Poor Psychosocial Safety Climate Increases Teleworker Vulnerability to Suicidal Ideation.

OBJECTIVE: Suicide is the leading cause of death among the working-age population in Japan. Unlike task-level occupational factors, the relation between suicidal ideation and psychosocial safety climate (PSC), a crucial organization-level factor to protect workers' psychological health, is understudied, especially among teleworkers. METHODS: A cross-sectional web-based survey was used to select 1988 participants. A series of multivariable logistic regression analyses with the interaction term of PSC and teleworking arrangements was performed. RESULTS: Poor PSC was associated with a higher risk of having suicidal ideation (adjusted odds ratio = 1.57, P = 0.008), and its relation was pronounced among teleworkers (adjusted odds ratio for the interaction term = 1.96, P = 0.035), even after adjusting for task-level occupational factors. CONCLUSIONS: This empirical study highlights the heightened risk of suicidal ideation by poor PSC, especially among teleworkers.

Insufficient Workplace Infection Control and Unhealthy Lifestyle Behaviors Are Related to Poor Self-Rated Health During the COVID-19 Pandemic.

OBJECTIVE: This study investigated whether workers who practiced unhealthy lifestyles but worked under organizations with insufficient control against coronavirus disease 2019 (COVID-19) would pose a synergistic risk of poor self-rated health (SRH). METHODS: A total of 22,637 workers (men, 48.5%) were extracted from an online survey during the COVID-19 pandemic in Japan (December 2020). Multiple logistic regression analyses were performed to estimate adjusted odds ratio (AOR) against poor (poor, fair) SRH. RESULTS: Accumulation of unhealthy lifestyle behaviors (AOR, 1.49 to 4.40; P < 0.05) and insufficient infection control (AOR, 1.80; P < 0.05) were independently related to poor SRH; however, when these factors were combined, SRH was additively worsened (AOR, 2.14 to 7.72; P < 0.05). CONCLUSIONS: This study highlights that not only unhealthy lifestyle practices but also poor organizational management against infection would worsen workers' SRH during the COVID-19 pandemic.

Changes in work/sleep patterns due to the COVID-19 pandemic are associated with psychological distress among Japanese workers.

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted working life quality. This study investigated whether changes in work/sleep patterns due to the pandemic are related to poor psychological status among Japanese workers during the third wave of the COVID-19 pandemic (December 2020). We hypothesized that workers who experienced drastic changes in working hours and sleep duration would be at an increased risk of psychological distress. Methods: A cross-sectional self-administered Internet survey was conducted that included questions regarding socio-demographics, lifestyle, health, and occupational background and conditions. Multivariable logistic regression models were utilized to examine the association between psychological distress and a combination of changes in working hours and sleep duration. Results: Among 25,762 workers, decreased work hours and decreased sleep duration presented 2.59 times higher odds of psychological distress (95% confidence interval [CI] = 2.05-3.28) compared to those who had no changes in work hours combined with unchanged sleep duration (reference group). Increased work hours and decreased sleep duration were associated with 1.98 times higher odds of psychological distress (95% CI = 1.64-2.39). Conclusion: Our observations confirmed that decreased sleep duration could be a key factor for psychological distress, irrespective of working hours. Interestingly, workers with a combination of decreased work hours and sleep duration posed the highest risk of psychological distress. Decreased work hours accompanied by financial difficulties in the early stage of the pandemic may have caused decreased sleep duration, resulting in a high prevalence of psychological distress. Our study underlined the importance of sleep management in maintaining workers' mental health, moreover, the need to consider situations and conditions of other daily tasks, such as work hours, for better sleep management.

Psychological Distress, Japanese Teleworkers, and Supervisor Support During COVID-19.

OBJECTIVE: During the COVID-19 pandemic, teleworking became the new workplace norm, creating a new challenge for workplace communication. This study investigated the association between source-specific workplace social support and psychological distress among Japanese teleworkers and nonteleworkers. METHODS: A total of 15,045 workers were extracted from a cross-sectional web-based survey that assessed psychological distress, workplace social support from supervisors and coworkers. After grouping participants into four groups based on their positions (managers, staff members) and teleworking arrangements (teleworking, nonteleworking), multiple logistic regression analyses were performed separately. RESULTS: Teleworkers with less supervisor support demonstrated the highest risk of psychological distress (adjusted odds ratio = 2.55, P = 0.024). CONCLUSIONS: Insufficient supervisor support for teleworking staff members may be a key occupational risk factor for psychological distress in the postpandemic future.

