December 14, 2020
Research and Survey Report

1907C
Empirical Research on the Prevention of Health-related
Accidents and Research on the Public Awareness Activities
for Preventive Measures
Takeshi Tanigawa: Professor, Course of Public Health, Juntendo University Graduate School of Medicine (PL)
Takashi Oguchi

Institute of Industrial Science, The University of Tokyo

Hiroo Wada

Graduate School, Juntendo University

Kazuhiro Ota

Senshu University

Setsuko Sato

Graduate School, Juntendo University

Masaya Takahashi

National Institute of Occupational Safety and Health, Japan

Kiyohide Tomooka

Graduate School, Juntendo University

Motoki Shino

Graduate School, The University of TokyoManami Kimura

Graduate School, Juntendo University

Kazuko Okamura

National Research Institute of Police Science

朱 沁曄Graduate School, Juntendo University

Shiho Kunimatsu

Department of Ophthalmology, Tohoku University Graduate School ofMedicine

Noriko Miyoshi

Ehime Sangyohoken Service

Migiwa Asano

Department of Legal Medicine, Ehime University School of Medicine

Koji Takeuchi

Traffic Planning Division, Traffic Bureau, National Police Agency

Shintaro Chiba

Department of Otorhinolaryngology, Jikei University School of Medicine

Tatsuya Horii

License Division, Traffic Bureau, National Police Agency

Ryutaro Shirahama

Graduate School, Juntendo University

Kazuaki SumiLicense Division, Traffic Bureau, National Police Agency

Dai Yamazaki

Safety Policy Division, Road Transport Bureau, Ministry of Land, Infrastructure, Transport and Tourism

Implementation Details for FY 2018

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)

2014

2013
Truck2015

2016

2017

Taxi

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

Current health-related accidents are just the
tip of the iceberg!
Health-related accidents of which the driver was
unaware that the cause was health related andwhere the police on-the-spot investigation failed
to take into account health issues were notincluded in "those in which the driver's illness
made it impossible to continue driving thecommercial vehicle.”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

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
RetinaIris
CorneaCrystalline lensPressure isapplied.

Pupil

90% of glaucoma patients are untreated and unaware.

Progression

The optic nerve iscompressed
Opticnerve
Optic disc

Purpose of This Project
The purpose of this project is to conduct screening
tests and questionnaire surveys on glaucoma,
hayfever, drowsiness, etc., and to clarify the actual
situation in order to establish countermeasuresagainst these health problems and to promote publicawareness of them. (Prevention of health-related
accidents that drivers are unaware of )Timeline of this Project
2018

2017
▶ Development of a questionnaire▶ Verification of the survey method using
the clock chart▶ Verification of the validity of the clock
chart and questionnaire for early
detection of patients with visual fielddeficit.

2019▶ Implementation of the survey
・Conducted a survey of approximately▶ Raising public awareness of the survey

2,000 professional drivers atresults by holding symposiums

transportation companies, cabetc.

companies, etc.
▶ Statistical analysis
・Visual field deficits and traffic▶ Securing the survey fieldaccidents(We plan to conduct the survey for general・Daytime drowsiness and traffic

drivers before the survey for commercial

accidentsdrivers.)▶ Conducting thorough follow-up surveys

etc.

Implementation Details for FY 2018
Conducting surveys of questionnaires and clock charts• Conducted a survey of approximately 2,000 professional drivers at
transportation companies, cab companies, etc.
• Returned the test result sheets to the examinees.

Statistical Analysis• Analyzed the relationship between visual field deficit and traffic
accidents, and the relationship between daytime drowsiness andtraffic accidents.

Clock Chart A simple screening tool for visual field
deficits caused by glaucoma, etc.
 Developed by Professor Chota
Matsumoto, Department ofOphthalmology, Kinki University School ofMedicine.
 Using one eye at a time, slowly rotate theclock chart while gazing at the center ●and check that all four creatures remain
visible during the rotation. Also, while
stopped, check if the center grid looks
distorted or if any petals are missing.

東北大眼科 国松志保

Significance of screening tests using aclock chart (Case 1)
ここに正常両眼視野をいれます

Since there are no symptoms, the person will
not be aware of it, and if the visual field
disorder progresses…

Left

Right

Field of view with superimposed
visual field charts for both eyes

東北大眼科 国松志保

Significance of screening tests using a clock chart
If known before visual field deficits occur in botheyes• Can be treated to prevent visual field deficits from progressing.

