Overwork Affects Extracellular Matrix of Arterial Vessel Wall in Rats / 中国医学科学院学报

Objective To explore the effect of overwork (OW) on extracellular matrix of arterial vessel wall in rats. Methods Random number grouping method was employed to assign 18 Sprague-Dawley rats into three groups(n=6):the control group(no special treatment),group OW(forced swimming twice a day for 15 days),and sleep deficiency(SD)+OW group(in addition to forced swimming twice a day,the rats were put on the platforms in water to limit sleep for 15 days).On the 16th day,the abdominal aorta and common carotid artery were collected after blood sampling from heart under deep anesthesia.A part of the abdominal aorta sample was taken for Masson staining of collagen fiber,and Verhoeff-Van Gieson staining was carried out for the elastic fiber of common carotid artery.Image J was employed for the quantitative analysis of collagen fiber and elastic fiber content.The expression of collagen 1(Col-1) protein was quantified by immunohistochemistry and the ultrastructure of vascular matrix was examined by transmission electron microscopy.The other part of the abdominal aorta sample was used to determine the mRNA levels of matrix metalloproteinase(MMP)-1,MMP-2,MMP-9,tissue inhibitor of metalloproteinases-1(TIMP-1),and Col-1 by quantitative real-time polymerase chain reaction. Results Compared with that in control group,the content of collagen fiber in groups OW and SD+OW had no significant change(all P>0.05);the content of elastic fiber in groups OW and SD+OW decreased(all P<0.001) and had no significant difference between each other(P>0.05).The vascular vessel wall of group OW showed slight fiber breakage,while that of group SD+OW presented wormhole-like or spongy fiber fragmentation.The mRNA levels of MMP-1 and MMP-2 in groups OW and SD+OW had no significant difference between each other(P>0.05) but were higher than that in control group(all P<0.001).The mRNA levels of MMP-9 and TIMP-1 had no significant difference among the three groups(all P>0.05).Groups OW and SD+OW had lower mRNA level(all P<0.001) and protein level(all P<0.001) of Col-1 than control group,while the mRNA and protein levels of Col-1 had no significant difference between groups OW and SD+OW(P>0.05). Conclusion OW can reduce the content of Col-1 and elastic fibers in the extracellular matrix of arterial vessels,destroy the elastic lamina of vascular wall,up-regulate the expression of MMP-1 and MMP-2,thereby injuring arterial vessels.

Evaluation of "Overwork" of medical workers and the influencing factors at county hospitals / 中华医院管理杂志

Objective To scientifically assess the degree of " overwork" and its influencing factors of doctors and nurses at county hospitals. Methods Six county hospitals were selected as the research objects. Descriptive analysis, chi-square test and ordered multi-class regression were used to analyze the degree of " overwork" and its influencing factors of doctors and nurses. Results 48. 3％ (156 / 323)of the doctors at these hospitals were working more than 60 hours per week. Work hours per week of the doctors were significantly longer than those of the nurses. At the same time, the workload of doctors based on the fatigue self-assessment scale was also significantly higher than that of the nurses, while 61. 9％ (200 / 323) of the doctors were exposed to a very high workload, and so were 33. 3％ (118 / 354) of the nurses. There were significant differences in the workload of doctors and nurses in terms of their gender, age, education level, seniority and number of children. And the work hours per week were an important factor affecting the workload of doctors and nurses. Conclusions We should formulate a reasonable work hours for doctors and nurses, especially focusing on young and middle-aged doctors.

Creencias irracionales, síndrome de Burnout y adicción al trabajo en las organizaciones / Irrational beliefs, Workaholism and Burnout syndrome inside organizations

El presente artículo de revisión, expone los resultados de una investigación bibliográfica sobre la relación existente entre las creencias irracionales, la adicción al trabajo y el síndrome de Burnout en el contexto de las organizaciones. Con esta finalidad, se contemplaron aspectos como la conceptualización de los constructos, su origen y sus interrelaciones, las características de las personas que lo presentan, los perjuicios en la salud física y estrategias de intervención. Entre las principales conclusiones señalamos que se deben fortalecer los estudios que tengan en cuenta los niveles individuales, organizacionales y grupales en la institución, para profundizar en la complejidad sistémica de la condición; además, se observa la necesidad de construir un modelo que permita la transformación de los contextos laborales no saludables

This article exposes the outcomes of a bibliographic research about the relation between irrational beliefs, workaholism and burnout. For this purpose, we contemplated aspects like definition, origin and connection between these three phenomena, characteristics of workaholics and people with burnout syndrome and the impact on health and intervention. We concluded it is required new researches that take into account individual, organizational and group levels in the organization to deepen the study of the systemic complexity of these phenomena; there is also necessary to build a model that allows the transformation of unhealthy work environments

Compensation for Work-Related Cerebrocardiovascular Diseases

The purpose of this study was to discuss the history of, and concerns regarding, the newly amended criteria of occupational cerebrovascular or cardiovascular diseases (CCVDs). Since the early 1990s, CCVDs have been the second most common occupational disease, despite fluctuations in their criteria. The first issue was the deletion of cerebral hemorrhage on duty as a recognized occupational disease in 2008. The second issue was the obscurity regarding definitions of an acute stressful event (within 24 hr before disease occurrence), short-term overwork (within 1 week), and chronic overwork (for 3 or more months). In this amendment, chronic overwork was defined as work exceeding 60 hr per week. If the average number of weekly working hours does not exceed 60 hr, night work, physical or psychological workload, or other risk factors should be considered for the recognition of occupational CCVDs. However, these newly amended criteria still have a few limitations, considering that there is research evidence for the occurrence of disease in those working fewer than 60 hr per week, and other risk factors, particularly night work, are underestimated in these criteria. Thus, we suggest that these concerns be actively considered during future amendment and approval processes.