Perspectives on Collaboration between Physicians and Nurse Practitioners in Japan: A Cross-Sectional Study.

BACKGROUND: Nurse practitioners (NPs) are known as effective healthcare providers worldwide. In Japan, nurse practitioner adoption is considered to be in a shaky period. Although nurse practitioners were introduced approximately 10 years ago at the initiative of educational institutions in Japan, the full extent of this trend is not known. Therefore, we have clarified the whole picture of nurse practitioners from two directions: the perception of nurse practitioners in Japan and the perception of physicians who work with nurse practitioners. This will inform discussions regarding the recruitment of nurse practitioners at the national level in Japan. METHODS: From 18 June to 24 July 2021, we administered a nationwide cross-sectional survey of NPs and physicians working in the same clinical settings as NPs in Japan. The domains of the survey included "scope and content of work", "perceptions of NPs' clinical practice", and "individual clinical practice characteristics". The survey was distributed and collected digitally. RESULTS: The total number of respondents to the survey was 281, including 169 NPs and 112 physicians; the percentage of NPs who responded was 50.5%. The number of valid responses was 164 NPs and 111 physicians, for a total of 275 respondents. Approximately 60% of NPs are concentrated in Tokyo, the capital of Japan, and the three prefectures adjacent to Tokyo. They also worked fewer hours per week, cared for fewer patients per day, and earned less money than physicians. More physicians than NPs indicated that "more NPs would improve the quality of care". A total of 90.1% of physicians and 82.3% of NPs agreed that "Nurse practitioners should practice to the full extent of their education and training," and 73.9% of physicians and 81.7% of NPs agreed that "Nurse practitioners' scope of practice should be uniformly defined at a national level". CONCLUSIONS: This study clarified the present working conditions of NPs from NPs' and physicians' perspectives in Japanese contexts. Japanese NPs may be able to work effectively in collaboration with physicians. Therefore, the implementation of NPs in Japanese medical conditions should be discussed further for better healthcare.

Burnout and poor perceived health in flexible working time in Japanese employees: the role of self-endangering behavior in relation to workaholism, work engagement, and job stressors.

The study aim was to examine whether flexible working time was associated with burnout and poor perceived health in relation to the work-related psychological/behavioral factors of self-endangering work behavior (SEWB), workaholism, work engagement, and job stressors. We analyzed data obtained from an Internet survey of 600 full-time Japanese employees. We also proposed a causal model using path analysis to investigate the overall relationships of burnout and perceived health to psychological/behavioral factors. The results indicated that flexible working time was associated with adverse work-related consequences and factors such as increased burnout, working hours, SEWB, workaholism, and job demands, and with positive factors such as improvement of work engagement. The path analysis suggested that burnout was caused by workaholism both directly and via SEWB, and by low job decision latitude, and was reduced by work engagement. Similarly, it was observed that poor health was caused by workaholism via SEWB, and reduced by work engagement. Thus, SEWB is driven by workaholism and plays a key role in the adverse health consequences of flexible working time. For workers to benefit from flexible working time, it is important to improve workaholism, SEWB, and low job decision latitude, and to develop work engagement in the workplace.

Giving social support at work may reduce inflammation on employees themselves: a participatory workplace intervention study among Japanese hospital nurses.

Previously, we reported that the participatory workplace intervention was effective in reducing stress-related inflammatory markers among 31 Japanese female nurses. During the analysis, we recognized that our intervention might have increased prosocial behaviors like giving social support to others in some participants. Based on this assumption, we ran a secondary analysis, which examined the effect of giving social support on inflammatory markers, autonomic nervous activity (ANA), and perceived job stress (PJS) before and after the intervention. A group of participants who had increased scores on giving social support (n=13) showed significant decreases in interferon-γ, interleukin-6, and interleukin-12/23p40 after the intervention. Another group of those who had decreased/unchanged in the scores (n=17) did not show changes in these markers. Regarding ANA and PJS, no significant changes were observed in both groups. This study presented insight that giving social support at work may provide health benefits towards employees themselves, via decreasing inflammation.

Development of the Japanese Version of the Self-Endangering Work Behavior (J-SEWB) Scale.

