Research and Survey Project for FY2020 <Social Contribution Project>
Presentation Material for External Debriefing Session on April 9, 2021

Public Awareness-Raising Activities for the Preventionof Health-Related Accidents in Asia
Project Members＜PL＞
Takeshi Tanigawa (Course of Public Health, Juntendo University Graduate School of Medicine)＜Members＞

浅野Asano水辺（愛媛大学医学部法医学教室）
MigiwaDepartment of Legal Medicine, Ehime University School of Medicine

太田 Ota和博（専修大学商学部）
Kazuhiro
Senshu University School of Commerce
小竹 元基（東京大学大学院新領域創成科学研究科）
Motoki Shino

Graduate School of Frontier Sciences, The University of Tokyoof Industrial Science, The University of Tokyo大口 Institute敬（東京大学生産技術研究所）
Takashi Oguchi

岡村 Second
和子（科学警察研究所交通科学部交通科学第二研究室）
Traffic Science Section, Department of Traffic Science, National Research Institute of Police Science
Kazuko Okamura＜Special Researchers＞

國松志保（医療法人社団済安堂
西葛西・井上眼科病院）
Inoue Eye Hospital
ShihoKunmatsu

朱 沁曄（順天堂大学大学院医学研究科公衆衛生学講座）
Course of Public Health, Juntendo University Graduate School of Medicine
朱 沁曄
金 会庆（安徽三联事故予防研究所）
Jin Fuiqing
Anhui Sanlian Accident Prevention Research Center
友岡 清秀（順天堂大学大学院医学研究室公衆衛生学講座）
Courseアング（順天堂大学国際教養学部）
of Public Health, Juntendo University Graduate School of Medicine
Kiyohide
Tomooka
ミョーエンMyo Nyein Aung

Juntendo University Faculty of International Liberal Arts

＜ Research Collaborators ＞

Course of Public Health, Juntendo University Graduate School of Medicine
Keisuke
大貫 Onuki
慧介（順天堂大学大学院医学研究科公衆衛生学講座）

崎山Sakiyama
紀子（東京医療保健大学看護学部）
NorikoTokyo Healthcare University Faculty of Nursing

山戸 健太郎（順天堂大学大学院医学研究科 公衆衛生学講座）

Kentaro Yamato

高橋 Research正也（（独）労働安全衛生総合研究所過労死等防止調査研究センター）
Center for Overwork-Related Disorders, National Institute of Occupational Safety and Health, Japan

Masaya Takahashi

佐藤Setsuko
Sato

准子（順天堂大学大学院医学研究科公衆衛生学講座）
Course of Public Health, Juntendo University Graduate School of Medicine
白濱 龍太郎（順天堂大学大学院医学研究科公衆衛生学講座）
Ryutaro Shirahama
Course of Public Health, Juntendo University Graduate School of Medicine
千葉 伸太郎（東京慈恵会医科大学耳鼻咽喉科学教室）
福島
Shintaro
Chiba 史人（自治医科大学附属さいたま医療センター救急科）
Department of Otorhinolaryngology, Jikei University School of Medicine
和田 裕雄（順天堂大学大学院医学研究科公衆衛生学講座）
Fumihito Fukushima

Emergency Department, Jichi Medical University Saitama Medical Center

Hiroo Wada

Course of Public Health, Juntendo University Graduate School of Medicine

Manami木村Kimura

Course of Public Health, Juntendo University Graduate School of Medicine
真奈美（順天堂大学大学院医学研究科公衆衛生学講座）
田島公衆衛生学講座）
Tomokazu
Tajima 朋知（順天堂大学大学院医学研究科
Course of Public Health, Juntendo University Graduate School of Medicine

Course of Public Health, Juntendo University Graduate School of Medicine＜ Observers ＞

Safety Policy Division, Road Transport Bureau, Ministry of Land, Infrastructure, Transport and 竹内
Tourism,Yukio
Yasuhara
安原幸生（国土交通省自動車局安全政策課安全管理室）

横田 剛士（警察庁交通局運転免許課）
Tsuyoshi Yokota
License Division, Traffice Bureau, National Police Agency
Koji Takeuchi

Traffic Planning Division, Traffic Bureau, National Police Agency

康二（警察庁交通局交通企画課）

Contents• Background and Purpose of This Study• Description of Social Contribution Projects for FY2020• Holding an international symposium• Creation of the awareness-raising video (short version)• Creation of the awareness-raising video (long version)• Creation of flyers• Creation of booklets• For the future

Contents• Background and Purpose of This Study• Description of Social Contribution Projects for FY2020• Holding an international symposium• Creation of the awareness-raising video (short version)• Creation of the awareness-raising video (long version)• Creation of flyers• Creation of booklets• For the futureHealth-related Accidents• Definition by the Ministry of Land,
Infrastructure, Transport and Tourism(MLIT): The driver is unable tocontinue driving the business vehicle
due to illness.

