[Epidemiological study of factors associated with quitting a job among pregnant working women].

OBJECTIVE: More women in Japan continue to quit a job when they find out they are pregnant than in other industrialized countries. The purpose of this study was to clarify factors affecting the quitting rate among female workers who become aware they are pregnant. METHODS: All pregnant women visiting or admitted to seven obstetrics medical institutions in Nara Prefecture between November and December 2004 for examination or delivery were surveyed. Of these women, 603 who were working when they discovered their pregnancy were subjects of the analysis. Quitting a job was treated as an event occurrence, and those working at the time of the survey were considered censored cases. The Kaplan-Meier method was used to determine the trend of the quitting rate associated with gestational weeks. The Cox proportional hazard model was used to examine the relationship between quitting a job and workplace factors such as number of staff at the workplace, types of employment, and availability of a legal maternity protection system, and individual factors such as age and thoughts (both subject's and husband's) on continuing work. RESULTS: The quitting rate up to delivery was 63.1%, but this increased to 69.8% when limited to pregnancy with a first child. Significantly independent factors behind continuation of work after discovering pregnancy were the following: receiving time off for medical examinations (HR=0.59, 95% CI (0.41-0.83)), availability of a child care leave system (0.37 (0.22-0.63)), arranged support system after returning from maternity and child care leave (0.60 (0.42-0.87)), workplace ambience is supportive of working after marriage and childbirth (0.59 (0.43-0.81)), and the subject (0.63 (0.43-0.93)) or husband (0.50 (0.30-0.86)) considers it good to continue working during pregnancy. In contrast, a non-regular employee (1.93 (1.46-2.56)) and being young (1.74 (1.10-2.75)) were factors behind quitting a job. CONCLUSIONS: Key conditions that encourage work continuation after becoming aware of pregnancy include creative adjustments at the workplace, motivating women and their husbands to consider work intentions, and having an established legal maternity protection system in the workplace. Moreover, comprehensive implementation of a child care leave system that is not available to all non-regular employees is also desirable.

Work-related aggression and violence committed by patients and its psychological influence on doctors.

OBJECTIVES: To determine the incidence rate of work-related aggression and violence (WRAV) against doctors and investigate risk factors and psychological influences of WRAV doctors. METHODS: We sent a self-administered questionnaire on WRAV committed by patients and their associates to 1,148 doctors in Nara Prefecture, Japan. We calculated the incidence rate of WRAV using the number of incidents encountered during the previous 12 mo and the doctor's average weekly working hours. Risk factors for the incidence WRAV were analyzed by Poisson regression, and the influence of WRAV on the symptoms of post-traumatic stress disorder (PTSD) was evaluated by multiple logistic regression analysis. RESULTS: A total of 758 (66.0%) doctors returned the questionnaire. The incidence rate of WRAV was 0.20 [95% CI: 0.17-0.24]×10(-3) per practice hour. Adjusted incidence rate ratios of WRAV were significantly increased among doctors 1) with a shorter career (11.0; 95% CI: 5.0-24.2), 2) working in a region with the lowest average taxable income (1.6; 1.1-2.4), and 3) whose specialties were dermatology (3.8; 2.3-6.3), psychiatry (2.7; 1.3-5.6) and ophthalmology (1.9; 1.2-3.2). Of 289 subjects who had encountered WRAV at least once during their career, 26 doctors (8.2%) had symptoms suggestive of PTSD due to the most severe incident. CONCLUSIONS: Doctors encountered WRAV at an incidence rate of 0.20×10(-3) per practice hour, and some of them might develop PTSD. Countermeasures are required to maintain sound health and safe workplaces for doctors.

Oxidative DNA damage and tubulointerstitial injury in diabetic nephropathy.

BACKGROUND: Oxidative stress is an important pathogenetic factor in underlying diabetic complications. Recently, 8-hydroxy-2'-deoxyguanosine (8-OHdG) has been reported to serve as a new sensitive biomarker of the oxidative DNA damage in vivo. We studied the relationship between oxidative DNA damage and tubulointerstitial injury in patients with diabetic nephropathy. METHODS: Type 2 diabetic patients (n = 25) and healthy control subjects (n = 20) were studied. The urine concentrations of 8-OHdG were measured by a competitive ELISA. The severity of the glomerular changes was graded using Gellman's criteria, and the severity of the tubulointerstitial lesions was determined by a semiquantitative estimate of the space occupied by the fibrous tissue and/or interstitial infiltrates. RESULTS: The urinary 8-OHdG excretion were significantly higher in the diabetics than in the healthy controls, and tended to increase with severity of the glomerular diffuse lesion, but it was not significant. The urinary 8-OHdG excretion significantly increased with severity of the tubulointerstitial lesion. CONCLUSIONS: Oxidative stress may contribute to the progression of tubulointerstitial injury in patients with diabetic nephropathy.