Objective: The concept of self-endangering work behavior (SEWB) was recently proposed to describe problematic behaviors to cope with heavy workloads and self-management. Although SEWB may enable workers to achieve immediate goals, it risks health and long-term work capacity. In this study, we developed a Japanese version of the SEWB (J-SEWB) scale, which was originally in German, and verified its validity and reliability. Materials: The original SEWB scale consisted of 21 items, constituting five subscales: "Intensification of working hours," "Prolongation/extension of working hours," "Refraining from recovery/leisure activities," "Working despite illness," and "Use of stimulating substances." We translated the scale into Japanese, then checked the wording using back-translation. Methods: The J-SEWB scale and questions for working conditions and sociodemographic variables was administered via an online survey with 600 participants registered with an internet survey company in Japan. Cronbach's α coefficients were calculated for each subscale to assess internal consistency. Construct validity was examined using principal factor analysis with equamax rotation. An analysis of variance evaluated the relationships of J-SEWB scores with working conditions and sociodemographic variables. Results: Cronbach's α coefficients ranged from 0.846 to 0.964 for five subscales, and 0.957 for all 21 items (total J-SEWB score) in 600 participants. The factor analysis identified five factors, classifying 21 items into corresponding subscales. Total J-SEWB scores were significantly higher for flexible work as well as longer working hours. Conclusions: The J-SEWB scale appears to be an effective tool for assessing SEWB in Japanese employees, with satisfactory reliability and construct validity.

Exploring the Competencies of Japanese Expert Nurse Practitioners: A Thematic Analysis.

Nurse practitioners (NPs) provide medical care equivalent to that of physicians and facilitate access to healthcare. Although Japan's first NP graduated in 2010, how Japanese expert NPs work effectively in clinical contexts is yet to be investigated. We aimed to identify the competencies that make expert NPs in Japan effective. Twelve Japanese expert NPs were purposely selected. The average age of the participants was 44.8 years, average NP experience was 7.5 years, and eight participants were women. Semi-structured interviews were conducted online from March to May 2021. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Thematic analysis revealed five themes: working in physicians' contexts, interprofessional collaboration, involvement in nurses' work, contribution to healthcare, and personal qualities for effective working. Japanese expert NPs can function effectively in clinical settings by flexibly and humbly collaborating with other medical professionals who have autonomous positions. They can improve the quality of healthcare by proposing practical solutions to problems faced by patients and medical organizations. These explored competencies can be applied to other aging and more complex societal contexts, and in updating the required competencies of Japanese NPs.

International cooperation on health and medical care for viral hepatitis: 30 years of activities on comprehensive viral hepatitis control of the JICA group training program for developing countries.

The National Hospital Organization Kumamoto Medical Center has conducted a group training course for health care workers (HCW) from developing countries on viral hepatitis and its related diseases in cooperation with the Japan International Cooperation Agency, for 30 years. In the first 10 years, the course included acquired immunodeficiency syndrome (AIDS), adult T-cell leukemia/lymphoma (ATL), and hepatitis. Following the discovery of the hepatitis C virus and the genotype of the hepatitis B virus, and development of treatments for hepatitis, viral-related cirrhosis, and cancer, the course was divided into two courses. In 2015, the hepatitis training course was renewed as the "Comprehensive Countermeasure for Virus Hepatitis", which ended its role in February 2018. Between 1998 and 2017, 175 HCW from 43 countries, including 36 participants from Egypt, participated. Between October 11 and 20, 2019, we conducted a follow-up survey of the results of the training and conducted a field visit on hepatitis control in Egypt.

Effects of participatory workplace improvement program on stress-related biomarkers and self-reported stress among university hospital nurses: a preliminary study.

Although participatory workplace improvement programs are known to provide favorable effects on high stress occupations like nursing, no studies have confirmed its effect using biomarkers. The aim of this study was to determine whether a participatory workplace improvement program would decrease stress-related symptoms as evaluated by biomarkers and self-reported stress among hospital nurses. Three actions to alleviate job stress, which were determined through focus group interviews and voting, were undertaken for two months. A total of 31 female Japanese nurses underwent measurement of inflammatory markers, autonomic nervous activity (ANA), and perceived job stress (PJS) at three-time points; before the program (T1), within a week after the completion of the program (T2), and three months after the program (T3). A series of inflammatory markers (Interferon-γ, Interleukin (IL)-6, and IL-12/23p40) decreased significantly at T2, and IL-12/23p40 and IL-15 significantly decreased at T3 compared to T1, while ANA and PJS remained unchanged. Our participatory program exerted beneficial effects in reducing inflammatory responses, but not for ANA and PJS. Further investigations with a better study design, i.e., a randomized controlled trial, and a larger sample size are warranted to determine what exerted beneficial effects on inflammatory markers and why other outcomes remained unchanged.

