Walking, which can be safely performed and easily incorporated into daily life, can be recommended as an adjunct therapy to diet treatment in obese NIDDM patients, not only for BW reduction, but also for improvement of insulin sensitivity.

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Electrocardiographic, biochemical, and physical data obtained from 237 shift and 115 day workers without any obvious disorders were assessed to clarify the impact of shift work on cardiovascular functions. The heart-rate corrected QT interval (QTc) was significantly longer in the shift workers than in the day workers. However, blood pressure, working duration, and biochemical and other data were comparable between the two work groups. When multiple regression analysis was used, shift/day work was significantly related to the QTc in all of the workers. The adjusted odds ratio of shift work to the prolonged QTc (> or = 440 ms1/2) was 8.15. The prolonged QTc has been thought to contribute to an increased risk of cardiac death. These findings, therefore, suggest that the increased risk for cardiovascular mortality in shift workers may be attributable to prolongation of the QTc.

Background The effectiveness of two different approaches for the prevention of low back pain (LBP) was compared in forklift workers. The ®rst approach (personal) consisted of providing lumbar support, arctic jacket and physical exercise, and the second (facility approach) included the improvement of forklift seats and tires. Methods The self-reported prevalence of LBP was surveyed three times before and after the two forms of interventions, in 260 male blue-collar workers including 27 forklift workers, and 55 male white-collar workers of a copper smelter. Results The initial prevalence of LBP was 63% in the forklift workers, which was signi®cantly higher than that found in the other blue-collar workers (32%) and in the white-collar workers (22%). One year after the ®rst intervention (personal approach) to the forklift workers, the prevalence of LBP fell to 56%. The second intervention (facility approach), which was mainly comprised of a reduction in whole body vibration, was subsequently added, and 9 months later the prevalence of LBP in the forklift workers further decreased to 33%. The reduction of the prevalence from the initial survey was signi®cant (P 0X008), and that from the second survey was nearly signi®cant (P 0X070). Conclusions These ®ndings suggest that the facility approach is more effective for a reduction of LBP than the personal approach.

Efficacy and Effectiveness of Liver Screening Program to Detect Fatty Liver in thePeriodic Health Check-Ups: Kyoko NOMURA, et al.: Department of Hygiene and Public Health, Teikyo University School of Medicine-To determine whether the current liver screening program for fatty liver has sufficient scientific evidence to justify its continued implementation. The liver screening program to detect fatty liver was performed on 411 Japanese workers utilizing serum aspartate aminotransferase (ALT), alanine aminotransferase (AST), and gammaglutamyl transpeptidase (γ-GTP). Based on the preceding studies, subjects with viral and alcohol hepatitis were excluded from the evaluation. The diagnosis of fatty liver was based on ultrasound findings. The program was evaluated by efficacy and effectiveness; efficacy was measured according to the receiver operating characteristic (ROC) curves in comparison with the Body Mass Index (BMI). Effectiveness, based on the efficacy determinations, was assessed by means of the positive predictive value (PPV) test performance, the disease characteristics, and the program price.The diagnostic performances of ALT and BMI were nearly acceptable but far from excellent. The areas under the curves of the two indices were 0.69 and 0.63, respectively and these were statistically equivalent. The PPV ranged from 15 to 28% where the prevalence of fatty liver was 12.3%. The price of the program was estimated at US 4 dollars per person based on the medical reimbursement fee rate. The efficacy of the liver screening program was found to be insufficient and BMI monitoring may provide a more suitable and inexpensive alternative. Furthermore, the effectiveness of the program is open to question, considering the generally benign prognosis of the disease in the absence of any accompanying Received March 6, 2004; Accepted Aug 10, 2004 Correspondence to: E. Yano, Department of Hygiene and Public Health, Teikyo University School of Medicine 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan (e-mail: eyano@med.teikyo-u.ac.jp) morbid conditions and the high price of the program. (J Occup Health 2004; 46: 423-428)