Efecto de los factores de riesgo psicosociales relacionados al trabajo en el desarrollo de enfermedades cardiovasculares / The impact of work-related psychosocial risk factors on the development of cardiovascular diseases

Durante los últimos años, las enfermedades cardiovasculares (en adelante ECVs) en Chile se han situado como la primera causa de muerte y discapacidad. Frente a esta situación, el Ministerio de Salud ha generado programas de control de los factores de riesgo comunes para el desarrollo de enfermedades cardiovasculares. Sin embargo, no se ha considerado los factores de riesgo psicosociales relacionados con el trabajo, los que según la tendencia internacional se han validado como parte de los factores causantes de enfermedades cardiovasculares. Este documento tiene por objetivo evidenciar la importancia que tienen los factores de riesgos psicosociales laborales (en adelante FRPSL) para el desarrollo de ECVs, reflexionando sobre la experiencia en otros países y comparando esas realidades con la mirada actual en el control de las enfermedades cardiovasculares en Chile. Las experiencias revisadas validan a los factores de riesgo comunes como los principales para el desarrollo de enfermedades cardiovasculares, pero avalan que los factores de riesgo psicosociales de origen laboral mantienen una relación tanto directa como indirecta con el desarrollo y/o agravamiento de estas patologías, pese a que en Chile esto aún no se reconozca en términos legales. (AU)

In Chile, in recent years, cardiovascular diseases (hereinafter CVD) have been the leading cause of death and disability. Faced with this situation, the Ministry of Health has developed programs to control the common risk factors for the development of cardiovascular diseases, however, the work-related psychosocial risk factors have not been considered, which according to the international trend, have been validated as part of the causative factors of cardiovascular diseases.This study aims to highlight the importance of work-related psychosocial risk factors (hereinaf-ter PWF) for the development of CVD, reflecting on the experience in other countries, com-paring these realities with the current perspective in the control of cardiovascular diseases in Chile.The evidence confirms common risk factors as the key to the development of cardiovascular diseases. However, it guarantees that work-related psychosocial risk factors maintaining a relationship both directly and indirectly with the manifestation of these diseases, in despite of this is not recognized legally in Chile yet. (AU)

Expression of Cx43 and Cx45 in Cardiomyocytes of an Overworked Rat Model / 法医学杂志

Objective To study the effect of overwork stress response on the expression of connexin 43（Cx43） and connexin 45（Cx45） in cardiomyocytes and on cardiac function. Methods The experimental animals were divided into control group, overworked 1-month group and overworked 2-month group. A overworked rat model was established by forcing swimming of overworked group. The expressions of Cx43 and Cx45 in myocardial tissues of experimental animals were detected by Western blotting, while the corresponding myocardial tissues were stained with hematoxylin-eosin （HE） staining and Masson's staining, then histologically observed. Results Western blotting results showed that, compared with the control group, Cx43 expression in myocardial tissues of overworked rats decreased while Cx45 expression increased. HE staining and Masson's staining results showed that hypertrophy, rupture and interstitial fiber tissue hyperplasia were observed in myocardial fibers of overworked rats. Conclusion Overwork stress response may affect cardiac function as an independent factor and may even cause heart failure or arrhythmias and lead to death.

The Concept, Status Quo and Forensic Pathology of Karoshi / 法医学杂志

"Karoshi" originates from Japan's economic take-off period in the 1960s and 1970s. It is generally believed that overwork lead to the accumulation of fatigue, which triggers the outbreak of potential diseases, and results in sudden death. Karoshi causes great harm to both the community and families because it occurs primarily in 30 to 60 year old young adults. Japan put Karoshi into the category of industrial injury for the first time in 2001 and started to undertake a series of studies in the sociological and pathological fields. However, there is a tremendous gap in the forensic pathological diagnosis domain. In China, research on Karoshi started from the 1990s and is closely related to the reform and opening up policy as well as economic development. According to the incomplete statistics, 600 thousand people die from overwork each year in China, the highest in the world. Karoshi has become one of the most serious social problems in China at the present stage, thus a systematic study in the sociology and forensic pathology fields is urgently required. This paper summarizes the past and present status of Karoshi, and puts forward the problems that need attention during the judicial expertise of Karoshi from forensic pathology perspective.

Karoshi Related to Labor Intensity and Risk of Cardiovascular Events：A Case Report / 法医学杂志

Karoshi rem ains one of the m ost troublesom e issues in forensic identification. It is rather a social m edicine than a clinical disease. Japanese scholars pioneered exam ining the relation betw een sud-den cardiac death (SCD ) and chronic fatigue from long tim e and/or high-tension work. In the current case, a 55-year-old m an, w hose job w as loading and carrying heavy cem ent bags, w as found dead after 11 days of continuous hard work. H is fam ily m em bers sued the cem ent factory for his death and claim ed for com pensation.The problemw as the difficulty of identifying the causative relation w ithout the precedent or the relevant regulations. H ow ever, the forensic problems were finally acknow ledged after autopsy and calculation of labor intensity.The law suit w as w on as the first case pertaining to Karoshi in the Chinese court.

Are Cerebrovascular and Cardiovascular Diseases among Employees Work-related? / 대한산업의학회지

Cerebrovascular and cardiovascular diseases (CVDs) are a major cause of deaths among workers as well as in general population in Korea. The term "Karoshi" in Japan represents work-related cerebrovascular and cardiovascular diseases (WR-CVD) due to excessive overwork. According to the Karasek's Demand-Control Model many prospective studies reported a significant association between working in jobs with high strain and increased likelihood of subsequent development of cardiovascular diseases. However, further understanding of the etiopathology of each different work-relatedness is needed to prevent WR-CVDs effectively. This review was planned to help the readers with knowledge on the etiopathology of the WR-CVDs. Based on the causal or triggering factors, work-relatedness in the literature can be classified into four types: 'accidental type (e.g. sudden cardiac deaths)', 'typical Karoshi type due to extreme overwork', 'maladaptation type due to dramatic change in job characteristics', and 'job stress type due to inherent characteristics'. Even though the outcome of each type is apparently similar, their causes and pathophysiologic mechanisms are quite different. In conclusion, the work-relatedness of CVDs among employees is very limited and usually works as a trigger rather than as the causal factors. A thorough understanding of the etiopathology of WR-CVDs can be very helpful in developing a prevention strategy.