If visual field deficits are found to exist in both eyes
• Can give the person advice, "You may miss a traffic light or a stop sign.
Be careful on the roads you take and try not to go down unfamiliar
ones."
Awareness of visual field deficits can lead tothe prevention of traffic accidents.

What is the jack-in-the-box phenomenon?
 It is often experienced by drivers with glaucoma or other visual fielddeficits.
 A phenomenon in which, due to a narrowing of the field of vision, thedriver suddenly feels as if a car or bicycle is coming out from the side ora pedestrian is jumping out at him or her while driving.
 As the missing parts become larger, the driver
may feel as if the traffic lights and stop signs thatshould have been there before on the road he or
she always travels are missing.

Jack-in-the-box Phenomenon
While driving a car or motorcycle, have you had any of the following experiences in the past 5 years?
There were times when traffic lights that were supposed to be at intersections were missing.

① Yes ② No

There were times when the stop signs that should normally be there were missing.

① Yes ② No

There were times when a car or bicycle suddenly jumped out in front of me, or disappeared right in front of me.

① Yes ② No

There were times when a pedestrian suddenly jumped out in front of you, or disappeared right in front of you.

① Yes ② No

You may find yourself slowing down or speeding up before you know it compared to the flow of cars in the vicinity.

① Yes ② No

Sometimes you think you are driving in the proper lane, but before you know it, you end up driving onto thesidewalk or into the oncoming lane.

① Yes ② No

Sometimes it is difficult to see road signs clearly and to drive according to the signs.

① Yes ② No

Sometimes you get confused because you don't know where you are driving on the road.

① Yes ② No

You have been pointed out by a passenger, such as a family member, that you were driving dangerously.

① Yes ② No

Combination of visual field deficits in three or more locations
and the jack-in-the-box phenomenon and its association withtraffic accidents
6

Number ofPeople: 781
Case: 442 people

Number ofPeople: 452
Case: 313 people

Number ofPeople: 68
Case: 35 people

Number ofPeople: 47
Case: 35people

Gender and age adjusted odds ratio

*543

*210

1.73

1.00

2.66
0.97
Three or more visual field

Three or more visual field

No びっくり箱現象
jack-in-the-box phenomenon－With jack-in-the-box +びっくり箱現象No visual field deficits － 視野欠損（3個以上）
No visual field deficits － 視野欠損（3個以上） + 視野欠損（3個以上） +視野欠損（3個以上）
deficits
deficits
Noびっくり箱現象
jack-in-the-box phenomenon－With jack-in-the-box +びっくり箱現象
phenomenon

Combination of visual field deficits in three or more locations and the jack-in-the-box phenomenon* P<0.05
Logistic regression analysis*Excluding those with one or two visual field deficits

phenomenon

Case: 61-year-old male cab driver Years of Service: 27 years
 BMI: 20.6 kg/m2
 Medical history: None Jack-in-the-box Phenomenon
 Suddenly, a pedestrian jumped out in front of him or disappeared from his sight.
 The speed of the car is sometimes slowing down or speeding up compared to the surrounding
traffic.
 Sometimes it is difficult to see the road signs and follow the signs.
 He has been notified by a passenger, such as a family member, that he was driving
dangerously.

 Traffic Accident ExperienceHe damaged his own car body. (Independent property damage) 1 time His car was hit by another car or motorcycle. (Property damage) 1 time
 Due to his negligence, he caused an accident resulting in bodily injury. 1 time

Clock Chart Findings
Clock Chart Results:
When a visual field deficit is observed, the location of the deficit is indicated by an X.
Left Eye

Right Eye

Blind
Spot

BlindSpotRelationship between Visual Field Loss, Jackin-the-box Phenomenon and Traffic Accidents
When the clock chart findings were combined with thejack-in-the-box phenomenon, the rate of traffic accidents
was significantly higher in those with both findings thanin those without both findings.

The combination of the clock chart and the questionnaireon the jack-in-the-box phenomenon were considered to be
useful in preventing traffic accidents caused by visual fielddeficits.

Project Results for FY2019

Implementation in FY 2019
Conducting follow-up surveys for those with clock chart findings• Of the survey targets (Company K) in FY 2018, those with findings on the clockchart were surveyed on their subsequent visits to the ophthalmologist.

Holding symposiums• Based on the findings of this study, symposiums on the prevention of healthrelated accidents were held in Matsuyama and Tokyo.