Number of Reports of Health-related Accidents(Number of Cases per Business Category)(Article 2 of the Automobile Accident ReportingRegulations)• The prevention of health-related
accidents is an important issue intraffic accident prevention.

2014

2013
Truck2015

2016

2017

Taxi

Charter/SpecificSharedSource: "Status of Health-Related Accidents and Efforts for thePrevention of Health-Related Accidents” by MLIT

Causes of Health-related Accidents
Heart disease

Brain disease

Digestive system disease
Side effects of medication
Respiratory disease
Glaucoma
AnemiaAortic dissection
Low blood sugar

Sleep apnea syndrome
Dementia
Heat stroke

Dizziness
Hay fever-induced drowsinessEpilepsy

Aging of drivers
Source: " Approaches to Health Management for Drivers of Commercial Vehicles" by MLIT

SAS: Sleep Apnea Syndrome
Soft palate
Uvula
Tonsils
TongueAirflow

Soft palate
Tongue root
Uvula

The upper airway is blocked,
and airflow is cut off.

Tensils● Frequent oxygen deficiency● Causing awakening to open airways andUnder normal conditions, the upper airway isnot closed, and airflow is maintained evenwhen lying down to sleep.

fragmentation of sleep, resulting in poor
sleep quality and increased sleepiness on
the following day

Relationship between Perceived Sleepiness andPrevalence of Sleep Apnea Syndrome
There is a risk of missing 86% of
critically ill patients if the decision isbased on ESS scores alone.

Sleep Apnea
Normal Range(Less than RDI5)

Weak↑
PerceivedSleepiness↓StrongESS
0 to 5ESS
6 to 10ESS
11 to 15ESS
16 to 20
Total

1,457(60%)
774(32%)142(6%)
37(2%)
2,410(100%)Slight Degree(RDI 5 to 19.9)

1,391(60%)
725(31%)
170(7%)
44(2%)
2,330(100%)

Medium Degree(RDI 20 to 39.9)201(53%)138(37%)34(9%)
5(1%)
378(100%)

Severe(RDI 40 ormore)Total

46(36%)
52(40%)
23(18%)
8(6%)
129(100%)

3,095(100%)
1,689(100%)
369(100%)
94(100%)5,247(100%)NOSSA: non sleepy sleep apnea
Sleep apnea without perceived sleepiness

Source: Takeshi Tanigawa and Hiroyasu Iso: " Building a Traffic Accident Prevention System by Screening Sleep Apneaof Occupational Drivers“
Grant-in-Aid for Scientific Research Report 2006 (Ministry of Education, Culture, Sports, Science and Technology)

Sleep Apnea and Traffic Accidents
Percentage of Accidents experienced by People
with Sleep Apnea by Level of Severity

Respiratory Disturbance Index
Source: H2535, H2651, H2763 (Government/Organization Collaboration) Project Research ReportGlaucoma• Glaucoma: A disease in which the optic nerve is damaged
for some reason, resulting in a narrowing of the visual
field (range of vision).
• The prevalence of glaucoma among Japanese aged 40 andover is 5.0% (1 in 20).
• The estimated number of patients in Japan is about 4.6
million people (2015).
• The progression of glaucoma can be slowed down by early
detection and appropriate treatment.

Schlemm’s canal

Ciliary body
RetinaIrisCornea
Crystalline lensPressure isapplied.

Pupil

90% of glaucoma patients are untreated and unaware.