Karoshi : Death from Overwork

The first case of karoshi was reported in 1969 with the death from a stroke of a 29-year-old, married male worker in the shipping department of Japan's largest newspaper company. It was initially called occupational sudden death. Shift work and an increased work load, together with excessive overwork in spite of ill health just before the stroke, were finally recognized as the occupational causes of death. It took five years for the family to receive compensation. In 1982, the first book entitled "Karoshi" was published by three physicians. This was the origin of the term karoshi. Karoshi is not a pure medical term but a sociomedical term. Karoshi-deaths were associated with long working hours, shift work, stress, and irregular work schedules. In Korea, karoshi was introduced in 1990. The cases with cerebral hemorrhage, subarachnoid cerebral hemorrhage, cerebral infarction, hypertensive encephalopathy, angina pectoris, myocardial infarction, and dissecting aneurysm would be compensated as occupational diseases if the patients had overworked. Now, the magnitude and kinds of diseases of karoshi is being extended. Medical doctors must understand the karoshi and make efforts to make the victims of karoshi be compensated. The evidence that overwork causes sudden death is still incomplete. More studies are needed to clarify the causal relationship. To prevent karoshi, the working hours should be shortened and health promotion programs for all workers should be encouraged.

A Study on Karoshi to Make Application for Industrial Accident Compensation in Busan / 대한산업의학회지

OBJECTIVES: Karoshi is a word meaning death from work-overload. Work-related diseases due to continuous overwork are primarily cerebro- and cardio-vascular in nature. In Korea, despite an increase in the incidence of Karoshi, it is not easy to recognise by workmen's compensation in Korea. This study intended to establish basic information concerning the incidence of Karoshi. METHODS: 219 cases were collected based on workers' compensation records of three Busan Regional Centers of Labor Welfare Corporation from 1991 to 1999. The size of workplace, occupation, daily working time, type of working schedule, job tenures, characters of work-overload and duration of work-overload were investigated according of subgroups of general characteristics. Both univariate and multiple logistic regression analyses were used to estimate the relationship between risk factors and a recognition of Karoshi. RESULTS: 1. 61.6 % of total cases were recognized as Karoshi. 30.6 % occurred in a small workplace of less than 50 workers, 34.7 % were drivers or guards, and 48.8 % were more than 50 years old. Additionally, 29.6 % worked more than 12 hours, 37.5 % were irregular hours and shift workers and 21.5 % of the total had been on the job less than 6 months. 2. Of the causes of death, 49.8 % was cerebro-vascular diseases and it was more than cardio-vascular ones. And 80.4 % of total cases was belonged to the recognition-category of the Labour Ministry's Law. The previous disease history was found on 49.8 % of all cases. Of them, hypertension was most common as 21.9 %. 3. 53.9 % of patients were exposed to job hazards such as driving, monitoring, guarding, risky jobs and frequent long-term official trips. 64.7 % recorded a increased work-overload of job contents and working hours. Of the several types of work-overload, 42.5 % displayed long-term physical and psychotic work-overload and 22.2 % exhibited job characteristic work-overload. 4. In this study, work-overload was associated with the incidence of Karoshi in 76.3 % of cases. This rate was higher than the recognition of Workmen's compensation recorded by the Korea Labor Welfare Corporation. Of these, 43.6 % belonged to sufficient factors, 10.4 % partial factors, and 22.3 % were due to aggravating factors. 5. Logistic regression demonstrated that death due to cerebro- and cardio-vascular disease, shorttenure within 6 month was significantly associated with a recognition of Karoshi (p=0.034, OR=3.00, C I = 1 . 0 9~8.30/p=0.016, OR=6.76, CI=1.43~32.07 respectively) and that an increase of work-overload was also associated, but its statistical significance was slightly lower(p=0.081, OR=2.02, CI=0.91.~4.46 ) . However, no association was found between this recognition and overtime work, hazardous job, irregular work schedule, low-income, injury-onset place, or small size of workplace. The elderly group(>50years old) and those with a previous disease history were negatively associated with recognition although the statistical association was low. CONCLUSIONS: Karoshi in Busan occurred frequently in a small workplace of less than 50 workers, especially drivers or guards. Additionally, these cases worked more than 12 hours, were irregular hours and shift workers. The death due to cerebro- and cardio-vascular disease, short-tenure within 6 month was significantly associated with a recognition of Karoshi. However Karoshi in this study occurred frequently in overtime work and high risk groups of work-overload. Therefore, for prevention of Karoshi, work-overload and overtime work need improved and controled.

Karoshi Associated with Bathing / 日本温泉気候物理医学会雑誌

We investigated the relationship between Karoshi (death due to overworking) and bathing. Three apparently healthy persons seem to have died of karoshi during bathing. All three pesons had complained of a severe fatigue and poor physical condition. We estimated that the thermal stimulation and hydraulic pressure during bathing would further injure the auto-nervous and endocrine systems that had been ruined by severe overwork. We also estimated that these injuries would cause Karoshi by means of lethal arrhythmia or acute coronary syndrome. Our study suggests that the cases of sudden death during bathing include the cases of Karoshi.