Medical Checkup
Status Survey
Items Surveyed
 Underwent a consultation with
an ophthalmologist
 Time of visit
 Name of diagnosis
 Reasons for not seeing a doctor
 Intention to see anophthalmologist in the future forthose who have not been seen

Flow of Medical Checkup Survey
Findings of visual field deficits by clock chart (326 patients)

Session 1: July 5 - August 10, 2019
Session 2: September 4 - 20, 2019 ( Providing a reminder of the medical checkup
status survey)
Session 3: November 27 - December 7, 2019 ( Providing a reminder to serious
case people)
Session 4: December 2019 - February 2020 (Individual interviews for those whohave not yet responded or have not been examined)

A Breakdown of Follow-up Survey Questionnaire
Replies and Responses
Return ofsurvey form
N=216
(66.3%)

Visitedophthalmologist

Glaucoma*

N=71(32.9% of those who
returned the surveyform)(19.7% of those who
visited theophthalmologist)

N=14

Others were diagnosed withcataract, epiretinal membrane,
inverted eyelashes, eye mucus,and dry eyes.

Company K
Presence offindings on clockchart
N=326

No return ofsurvey forms
N=91(27.9%)

Not visited
ophthalmologist

Will visit a doctor inthe future

N=145

N=62

(67.1% of those who
returned thequestionnaire)(42.8% of those whohave not visited anophthalmologist)

Added up on March 5, 2020

Omission**
N=19(5.8％)* Including 1 case of suspected glaucoma** Retired peopleClock Chart Results for Those Diagnosed with
GlaucomaClock Chart Results for Those Diagnosed with
GlaucomaClock Chart Results for Those Diagnosed with
GlaucomaResult ②-1 Reasons for not receiving medical
examination (total)
N=145 Plural answers available
0

10

2030

Have
no time
時間がない

40

50

50

Too muchtrouble
面倒である

52

Afraidof being diagnosed
診断を受けるのが怖い

12

Feel financial burden
経済的負担を感じる

11

There are医療機関が近くにない
no medical institutions

2

Don'tknow where to go to see a doctor
どこを受診して良いかわからない
Feel distrust of doctors
医療に不信感を感じる
Otherその他

60

231049Result ②-1 Reasons for not receiving medical
examination (Other: Excerpt of free text description)
Reasons
I didn't understand the explanation during the clock chart test.
I have some questions about how to inspect the clock chart.
I have some questions about the test results.
I don't think my condition was bad enough to see a doctor./I don't feel the need to see a doctor based on thetest results.
I am not self-aware/do not feel any abnormalities in my vision.
I don't see myself as a therapeutic target.
I didn't know I was a therapeutic target.
They didn't tell me anything at the time of the test./They didn't tell me there were any abnormalities.
I had a fundus examination at an ophthalmologist about a year and a half ago.
I don't think it's glaucoma but something else.

Feedback from Participants who Underwent
the Examination
 I feel very grateful for this test.
 It was a simple test, but I had signs of glaucoma and decided to see an ophthalmologist. I am
glad that this test revealed that I have early signs of glaucoma.* It was a good opportunity for me to see an ophthalmologist. Thank you very much.
 I feel relieved.
 I have an eye examination and checkup every three months. * It is good if something that cannot be found by the person himself/herself can be found.* I went to see the ophthalmologist because I was advised to undergo a thorough examination
during an in-house health checkup.*
 I would like to see this examination included in the annual health checkup as it does not takemuch time.*
 I am glad that it was detected early.*
Comments with * are from people who have been diagnosed with glaucoma.

Potential Glaucoma Patients in This StudyOf the 326 patients with clock chart findings, 14 of 71(19.7%) who visited the ophthalmologist werediagnosed with glaucoma.
If all 326 patients with findings on the clock chart areexamined, it is estimated that about 64 people will
be diagnosed with glaucoma.
Of the 1,921 cab drivers targeted in this study, it can beestimated that about 3% are potential glaucoma
patients.

Traffic Safety
SymposiumDate & Time:
2:00 p.m. - 4:40 p.m., Tuesday,
December 10, 2019
Place:Ehime Prefectural Medical
Practitioners Hall, 4F
Conference Room 1
Number of Participants:
81 people

Results of questionnaire
on "Prevention of andCountermeasures for
Health-Related
Accidents," a symposiumfor citizens on traffic
safety (Number ofresponses: 62)

Before participating in this symposium, did youknow that sleep apnea can cause traffic accidents?