Progression

The optic nerve iscompressed
Opticnerve
Optic disc東北大眼科 国松志保

Ratio of Glaucoma Unawareness and Untreated Patients by Stage
among 250 Glaucoma Patients Visiting the Department ofOphthalmology, Tajimi City Hospital

Early Stageto-6dBMiddleStage
to 12dB-6dB
Late Stage
to-12dB

Unaware(Untreated)

Glaucomadiagnosed
and undertreatment

Glaucomadiagnosed but
untreated

140/149(94.0%)

3/149(2.0%)

6/149(4.0%)

149

51/56(91.1%)

4/56(7.1%)

1/56(1.8%)

56

41/45(91.1%)

3/45(6.7%)

1/45(2.2%)

45

Total

There are no noticeable symptoms of glaucoma in the early, middle, or late stages.
Yuko Ikuno, etc. Folia Japonica de Ophthalmologica Clinica 100(7) : 496-923, 2006

Visual Field Deficits and Traffic Accidents
Combination of visual field deficits in three or more locations
and the jack-in-the-box phenomenon and its association
with traffic accidents
Number of people: 781
Case: 442 people

Gender and age adjusted odds ratio

Clock Chart

Number of people:425
Case: 313people

Number of people:68
Case: 35 people

Number of people:47
Case: 35 people

No visual field deficits

No visual field deficits

Three or morevisual field deficits

Three or morevisual field deficits

No jack-in-the-box phenomenon

With jack-in-the-box phenomenon

No jack-in-the-box phenomenon

With jack-in-the-box phenomenonCombination of visual field deficits in three or more locations and the jack-in-the-box phenomenon

Logistic regression analysis*Excluding those with one or two visual field deficits

Source: 1707A, 1807B, 1907C (Independent Research) Project Research ReportOphthalmology
Visits Survey• Of the 326 patients with clock chartanomaly observation, 14 out of 71 (19.7%)
who visited the ophthalmologist werediagnosed with glaucoma.
• If all 326 patients with clock chart anomaly
observation receive a medical examination,
it is estimated that about 64 patients will bediagnosed with glaucoma.
• It can be estimated that about 3% of the1,921 employees in the transportationindustry in this study are potential glaucoma
patients.

Issues Identified as a Result of theThree-year Project Research• The fact that sleep apnea syndrome and glaucoma can be causes of traffic
accidents is not sufficiently well known by the general public. In particular,
few people are aware that glaucoma can be a cause of traffic accidents.
• In other countries, especially in Asia, little effort has been made to deal withhealth-related accidents.

Further awareness-raising on the prevention of health-related accidents isneeded in Japan, and efforts to prevent health-related accidents are alsoneeded in the Asian region.

Purpose of this Project
The purpose of this study is to contributeto the reduction of health-related roadtraffic accidents by applying theknowledge gained from previous studies
to the Asian region.

Contents• Background and Purpose of This Study• Description of Social Contribution Projects for
FY2020• Holding an international symposium• Creation of the awareness-raising video (shortversion)• Creation of the awareness-raising video (longversion)• Creation of flyers• Creation of booklets• For the future

International Symposium• Time and Date: Friday, November 20, 2020
From 6:00 p.m. to 8:00 p.m.
• Place: Held online via Zoom
• Number of Participants: 146

Takeshi Tanigawa

Shiho Kunimatsu

Naricha Chirakalwasan

Huiqing Jin

Migiwa Asano

Fumihito Fukushima

From the Questionnaire of theInternational Symposium
Before participating in this symposium, did
you know about health-related accidents
caused by sleep apnea, glaucoma, etc.?
1, 2%

Did you gain a better understanding ofhealth-related accidents by participatingin this symposium?
12, 22%13, 24%9, 17%

31, 57%42, 78%Knew a lot about it

Knew a little about it

Strongly agree

Somewhat agree

Did not know much

Did not know at all

Not so much

Not at allabout it
N=54

From the Questionnaire of theInternational Symposium
Do you think this symposium is useful as
an initiative to prevent health-related
accidents?
1, 2%

Did you find this symposium useful?
2, 4%
13,24%

11, 20%39,72%

42, 78%Strongly agree

Somewhat agreeNot so much

Not at all

N=54

Very usefulNot very usefulSomewhat usefulNot useful at allWhat efforts do you think are necessary
to prevent health-related accidents?
• The necessity of a social prevention system• We need to improve the measures under the surface of the iceberg. Prevention measuresneed to be improved.
• Identifying the true cause of the problem through close collaboration with relatedorganizations and building technology to detect the problem before it occurs.
• The necessity of raising public awareness• It is important to have not only drivers but also society in general be aware of the dangers(characteristics) of sleep apnea syndrome and glaucoma, which causes the narrowing of thevisual field.
• We need to change the culture of thinking that drowsiness and falling asleep is anindividual's negligence and make it known that it is a health and public health issue thatneeds to be thoroughly addressed and that there are measures that can be taken.
• Expansion of inspection system• It would be great if there was a social system to detect diseases such as SAS, glaucoma, andheart disease, although the most important thing is for each person to take care of his or her
health and have a checkup.
• In addition to screening and early action, the importance of sleep hygiene and restfullabor management was acknowledged.