Study on the Accepted Criteria of Sudden Death from Overwork : Focusing on Courts' Test / 대한법의학회지

The purpose of this study was to review the tendency of the Supreme Court's test for death from overwork (so called 'Karoshi'). Using inner-network of court, we analyzed judicial tests from 2000 to 2010, associated with claimed death from overwork and/or psychological stress. Judicial tests were classified according to the clarification of cause of death and preexisting diseases. Through analyzing relevantly the tests for death from overwork, the authors found that many tests have emphasized the necessity of forensic autopsy to elucidate the proper casual relationship between death and overexertion. This study also shows recent changes in judicial tests based on the latest medical knowledge. Therefore, it is suggested that social issue on forensic autopsy system need to recall Korean society to establish the clarification of the proper casual relationship associated with death from work as well as social justice.

Influencing Factors in Approving Cerebrovascular and Cardiovascular Diseases as Occupational Disease in Seoul / 대한산업의학회지

OBJECTIVES: This study was performed to analyze the factors that affected the decision making process in approving workers' compensation claims for cerebrovascular and cardiovascular diseases cases that occurred just before refoming approval standards of Industrial Accident Compensation Insurance Act on 1 July 2008 and to provide fundamental information in preparing better standards. METHODS: We examined 283 claims cases involving cerebrovascular and cardiovascular diseases that occurred between 1 January, 2006 and 31 December, 2007 and collected data based on the worker's compensation records from 3 Seoul Regional Centers of the Workers' Compensation & Welfare Service. We analyzed the approval rates and odds ratios according to the general characteristics, injury information, past medical histories, and work related information using chi-square or univariate logistic regression. In addition, we identified the factors affecting the approval using multivariate logistic regression. RESULTS: Overall, 101 of the 283 cases were approved and approval rate was 35.7%. Approval rates differed significantly according to type of disease, survival, accident site, accident time, the presence of associated disease and overwork (p-value <0.05). In the multivariate logistic regression analysis with adjusted for age and sex, approval rate of death cases with associated disease was lower than cases without associated disease (OR 0.22, 95% CI 0.12~0.42). Approval rate of cases occurred in worksite was higher than others (OR 4.81, 95% CI 2.22~10.40). Cases of accepted overwork had a higher approval rate significantly than cases of not accepted (OR 28.53, 95% CI 9.74~83.52). CONCLUSION: Factors in approving cases of cerebrovascular and cardiovascular disease as cases involving occupational disease included conditions of overwork, high rate of accidents in the workplace and the presence of associated disease. It is necessary to investigate further behaviors of work and chronic work-related stress.

The occupational hazards of interns & residents during training / 대한산업의학회지

OBJECTS: Residents are exposed to various hazards and harassed by sleep deficiency due to overwork. This study was performed to outline the health condition of residents and develop the ways of improving it. METHODS: A questionnaire was distributed to 881 army doctors who enrolled at the Korea Third Military Academy and The Armed Force Health Service School in 2000 with the exception of medical doctors who joined the armed service without going through intern and resident periods , dental and oriental medical doctors. 784 (89.0%) of the 881 questionnaires were returned of which 704 cases (79.9%). This should actually be 89.0% were regarded for analyses as being reliable data. RESULTS: More than 20% of residents were exposed to radiation, laser, disinfectants, anesthetic gas, and anticancer drugs during their training periods with preventive measures for each of these hazards taken in about 10% of the cases of the lesser hazards but in about 35% for the hazards from radiation and laser. 91.1% of residents had experience of needlestick injuries during their training periods with over 36.3% being exposed to patients with infection during that time. The cases contracting HBV and HCV diseases due to pricking are 2.3 and 0.6% respectively. The average number of night duties per month during a one-year resident's period was about 19. The average sleeping time on duty during a one-year residents was less than 4 hours .28.4% of respondents were not satisfied with their occupation, 96.5% felt tired from overwork and 69.5% wanted to change their occupation to another that would pay the same salary. CONCLUSION: Residents are exposed to harmful physical , chemical and biological factors, but the preventive care seldom undertaken. In addition, their overwork brings about lack of sleep which causes them problems when giving medical treatment to patients during their training periods. Despite the resident's interest in an occupation as a doctor, many intend to select other occupations if they can receive the same salary. According to the above results, preventative systems and measures should be prepared with environmental improvements for residents, and proper rewards for their overwork should be accomplished.

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.