[The influence of lifestyle and night-shift work on sleep problems among female hospital nurses in Japan].

STUDY OBJECTIVE: In this study, by conducting a questionnaire survey, we aimed to clarify the situation regarding sleep disorders in female hospital nurses and their relation with night-shift work and lifestyle. METHODS: The subjects were female nurses working at 5 hospitals, each with more than 400 beds. The survey was carried out in July 2000. The questionnaire contained six items concerning sleep quality from the Pittsburgh Sleep Quality Index (PSQI), two new items on sleep drafted by ourselves, and some questions on lifestyle and shift-work status. RESULTS: Among all female nurses, statistically significant differences were observed between those working and those not working night shifts for 7 items regarding sleep (P < 0.05). Significant correlations were observed between sleep disorders and the following factors: (1) working night shift, (2) having anxiety or stress, (3) getting less than 6 hours of sleep, (4) working in cities, (5) having children, and (6) bathing more than 1 hour before going to bed. In addition, significant correlations were observed between getting less than 6 hours of sleep and the following factors: (1) being 40 years of age or older, (2) working in cities, and (3) having anxiety or stress. CONCLUSIONS: The results of this study suggest that sleep problems among nurses are associated not only with night-shift work but also with lifestyle. They also suggest that nurses who work night shifts, especially in Tokyo, should try to get sufficient hours of sleep to ensure good quality of sleep.

Prevalence of chronic complications in Japanese diabetic patients.

In November 1990, we carried out a survey of chronic complications of diabetes in more than 2000 diabetic patients who were seen on one day in 35 medical institutions including university hospitals, other hospitals and small clinics. More than 60% were aged 55-74 years. About 7% of patients had IDDM. Hypertension was present in 38.5%. Proteinuria was positive in 20% and 1% of patients were on dialysis therapy. 28% had visual disturbance and 2.9% had blindness in one or both eyes. Retinopathy was observed in 38% and proliferative retinopathy in 10%. The prevalences of myocardial infarction, angina pectoris, cerebral infarction and foot ulcer and gangrene were 2.1%, 4.7%, 5.7% and 2%, respectively, including the histories of these complications. Amputation of lower extremities was seen in only 0.6%. Microangiopathies were generally more frequent and more severe in IDDM than NIDDM. The prevalence of microangiopathy was as common as, but macroangiopathy seems less frequent than, the figures given in 'Diabetes in America'.

[A study on stressful life events of workers in Japan].

The experience rates of eighteen life events of Japanese workers were surveyed and the strength of each of the events was evaluated by a self-reported questionnaire. The fifteen professions surveyed included construction, transport, mailing, chemical production, banking, newspaper, TV services, commercial publishing, advertising, teaching and civil service. The number of workers who answered was 18,657 males and 4,443 females, aged 20 to 59 years. The male workers were divided and analysed in six job groups: clerical workers (n = 5,866), professionals (n = 3,696), blue collar day workers (n = 1,623), blue collar night or shift workers (n = 3,191), drivers (n = 1,663) and construction workers (n = 2,466). They were divided into groups and compared according to job, sex and five different age groups. The highest experience rate in each of the life events such as family trouble for both sexes, death of a family member, financial trouble and anxiety, death of a close friend, dissatisfactory transport to workplace or job, respectively. Comparing the experience rates between males and females we found no significant difference for five items. However, other items had higher experience rates for males than for females with the exception of family trouble. In regard to the age characteristics of each of the life events, as the age increased the experience rates of health-related life events such as the death of a spouse, child, family member or close friend and one's own illness or injury became higher. In contrast, the experience rates of items such as moving to a worse residence and failure in a school or training program became lower as the age increased for both sexes. Among job groups, construction workers had the highest experience rates of most life events except for the item of dissatisfactory transport to the workplace or job. Among other job groups, drivers had higher experience rates in the following four items: re-employment, death of spouse, divorce and financial trouble and anxiety. Blue collar day workers had higher rates for failure in school or training program and family trouble. The blue collar night or shift workers had higher rates for failure in school or training program and dissatisfactory transport to the workplace or job. The mean values of strength in six life events: re-employment, death of a family member, death of a close friend, serious physical illness, dissatisfactory transport to the workplace or job and family trouble were stronger in females than in males.(ABSTRACT TRUNCATED AT 400 WORDS)

[Mental health and its related factors among middle-aged male workers: an eighteen-month follow-up study].

