An initial analysis: working hours and delay in seeking care during acute coronary events.

BACKGROUND: The purpose of the study was to examine the association between working hours, job strain, and duration of prehospital delay in seeking care by employed patients with acute coronary syndrome (ACS) in the United States and Japan. DESIGN AND SUBJECTS: In this cross-sectional study, a total of 234 consecutive patients (Americans, n = 148; mean age, 50.7 [SD +/- 7.1] years and 73.6% male, and Japanese, n = 86; mean age, 56.3 [SD +/- 11.0] years and 93.0% male) admitted with ACS who worked more than 20 h/wk were recruited. A structured interview was conducted while patients were hospitalized to assess prehospital delay time, ambulance use, number of working hours per week, and job strain. RESULTS: In the US sample, the median delay time was 4.4 hours, whereas in the Japanese sample, the median delay time was 8.3 hours. Average working hours per week in the US and Japanese samples were 49.7 (SD +/- 13.2) hours and 55.1 (SD +/- 19.5) hours, respectively. In multivariate analysis, the interaction between working hours and nationality on log-transformed delay time was significant (P = .001) after controlling for potential confounding factors. Among the Japanese sample, for every 1-hour increase in working hours per week, prehospital delay increased by approximately 4% (95% confidence interval [CI]; 1.0%-7% [P = .003]). However, among the US sample, no association was found (-2.0%; 95% CI, -4.0% to 0%; P = .08). CONCLUSIONS: These findings support the need for worksite educational programs, particularly in Japan, that encourage a rapid response to acute cardiac symptoms.

Effect of job strain and depressive symptoms upon returning to work after acute coronary syndrome.

The purpose of this study was 2-fold: to assess whether job strain and depressive symptoms were independent predictors of the timing of return to work after acute coronary syndrome, and to determine whether the association of job strain and timing of return to work was moderated by depressive symptoms. In this 6-month longitudinal study, a total of 240 employed women and men who were admitted to hospital with acute coronary syndrome were consecutively recruited in the United States and Japan. A structured interview and medical record review were conducted to collect baseline data during hospitalization. At 2 and 6months post-hospitalization, we mailed a questionnaire to assess the timing of first day of return to work and presence of depressive symptoms. It was found that job strain was a significant independent predictor of a later return to work, even after controlling for potential confounding variables. In addition, when depressive symptoms were treated as a time-dependent covariate, patients who had Beck Depression Inventory-II scores of > or =6 to <16 or > or =16 were slower to return to work than patients with scores <6. An earlier return to work might be promoted by interventions focused on reducing psychological job demand, increasing perceived job control, and treating depressive symptoms.