[Cost-benefit analysis of mental health activities in the workplace].

In order to examine the cost-benefit of mental health care activities in the workplace, the total costs of the fiscal year 2005, during which the old-type mental health care was conducted, and those of the fiscal years from 2006 to 2008, during which the new-type mental health care was conducted according to the governmental guidelines of each year, were compared using about 3,000 workers in a particular workplace in 2005. The total cost comprised the sum of the medical fees, the payment compensation for sick absences, and expenditures for health care activities of mentally ill health workers. The total costs from 2006 to 2008 were not markedly different from those in 2005, and the benefit due to new-type activity was not shown. However, the following was found: payment compensation for sick absences accounted for 60% of the total cost; personnel expenses which were a large part of the expenditure of health care activities largely changed over the years because of the age structure of the staff in charge. The results show that a cost-benefit analysis may be a useful tool for examining health care activities in the workplace for various members in the workplace although health care issues usually tend to be solved by specialists.

[Application of multiple-attribute utility technology (MAUT) to decisions about a work-site stress-control intervention for public-sector office workers].

The reasons behind the establishment of particular health-promotion programs in community or work settings are often unclear, and such programs are rarely evaluated from a broad perspective after they are implemented. Thus, multiattribute utility technology (MAUT) was used to design a work-site stress-control program. The sample consisted of public-sector workers in B City in Japan. Stakeholders in the work-site stress-control program included employers (municipal authorities), employees (public workers), and healthcare personnel. Six goals and three strategies (i.e., personnel, self-care, and staff) related to stress-control programs were considered. The results showed that the self-care strategy received the highest score for overall utility (i.e., 96.2), and the overall-utility score for the remaining two strategies was approximately 70. The self-care strategy emerged as the most useful of the three strategies for developing a stress-control program in a target work place. The application of MAUT may be useful for developing an effective stress-control program in occupational settings.

Patient and physician perceptions of the physician's explanation and patient responses to physicians.

Although theories on meta-cognition and self-monitoring imply the importance of meta-cognition in patient-physician interactions, there is no evidence to support this hypothesis. Thus, we evaluated patient and physician perceptions of the level of a physician's explanation and explored the possible influence of patient meta-cognition on patient responses to physicians. We conducted a questionnaire survey of 579 internist-patient pairs in Japan. The findings show that patient meta-cognition, and not perception, of the sufficiency of a physician's explanation plays a critical role in determining extreme patient responses to a physician, such as ignoring the physician's advice and doctor-shopping, whereas patient perception is a predictor of milder patient responses such as patient understanding and satisfaction.

Media suicide-reports, Internet use and the occurrence of suicides between 1987 and 2005 in Japan.

BACKGROUND: Previous investigations regarding the effects of suicide reports in the media on suicide incidence in Japan have been limited and inconclusive and, although Internet use has greatly increased, its influence on suicide is completely unknown. Thus, the relationship between newspaper articles about suicide, Internet use, and the incidence of suicide in Japan was examined. METHODS: A linear model was fitted to time series data from January 1987 to March 2005 (218 months). RESULTS: Consistent with previous findings, the number of newspaper articles about suicide was a predictor of suicide among both male and female subjects. Internet use was also a predictor of suicide among males, probably because males spent more time online than females. CONCLUSION: Because this is the first, preliminary study examining the association between Internet use and suicide, further research is required to verify the present findings.

Association between physicians' communicative behaviors and judges' decisions in lawsuits on negligent care.

OBJECTIVES: Although findings of an association between physician communicative behaviors and the quality of health care have accumulated, the relationship between physician explanatory behaviors and negligent care has not been examined. The purpose of the study is to explore the association between physicians' explanatory behaviors and judges' decisions in lawsuits on negligent care. METHODS: We analyzed the decisions made by 10 of the 47 district courts in Japan between 1986 and 1998. We employed two types of linear model to examine the association between physician explanatory behaviors and findings of medical negligence. RESULTS: The quality of a physician's explanatory behaviors, together with listening and talking to the patient or family, was related to decreased probability of a court decision of negligent care. However, explaining and listening to patients or their families were also related to the increased level of compensation. CONCLUSIONS: The results imply that physician's explanatory behaviors accompanied by explaining and listening to patients or their families markedly reduces the risk of a negligent care decision. However, more detailed communication of the facts about a case was associated with an increased level of compensation in the context of cases filed for medical negligence.

Physicians' and patients' recognition of the level of the physician's explanation in medical encounters.

The association between patients' and physicians' evaluations of physicians' explanations of medical test results and diagnoses in actual practice was examined in this study. The participants were 630 physician-patient pairs in Japan. Loglinear models for matched-pairs data revealed the following: (a) Concerning the association between patients' and physicians' evaluations, the agreement plus uniform association model fit the data best, and (b) for the physicians' explanations, the physicians' and patients' judgment agreed on the explanation of the medical test results but not on the explanation of the diagnosis. In interacting with patients, physicians should bear in mind that their judgments do not always agree with those of patients with respect to the level of explanation necessary.