Based on a longitudinal questionnaire survey of 11,121 subjects (males aged 30-59, engaged in various occupations and firms), this study examined the relationships of the baseline psychosocial work environment and personal health practices to mental disorders which occurred during an 18-month follow-up period. The onset of mental disorders during the follow-up period was assumed to be the time when the subject reported to have received medical treatment for the first time due to mental disorder. The psychosocial factors of the work environment were conceptually constructed from two aspects of working conditions and occupational stress. Working conditions were assessed by actual working hours, frequencies of late night work (10 p.m.-5 a.m.), and role in the organization. Occupational stress was measured by psychological work overload and job characteristics (job demands, decision latitude). Various factors associated with positive health behavior were examined through an index based on six variables, that is, supper time, exercise, smoking, alcohol consumption, sleep and weight. Multiple logistic analysis showed that both psychological work overload and late night work have a significant independent effect on the onset of mental disorders after controlling for other variables.

[A study of birth weight of the Republic of Central Africa].

It is known that the rate of low birth weight in African developing countries is very high. A birth weight analysis based on their delivery charts is made in this paper for the babies born from 1988 to 1990 at two maternity hospitals, Castor and Boy-Rabe, in Bangui, the capital of the Republic of Central Africa. The total number of births amounted to 27,188 for Castor and 7,667 for Boy-Rabe, excluding multiple births. As a result, it was found that the youngest mother's age was twelve and the oldest fifty three, with the average age at the first delivery seventeen, followed by the another delivery every two years. Mean birth weight (MBW) values were significantly higher in Castor (males 3,134 +/- 527.5, females 3,018 +/- 511.6 grams) than in Boy-Rabe (males 3,017 +/- 542.6, females 2,909 +/- 507.1 grams). The total rate of low birth weight (LBW) under 2,500 grams was 10.9 percent. That of Castor maternity was 9.8 percent, while it was 14.7 percent for Boy-Rabe, which is significantly higher than the former. In addition, the rate of LBW is the highest in the first delivery for mothers younger than 16, while it is the lowest in the sixth delivery of the group of mothers group aged 25-29. Looking at the seasonal variation of LBW, we noticed that it became higher in July and August every year, the busiest period for farming, with harvesting followed by planting. These findings suggest that low birth weight infants are due to the age of delivery being younger than sixteen and also to the mother's heavy labor.

[Mental health, work environment, and health practices among middle-aged male workers].

A study was made on the cross-sectional relationship of the psychosocial work environment and personal health practices to mental health level among 15,639 male subjects aged 30-59 engaged in various kinds of occupations and firms. Mental health level was dichotomized by self-reported mental disorders. The psychosocial factors of work environment were conceptually constructed from the aspects of working conditions and occupational stress. Working conditions were assessed by work overload, work shifts and role in the organization. Occupational stress was measured by psychological work load and job characteristics (job demands and decision latitude). Various factors associated with positive health behavior--an index based on six parameters such as supper time, physical exercise, smoking, alcohol consumption, sleep, and weight--were examined. The prevalence of self-reported mental disorders was 17.5 per 1,000 population. Multiple logistic analysis showed that both psychological work load and health practice index have a significant independent effect on mental health levels after controlling for age and marital status. Limitations of the present study indicate a need for future longitudinal studies.

Long working hours and occupational stress-related cardiovascular attacks among middle-aged workers in Japan.