6, 10%

5, 8%

13, 21%38, 61%

Knew a lot about it

Knew a little about it

Did not know much about it

Did not know at all

Do you think that screening tests for sleep apnea
are necessary to prevent traffic accidents?
Before Symposium
1,2%
18,29%

After Symposium
4,6%

3,5%

14,22%

55,89%

29,47%

Very necessary

Somewhat necessary

Very necessary

Somewhat necessary

Not very necessary

Not necessary at all

Not very necessary

Not necessart at all

No answer

No answer

Before participating in the symposium, did you
know that glaucoma can cause traffic accidents?
1,2%

2,3%

10,16%
19,31%

30,48%

Knew a lot about it

Knew a little about it

Did not know at all

No answer

Did not know much about itDo you think that screening tests forglaucoma are necessary to prevent traffic
accidents?
Before Symposium
2,3%

1,2%

9,15%

After Symposium
4,6%

3,5%

22,35%
28,45%

55,89%

Very necessary

Somewhat necessary

Very necessary

Somewhat necessary

Not very necessary

Not necessary at all

Not very necessary

Not necessary at all

No answer

No answer

Did you find this symposium useful?

7,11%
12,19%
43,70%

Very usefulSomewhat usefulNot very useful

No useful at all

No answer

Special Lecture: "Prevention ofand Countermeasures for
Health-Related Accidents" Visual Field Deficits and TrafficAccidents
Date and time:
6:00 p.m. to 8:05 p.m.,
Wednesday, February 19,2020
Place:Juntendo University,
Century Tower 8F, LargeClassroom
Number of participants
74 people

Questionnaire Results on
Special Lecture:"Prevention of andCountermeasures for
Health-RelatedAccidents" - Visual Field
Deficits and TrafficAccidents(Number of answers: 53)

Before participating in the lecture, did you knowthat glaucoma can cause traffic accidents?

6,11%

5,10%

9,17%

33,62%Knew a lot about it

Knew a little about it

Did not know at all

No answer

Did not know much about itDo you think that screening tests forglaucoma are necessary to prevent traffic
accidents?
Before the Lecture
10,19%

After the Lecture
1,2%

1,2%
20,38%

1,2%
10,19%

41,77%

22,41%

Very necessary

Somewhat necessary

Very necessary

Somewhat necessary

Not very necessary

Not necessary at all

Not very necessary

Not necessary at all

No answer

No answer

Did you find this lecture useful?

14,26%
39,74%

Very usefulSomewhat usefulNot very useful

No useful at all

No answer

Future Development

Empirical research on the prevention ofhealth-related accidents and the study ofpromoting public awareness of preventivemeasures
Candidate Region①
ChinaDevelopment of Public Awareness in Asia
Candidate Region ②Thailand

Professor Jin Huiqing
 Founder of ANHUI SANLIAN GROUP
 Former Vice Chairman of China Chamberof Commerce and Industry
 Representative of the 9th, 10th, 11th and12th National People's Congress Director of National Automobile Driving
Safety Engineering Technology ResearchCenter President of Anhui Sanlian University
 Visiting Professor, University of Tokyo Director of Anhui Sanlian Accident
Prevention Research Center

Development in China
A web conference washeld on February 18,
2020.
A web conference washeld on February 18,
2020.The participants
were introduced to theprojects and research ofAnhui San Lian Group,and the opinions wereexchanged on theimportance of healthrelated accident
prevention in China.

Professor Myo Nyein AungSpecially Appointed Associate
Professor, Juntendo University Facultyof International Liberal Arts.
Area of Expertise: Public health,
medical education, clinical research
Main Research Field: Medicaleducation and research, global health,infectious diseases, non-infectious
diseases, smoking control, measures
for aging, etc.

Developmentin Thailand
 On February 3, 2020, we exchanged
opinions with Specially Appointed
Associate Professor. Aung at IATSS.
 We are planning to hold a symposium
on health-related accident prevention
in collaboration with the Department ofDisease Control, Ministry of Health,Thailand, Chulalongkorn University
Faculty of Medicine, WHO Collaborating
Center for Safety Promotion andTrauma Prevention, and otherorganizations.

Future Development
Dissemination of Research Results

Juntendo
Symposium held inThailand in collaboration
with the Thai Ministry ofHealth, Chulalongkorn
University, WHO, etc.

Exchange of opinions with
Anhui Sanlian Group andother professionalorganizations related totransportation in China

China

Organize joint
symposiums
between Japan,China, and Thailand
in JapanThailandThank you very much for your attention.