Doctor and patient perceptions of the level of doctor explanation and quality of patient-doctor communication.

BACKGROUND: Several measures, such as the frequency, duration and ratio of quantitative communication behaviours, have been used to evaluate patient-doctor communication; however, these measures have several major problems. Therefore, we examined whether doctors' and patients' perceptions of the level of doctors' explanations provide a better measure for evaluating the quality of patient-doctor communication. METHODS: The subjects were 630 doctor-patient pairs in Japan. One-way anova and multiple logistic regression analysis were used for the data analysis. RESULTS: Of 190 doctors and 950 patients selected randomly, 126 doctors and 630 patients returned questionnaires (response rates, both 66.3%). We found the following. (i) With respect to the sufficiency of the doctor explanation, the 'patient-better' situation (i.e. when patients' evaluations were better than doctors' evaluations) had a more positive influence on patients' outcome measures than did other situations. (ii) The 'doctor better' situation (i.e. when doctors' evaluations were better than patients' evaluations) had the most negative influence on patient outcome measures compared with the other situations. (iii) The length of clinical experience, patient gender and guidance concerning a change in lifestyle were predictors of the doctor-better condition in the two types of doctor explanations. CONCLUSIONS: A measure that classifies patient-doctor pairs into doctor-better and the other situations might be effective for evaluating the quality of patient-doctor communication. As this is a new approach to evaluating patient-doctor communication, more studies are necessary to verify these findings.

Physician and patient perceptions of the physician explanations in medical encounters.

Although, in actual practice, physicians have to subjectively judge the level of the explanation that they provide, little is known about this judgment. Therefore, making use of 630 physician-patient pairs in Japan, we investigated the association between patient and physician evaluations of physician explanations of medical test results and diagnoses. We found that the physician's judgment does not always agree with that of the patient, with regard to the level of explanation necessary. In addition, we first identified factors relating to the accuracy of physician judgments with regard to their explanations to patients. More studies will be necessary to verify the present findings.

A signal detection approach to patient-doctor communication and doctor-shopping behaviour among Japanese patients.

OBJECTIVES: As one of the factors related to doctor-shopping behaviour (i.e. consulting multiple doctors with regard to the same illness episode), very little has been revealed about the role of doctor explanation. We examined therefore the association between doctor explanation and doctor-shopping behaviour. METHODS: The subjects were internist-patient pairs in Japan. Signal detection analysis (SDA) was used for the data analysis. RESULTS: Of the 303 patients, 84 patients engaged in doctor shopping (27.7%). The following results were obtained: (1) of the 19 relevant variables, the 'level of doctor explanation: treatment' was the most significant predictor of doctor-shopping behaviour (P < 0.01), and (2) with regard to their subjective evaluations of the sufficiency of their explanations about treatment or testing, the evaluations of the doctors, rather than those of the patient, were significant predictors of doctor-shopping behaviour. CONCLUSIONS: These results imply the following: (1) a patient's inability to understand a doctor's explanation about treatment, which results from a large gap between the perceptions of the patient and those of the doctor, is the most significant predictor of doctor-shopping behaviour, and (2) in the context of favourable patient-doctor interactions, when doctors feel their explanations are insufficient, they may be able to prevent doctor-shopping behaviour by providing relatively thorough explanations about treatment.

Moderating effects of psychological job strain on the relationship between working hours and health: an examination of white-collar workers employed by a Japanese manufacturing company.

The effects of working hours on health were examined taking psychological job strain into account. White-collar workers employed at the main office of a Japanese manufacturing company provided data for analysis done in 1997. The eligible subjects were 286 workers aged 20-39. Causal relationships between working hours, health, and psychological job strain were examined by covariance structure analyses. The main findings were as follows: Not only working hours but also sleeping hours and vacations affected the workers' effort to deal with work as a work-related hour factor. Decision authority and skill discretion of Karasek's psychological job strain items significantly constituted a discretion in the work factor, and this factor moderated the effects of the work-related hour factor on health. The effects of psychological job strain, especially discretion, must always be taken into account in examinations of working hours and health.

A prospective observation of onsets of health defects associated with working hours.

A prospective study examined whether working 50 hours or less per week was associated with an increase of mental and circulatory disorders, and if so, whether it was significant for managing workers' health. White-collar workers aged 20 to 60 working at an office of a Japanese company were surveyed from August 1997 to March 2001. The onsets of the diseases were confirmed using medical insurance claims, and the overall incidence rates were 6.6 and 15.7 per 10,000 person months for both the disorders, respectively. Though not significant, those who worked 45 hours or more showed higher relative risks for mental disorders compared with those who did not. No other analysis indicated distinct findings. The small number of onsets of the diseases, the attention to personal health for workers who worked shorter hours, and intensive health care system for circulatory diseases in the workplace may partly account for the findings above. However, through reviewing other reports, it was suggested that the perception of work time could disturb the association between these findings, especially for white-collar workers. Also, it might be useful to observe the onset of mental disorders in work of less than 50 hours with the workers' perception of work time.

