In Japan, Hirobe et al. Epacadostat (2005) had response from OPs at a rate of 20.4% when they made a survey on myocardial infarction morbidity of workers. When a questionnaires survey on OPs’ activities in SSEs was conducted, Terada et al. (2005) succeeded to obtain a higher response from OPs at 37.5% that was achieved when the survey was conducted in cooperation with medical associations in the regions. Muto et al. (1997) reported a similarly high response rate of 37.9% in a questionnaire

survey on the methods to persuade high management to support OHS, but the respondents included non-MDs (such as occupational nurses and safety and health supervisors) and OPs accounted for 37%. Taking these experiences by other study groups into consideration, the response rates in the present study may not be too low. The structure of the questionnaires used in the present study might have contributed to reduce response rates. The questionnaires set was rather bulky with 20 questions [including

some complicated ones (e.g., Q. 11, Q. 12 and Q. 13); see the appendix], and several questions (e.g., Q. 14 and Q. 15) requested answers in free writing. In fact, some OPs in both countries complained in the margin of the questionnaires sheet that “the questionnaire is too complicated and time consuming to complete”. The authors could not prepare a reward for the Z-VAD-FMK datasheet reply as well. These situations might have affected the response rate. There remain several points to be studied. The points include the satisfaction of employers and employees with current OHSs, effectiveness of OHSs to solve

or prevent problems, and possible effects of socio-economic Thiamine-diphosphate kinase factors. They are the subjects of future studies. In conclusion, the present survey suggests that service patterns are different between OPs in Japan and OPs in the Netherlands, i.e., more time for health and safety committees, worksite rounds, and overwork prevention in cases of Japanese OPs, whereas it is sick leave issues for OPs in the Netherlands. Both groups of OPs consider that the education of employers (possibly owner-managers in cases of SSEa) is important in addition to traditional education of workforces. These conclusions should, however, be taken as preliminary, due to various limitations especially low response rates. Further studies are apparently necessary before reaching solid conclusions. Acknowledgments We are grateful to the staff in the Coronel Institute of AMC and the Netherlands Society of Occupational Medicine, Mr. Jim de Beer and Miss Fumiko Ohashi who gave invaluable assistance for this study. Thanks are also due to National Federation of Industrial Health Organizations, Japan, Japan Society for Occupational Health, Society for the Study of Occupational Health Promotion, and staff in Kyoto Industrial Health Association, Japan.