work plus long-sleep workers'. Thus, working hours are associated with CMP frequency, but sleeping sufficiently may prevent CMP in workers even if they work for long hours. In conclusion, adequate instructions on sleeping hours should be provided by occupational health staff, as this may be effective in preventing CMP.

It has been suggested that the agonist-induced internalization of G-protein-coupled receptors from the cell surface into intracellular compartments regulate cellular responsiveness. We previously reported that Gq/11-protein-coupled human histamine H1 receptors internalized via clathrin-dependent mechanisms upon stimulation with histamine. However, the molecular determinants of H1 receptors responsible for agonist-induced internalization remain unclear. In the present study, we evaluated the roles of the intracellular C-terminal of human histamine H1 receptors tagged with hemagglutinin (HA) at the N-terminal in histamine-induced internalization in Chinese hamster ovary cells. The histamine-induced internalization was evaluated by the receptor binding assay with [3H]mepyramine and confocal immunofluorescence microscopy with an anti-HA antibody. We found that histamine-induced internalization was inhibited under hypertonic conditions or by pitstop, a clathrin terminal domain inhibitor, but not by filipin or nystatin, disruptors of the caveolar structure and function. The histamine-induced internalization was also inhibited by truncation of a single amino acid, Ser487, located at the end of the intracellular C-terminal of H1 receptors, but not by its mutation to alanine. In contrast, the receptor-G-protein coupling, which was evaluated by histamine-induced accumulation of [3H]inositol phosphates, was potentiated by truncation of Ser487, but was lost by its mutation to alanine. These results suggest that the intracellular C-terminal of human H1 receptors, which only comprises 17 amino acids (Cys471-Ser487), plays crucial roles in both clathrin-dependent internalization of H1 receptors and G-protein signaling, in which truncation of Ser487 and its mutation to alanine are revealed to result in biased signaling towards activation of G-proteins and clathrin-mediated internalization, respectively. This article is protected by copyright. All rights reserved.

OBJECTIVES We investigated the working behavior of part-time occupational physicians using practical recording sheets to clarify issues of occupational physicians' activities according to industrial groups or size of business. METHODS We collected 561 recording sheets in 96 industries from 11 part-time occupational physicians as collaborators, who volunteered to be a part of this research. We collected a variety of information from the practical recording sheets, including the industry in which each occupational physician was employed, the annual number of times of work attendance, occupational physician-conducted workplace patrol, and employee health management. We investigated their annual practices regarding work environment management, work management, health management, and general occupational health management. In addition, we analyzed the differences between the secondary and tertiary industry groups and between the group of offices employing 100 people or fewer (≤100 group) and 101 people and above (≥101 group) in each industry group. RESULTS The median work attendance by all occupational physicians was four times a year; the tertiary industry group had a significantly lower rate of work attendance than the secondary industry group. The occupational physicians' participation in risk assessment, mental health measures or overwork prevention, and the formulation of the occupational health management system and the annual plan were significantly lower in the tertiary industry group than in the secondary industry group. We observed that for the annual number of times of work attendance, occupational physician-conducted workplace patrol was significantly lower in the ≤100 group than in the ≥101 group in each industry group. CONCLUSIONS These findings show that occupational physicians' activities have not been conducted enough in tertiary industries and small-sized offices employing ≤100 people. It would be necessary to evaluate how to provide occupational health service or appropriate occupational physicians' activities for small-sized offices or tertiary industries. Thereafter, it would likely be beneficial to construct a system to support the activities of part-time occupational physicians as well as the activity of occupational health at workplaces.

Introduction Previous studies have reported on the relationship between workers’ presenteeism, specifically where a loss of work productivity results from an employee’s health problems, and musculoskeletal pain (MSP). Other studies have reported that chronicity and an increase in lower back pain were brought on by individual fear–avoidance beliefs. We considered that workers’ fear-avoidance beliefs linked with MSP cause chronic MSP and exacerbate their presenteeism. The aim of this study was to clarify the effects of presenteeism arising from fear–avoidance beliefs among workers with MSP. Methods We conducted a prospective study issuing self-administered questionnaires to 3406 workers in 118 companies, from June 2016 to February 2017. We distributed questionnaires on two occasions and obtained responses from 1673 individuals (response rate: 49.1%). In total, 1490 individuals were eligible for this survey (effective response rate: 89.1%). We excluded individuals whose pain status responses were not clear. We sought information from participants about various individual and work-related characteristics and the prevalence of MSP using an original questionnaire. The Work Functioning Impairment Scale (Wfun) was used to measure presenteeism, and the Tampa Scale for Kinesiophobia (TSK) was used to measure fear–avoidance beliefs. We statistically analysed the change in the Wfun and the TSK scores among groups with: no prevalence of MSP; transitional MSP (in two groups, with participants either developing or recovering from MSP), and; chronic MSP. Results The Wfun score in the chronic MSP group was significantly higher than that of the other groups for both survey measures. The TSK score of the chronic MSP group was also significantly higher than for the transitional MSP groups. We observed a significant positive correlation between the change of Wfun score and TSK score. Conclusion Our study suggests that fear-avoidance beliefs of workers with MSP leads to MSP chronicity, and exacerbates worker presenteeism.

Purpose To measure the risk of pulmonary disease due to toner dust exposure, in a 10 year prospective cohort study among toner handling workers. Methods Subjects that were included in the analysis of this study were 260 male employees of a Japanese photocopier, printer and toner production company. Onset of pneumoconiosis, pulmonary fibrosis, granulomatous pneumonia and lung cancer were assumed as endpoints of the investigation, and blood markers (KL-6,SP-D), respiratory function index and the chest CT shadow reading were used as substitute end-points for before the onset of these diseases. Disease onset was determined via a self-administered questionnaire, blood tests and respiratory function tests were conducted once a year, while Chest CT examinations were conducted in the 1 st, 5th and 10th year of the study. Subjects were classified by duration of toner handling work into four groups - long-exposure (>20 years): n=65 (mean 40 years, smoking rate 35%); medium-exposure (10–20 years): n=71 (mean age 31.9 years, smoking rate 47.9%), and short-exposure ( Results None of the endpoint diseases developed in any of the four groups. Annual percent change for blood marker and respiratory function levels, and chest CT parameters were compared across the four groups but no statistical significance was seen. Conclusion The risk of developing respiratory disease with the levels of toner dust exposure found in this study was extremely low.

It has been suggested that the agonist-induced internalization of G-protein-coupled receptors from the cell surface into intracellular compartments regulates cellular responsiveness. We previously reported that G