Positive and negative effects of social support on the relationship between work stress and alcohol consumption.

OBJECTIVE: This study was performed to evaluate both positive and negative influences of social support on the relationship between work stress and alcohol consumption in male white-collar workers. METHOD: This study was performed in a population of male white-collar workers in Osaka, Japan. The subjects (N = 661) were categorized into nine subgroups based on the moderated mediation model of Frone and on the results of signal detection analysis using chi-square parameters calculated from work stressors and depression (mediators). Hierarchical linear regression analyses were performed among the nine subgroups to test the effects of interactions between four types of social support (i.e., two types of belonging support and two types of appraisal support) and work stress on alcohol consumption. RESULTS: Our results verified that social support has both positive and negative effects on the relationship between work stress and alcohol consumption: (1) interactions between "belonging support (1)" and depressive symptoms were related to decreased alcohol consumption in two subgroups (p < .01 in Group 1 and p < .05 in Group 6), whereas the interaction was related to increased alcohol consumption in one subgroup (p < .01 in Group 7); (2) interaction between "belonging support (2)" and depressive symptoms was related to decreased alcohol consumption in two groups (p < .05 in Group 5 andp < .01 in Group 7), whereas the interaction was related to increased alcohol consumption in one group (p < .01 in Group 1). CONCLUSIONS: Social support was suggested to have various types of influences (i.e., positive, negative or no effect) on the relationship between work stress and alcohol consumption, depending on the type of social support and environmental factors defining the groups.

Grouping participants for tailored work-site weight loss programs: a signal detection approach.

BACKGROUND: Although work-site obesity prevention programs have been widely promoted, they have a high rate of attrition and participants find it very difficult to maintain the decreased weight. It is necessary to develop effective work-site programs that match the type of intervention to the participants and offer the necessary support. To this end, higher-order interaction of the causal factors of obesity needs to be analyzed. METHODS: The subjects were male, white-collar workers (20-64 years of age), in Osaka, Japan. Since conventional methods, such as regression analysis or analysis of variance, cannot deal with the interaction of many variables, signal detection analysis by Kraemer was used to identify the higher-order interaction of multiple predictors of obesity. RESULTS: Out of 15 independent variables, a higher-order interaction consisting of 8 significant variables was identified. Consequently, the subjects were categorized into nine subgroups. It was revealed that the obesity of two groups of workers, 40 or more years old with a high degree of obesity, had different causes: one was related to working conditions, and one was related to smoking cessation. For the other terminal groups, further factors related to obesity were revealed. CONCLUSION: Although the applicability of the findings is limited, the methodology using signal detection analysis might be applicable to other weight loss programs as a way of facilitating the matching of the type of intervention and the target group.

[The present state and forthcoming problems in the work of occupational health physicians engaged in the workplace].

The authors conducted a survey in July 2001 to examine the present state and forthcoming problems facing occupational health physicians (OHPs). The establishments investigated were those which employed 1,000 or more workers and had consulted us for the employment of OHPs. The number of establishments chosen was 1,658. A questionnaire was sent to the division chiefs responsible for the health management of the establishments, and those who supervised the OHPs engaged in the establishments were asked to complete the questionnaire. The questionnaire included items about the attributes of the perspective establishments, the work of OHPs and the personnel management system for the OHPs. Four hundred and forty-seven establishments (27.0%) out a total of 1,658 returned eligible responses for further analysis, and the major results were as follows: First, 79.2% of the manufacturing establishments which responded comprised those which employed 1,000 or more workers, even though the percentage of companies which employ 1,000 or more workers throughout Japan is 62.5%. The percentage of the establishments which employed full time OHPs was 64.2% in secondary industries (mining, constructing and manufacturing), and higher than the 40.8% in tertiary industries (other than farming, forestry, fishing and secondary industries). Second, although OHPs properly coped with the obligatory issues regulated by the related laws, the OHPs who routinely consulted with workers about their work-related health problems were few (36.7%). Third, despite the low percentage of the establishments (23.5%) which had recognized OHPs' work to be part of enterprise management, the budget of the health care section was kept unchanged (55.0%). And, in 49.0% of the establishments, the nomination of OHPs was recognized to be necessary irrespective of the presence of the related laws, and OHPs were expected to cope with the work-related health problems of workers (62.9%). On the other hand, the personnel management system for OHPs was insufficient, and the performance rating for OHPs' activity was prepared for only 50.3% of the establishments. In addition, when the subjects were confined to regular OHPs, they were allowed to attend internal training courses for regular employees in only 25.0% of the establishments. Taking the above into account, the activity of OHPs has to be developed more in tertiary industries. OHPs may also be asked to positively cope with workers' work-related health problems. Simultaneously, the personnel management system for OHPs has to be arranged properly.