Two hundred and three Karoshi victims who suffered cardiovascular attacks and for whom workers' compensations was claimed were surveyed. These cases were 196 males and 7 females in middle age, and comprised 123 strokes, 50 acute cardiac failures, 27 myocardial infarctions and 4 aortic ruptures. As a sociomedical background, it was shown that two-thirds of them were working for long hours such as more than 60 hr per week, more than 50 hr overtime per month, or more than half of their fixed holidays before the attack. Moreover, among the white-collar workers, these long working hours were accompanied with other stressful work issues such as career problems, excessive business trips, strident norms, and changes of work places; among the blue-collar workers, they were accompanied with those such as irregular midnight work, insufficient manpower and long-distance driving, etc. On the other hand, eighty-eight cases of them experienced several minor and sudden events including work-related emotional anxiety or excitement, rapid increase of workload, unexpected work trouble or environmental changes of work places anticipated at least within 24 hr directly before the attack. It was concluded that Karoshi, meaning fatal attacks by overload, was one of the work-related diseases mainly triggered by long working hours.

[A five-year follow-up study of recipient rates for welfare allowance for the disabled elderly in a metropolitan area].

Improvement of the domiciliary care system for the disabled elderly is one of the most urgent issues of welfare for the elderly. In order to understand more clearly the utilization of domiciliary care service in a metropolitan area, we studied recipient rates for welfare allowance for disabled elderly which was the most frequently used welfare service. Between October 1984 and March 1985 a baseline survey was performed on a random sample of elderly living at home, aged from 65 to 89, in Shinagawa-ku, Tokyo. A follow-up survey of this sample of 873 persons was performed in November 1989 where survival and their recipience of welfare allowance were reviewed. The main results were as follows: 1. Recipient proportion of welfare allowance increased rapidly with disability of ADL. Of the severely disabled elderly at the baseline the recipient proportion was 46%. During the following five years 27% of the severely disabled were accepted as new recipients. 2. Recipient proportion of elderly who died at age 75 or greater for the following five years was more than 30%. 3. The recipient incidence rate of those who were non-recipient at baseline increased significantly with age after controlling for ADL. This indicates that the risk of ADL disability increases with age. 4. Mean recipient duration varied according to age. Mean durations for those aged over 80 and those under 80 were 2.1 years and 3.9 years respectively.

[A study on the physical effects of short-time recreation activities at a hot spring resort on unhealthy middle-aged workers].

A pilot study to improve unhealthy life habits of thirty middle-aged male clerical workers (45 +/- 3.58 yr.) with mild health disorders such as hypertension, hypercholesterolemia, diabetes mellitus and fatty liver was carried out. Under prohibition of smoking and alcohol intake, they spent five nights and six days at a hot spring resort, taking part in planned health training programs which included aerobic training, hiking in forests, hot spring baths, cooking practice and lectures about healthy life, controlled by medical, dietary and physical training staffs. To evaluate the short-term effects of these activities, body weight, blood pressure, serum lipid (total cholesterol, high-density-lipoprotein cholesterol, triglyceride, total free fatty acid and phospholipid), blood sugar, uric acid, gamma-glutamyl transpeptidase (gamma-GTP) and glutamic-oxaloacetic transaminase (GOT) were examined early in the morning of the second (before) and the fifth (after) days, and then their impressions of these recreation activities were monitored by questionnaires on the sixth day. By t-tests of all before-and-after data, it was shown that mean values of body weight, systolic blood pressure, high-density-lipoprotein cholesterol, triglyceride, phospholipid and gamma-GTP were improved, but fasting blood sugar, uric acid and GOT were not improved. In comparison of blood pressure levels, the hypertensive group (n = 9) showed lowering in both systolic and diastolic blood pressure, though the normal group (n = 10) had slight elevation. In addition, in the hypercholesterolemic group (n = 11, greater than or equal to 220 mg/dl) mean total cholesterol values decreased, conversely in the hypocholesterolemic group (n = 6, less than 180 mg/dl) they increased. Moreover, the obese group (n = 15, obesity index greater than or equal to 120%) showed greater decreases of body weight, triglyceride and phospholipid than the non-obese group. From questionnaires, it was confirmed that through these recreation activities most participants found mental and spiritual satisfaction, in spite of heavy physical loads. The short-term recreation activities under a stressless environment seemed to maintain the function of homeostasis in the body, but further investigation is needed to examine the relation between the contents of diets and physical activities, and to follow the long-term effects on the participants.