What would you like to know about
health-related accidents in the future?
• Relationship between various diseases and traffic accidents• In particular, the causal relationship between mental disorders such as depression and dementia andtraffic accidents• Correlation between accidents and the prevalence of lifestyle-related diseases among occupational
drivers, etc.
• Trends in research on narcolepsy• International evidence and data
• Epidemiological data worldwide• Differences in the causes of accidents in each country• Prevention and solutions• Although I understand the diseases that can cause accidents, how can we prevent them? In addition,even if one has the disease, there may be many cases where one has no choice but to drive a car in an
aging society. In such cases, I would like to know how far the mechanical technology has evolved in order
to assist people and prevent accidents.
• I would like to know more about the symptoms and signs of the driver for each disease prior to theoccurrence of health-related accidents.
• What kind of support and advice is actually given to people diagnosed with an illness regarding driving
and accidents?
• It is hoped that concrete solutions will be implemented on how to reduce the number of health-relatedaccidents.

Please feel free to write your opinions
and requests.
• I learned so much about health-related accidents.
• I felt that collaboration between the public, private, andacademic sectors will be an important key to addressing eachof the issues discussed today.
• Today, thanks to Zoom, we were able to attend the lecture evenfrom a local area. I appreciate it.
• I am very happy that there are more online symposia like thisone, although the Covid-19 crisis is not good. Please continue
to do this in post-Covid 19.
• It was a great opportunity to experience the realistic feelingthat only online can provide.

In creating the awareness-raising tools…
In the 2019 internal debriefing survey, the following are someof the comments we received.
• It is hoped that it will be widely spread throughout society.
• It is necessary to expand overseas, but I think it would be better tomake more extensive efforts to make this a domestic issue.
• The situation surrounding sleep apnea syndrome has not changed
much in Japan, so I would like to see more improvement in Japan
than overseas.

Creation of Awareness-raising Videos• Created four videos, short and long, on sleep apnea syndrome and glaucoma,respectively.
• Objective: To make people aware that the sleep-apnea and glaucoma can cause traffic
accidents• To create the video, we conducted interviews with transportation-related organizations,
including Sompo Japan Insurance, Sompo Risk Management, JAF, All Japan Rent-A-Car
Association, and Tokio Marine & Nichido Fire Insurance.

Short VersionLong Version• Target: General public, all ages
• Duration: About 3 minutes• Target: Professional drivers, managers, etc.
• Duration: About 15 minutes• The content should be animated so that not
only the target audience but also their families(children, grandchildren, etc.) can easily viewit.

• Created mainly for use in training programsfor professional drivers at companies.

• The contents can be viewed in spare time or
during travel time as a way to "pass the time.

Sleep Apnea Syndrome Awareness Video(Short Version)

Glaucoma Awareness Video(Short Version)

Sleep Apnea Syndrome(Long Version)

Glaucoma(Long Version)

Sleep Apnea Syndrome(Long Version)

Glaucoma (Long Version)Flyer (Sleep Apnea Syndrome)• Created a flyer to promote the short version of the video on sleep apnea and glaucoma.

Flyer (Glaucoma)• Created a flyer to promote the short version of the video on sleep apnea and glaucoma.

Booklet• This booklet contains thelectures given by Dr. Shiho
Kunimatsu (Nishikasai Inoue
Ophthalmic Hospital) and Dr.
David Crabb (City, University ofLondon) at the "1907C
Research Project Special
Lecture" held in FY2019.

Contents• Background and Purpose of This Study• Description of Social Contribution Projects forFY2020• Holding an international symposium• Creation of the awareness-raising video (shortversion)• Creation of the awareness-raising video (longversion)• Creation of flyers• Creation of booklets• For the futureFuture Prospects• Distribution of awareness-raising tools• Provide video streaming of the short version and conduct training using thelong version of the videos at transport-related organizations including
Sompo Japan Insurance, SOMPO Risk Management, JAF, Japan Rental Car
Association, Tokio Marine & Nichido Fire Insurance, etc., as well as atdriver's license examination centers nationwide.

• The necessity of international collaborative research on
health-related accident prevention• In addition to clarifying the actual situation of health-related accidents ineach country through the joint research with China and Thailand establishedin this project, it is necessary to conduct demonstration experiments on the
introduction of screening for sleep apnea syndrome and visual field
disorders, which have been conducted in previous project research.