[Prevalences of allergic diseases among synthetic chemical workers].

We studied the prevalence of allergic diseases among synthetic chemical workers, using a cross-sectional questionnaire, to clarify the epidemiological evidence of occupational allergy due to chemicals which workers were handling and manufacturing. A file, registered in 1981, of 6,819 person, was used to calculate the prevalence during the preceding 12 months of "allergy," "asthma," and "skin disease," and to analyze the relationship between the prevalence and the exposure risks such as the work or the chemicals being manufactured. The main results were: 1) In workers who were exposed to the various chemicals, the prevalence of "allergy," "asthma," and "skin disease" were 3.2, 1.9, and 9.0%, respectively. 2) Among the workers who were engaged in the manufacturing of synthetic resins, paints, films, titania or pharmaceuticals, the prevalence of "allergy" was significantly higher than among others. The rates of "asthma" were significantly higher than others among workers in cosmetics, synthetic resins, or fertilizers. The rates of "skin disease" were significantly higher among those working with cosmetics, synthetic resins, paints, dyes, or organic solvents. The results indicate that allergy research should be concentrated on workers engaged in manufacturing the above chemicals.

[Some experiments on the allergic reaction among workers in a pharmaceutical factory (author's transl)].

A survey was made on workers handling powdered drugs in a pharmaceutical factory. In this factory, two kinds of anti-inflammatory enzyme (bromelain and trypsin), one anti-inflammatory agent (flufenamic acid), one antispasmodic (flopropion) and two kinds of antibiotics (ampicillin and cephalexin) are mainly produced. Twenty four workers were examined by interviews and checked by Cornell Medical Index, and 18 of them complained of respiratory symptoms. These 18 workers were physically examined by skin scratch tests, pulmonary function tests and serum immunological tests. Among 24 workers, 9 handled powdered drugs (A group), 5 handled the same in the past and had already been transferred to other sections for their symptoms (B group), 3 engaged in the process of capsul-filling (C group) and 7 handled several times occasionally during one year (D group). Their average months spent in handling powdered drugs were, in the case of anti-inflammatory enzyme, A group 53.2, B group 66.2, and in the case of antibiotics, 5 workers in A group 24.0, 2 workers in B group 7.0, 3 workers in C group 25.7. Twenty workers complained of symptoms which were mainly irritation of mucosa including the respiratory system and itching of the skin while they were working, and accelerated nasal discharge, urticaria and asthma after working. Group A and group B were higher than group D in the rate of respiratory complaints in C.M.I. (p less than 0.001). Fourteen workers pointed out anti-inflammatory enzyme as a cause of main symptoms, 7 workers flufenamic acid, 3 workers flopropion, 4 workers antibiotics. Three workers who had past history of asthma or articular rheumatism had been transferred to other sections. Of 18 workers who were physically examined, 11 workers showed positive reactions to skin scratch tests with handling drugs. On 8 workers of them, some kinds of drugs which were pointed out as drugs causing main symptoms reacted positively. Numbers of workers with increased immunoglobin values were, IgE 3, IgM 2, IgA 4, IgM 2. Two workers showed decreased FVC and FEV (1.0 sec.) values in pulmonary function tests. The causes of the occupational allergic reaction in this factory are guessed as follows: 1) control of powdered materials was incomplete in the process of production, 2) various kinds of sensitizing drugs were handled by the same workers.