[Association of self-rated health with inflammatory markers among nursing home employees].

OBJECTIVES: Although self-rated health (SRH), the self-evaluation of one's own health status, has been reported to be associated with the immune status, the relationship between three different SRH measures (global, self-comparative, and age-comparative) with inflammatory markers as well as the relative strength of these associations by age are not well understood. The current study investigated the associations between SRH measures and inflammatory markers among nursing home employees. METHODS: A sample of 120 Japanese employees at a nursing home (90 women and 30 men), aged 21-68 years (mean, 40.9 years), underwent a blood test for the measurement of inflammatory markers (interferon-γ, interleukin [IL]-4, IL-6, and tumor necrosis factor [TNF]-α, white blood cell count) and SRH during the annual health checkup. Multiple regression analysis adjusted for covariates was performed to analyze the relationship between inflammatory markers and SRH measures stratified by age, that is, aged < 40 years (younger age group) and 40 years and over (older age group). RESULTS: Among the participants aged 40 years and over, poor global SRH was significantly associated with an increase in IL-6, while poor age-comparative SRH was significantly associated with an increase in TNF-α among participants aged < 40 years in the fully adjusted model controlling for potential confounders. Age-comparative SRH was also significantly associated with an increase in IL-6 among all participants. Self-comparative SRH was not significantly associated with inflammatory markers. CONCLUSIONS: Our results suggest that three SRH measures are not equivalently associated with inflammatory markers, especially when the analyses were performed separately for the younger and older populations. This implies that not only differences in forms of SRH but also in age modify the relationship between SRH and inflammatory markers.

Trends in Uterine Cervical Cancer Screening at Physical Health Checkups for Company Employees in Japan.

The consultation rate for uterine cervical cancer screening in Japan is markedly low in comparison with other developed countries. The purpose of this study is to investigate the trends in uterine cervical cancer screening during regular company checkups and to identify potential problems. Questionnaires were sent to occupational health physicians through Sansuiken (Alumni Association of the University of Occupational and Environmental Health, Japan). Overall, 127 valid responses showed that Papanicolaou (Pap) tests are conducted in 100 companies (79%). The detailed information from 50 of the 100 responses was analyzed. Mandatory cervical cancer screenings are performed at just 6 companies (12%). Pap test are started at 30 years of age at 9 of 49 companies, and only 18 of 49 companies (37%) start Pap tests for employees at 20 years old. Of the 86,695 women, 31,294 (36%) received cervical cancer screening. Abnormal Pap test results were detected in 3.0%. Although cervical cancer screening rates have slightly increased compared to our previous studies (17% in 2004, 23% in 2008), it remains at a low level. Complete examinations with colposcopy and punch biopsy were carried out in 70% (61 of 87 women) of those with an abnormal Pap test. Twelve of 26 companies had no information about detailed examination results. It is important to note that cervical cancer incidence and mortality are increasing among young women in Japan. Occupational physicians and health nurses should manage female health education and care at the workplace, by including uterine cervical cancer screening in the growing female working population.

[Stressors and the Sense of Coherence Related to the Mental Health of Nurses Assuming the Roles of Wives and/or Mothers - Investigation into the Effects of Leaving Jobs Because of Marriage, Childbirth, and Childrearing].

Many female nurses leave their jobs because of major life events. However, the mental health status and related factors among nurses who assume the roles of wives and/or mothers have been insufficiently examined. Therefore we examined the mental health levels and related factors among such nurse. We conducted a questionnaire survey on 763 female nurses working at general hospitals with over 200 beds in Fukuoka Prefecture. Of 402 responses, 108 were divided into two groups: nurses who had left because of marriage, childbirth, or childrearing (leaving group), and those who had not (non-leaving group). The following were assessed: work satisfaction level, the Brief Job Stress Questionnaire, The General Health Questionnaire (GHQ) 28, and the Sense of Coherence (SOC) scale. Results showed that nurses who had assumed the roles of wives and/or mothers had lower mental health status than general women, and nurses who retained their jobs had higher mental health status and sense of comprehensibility on the SOC scale than those who left. Multiple regression analyses using the total GHQ score as an objective variable showed that only the sense of comprehensibility on the SOC scale correlated with mental health status in the non-leaving group. For the leaving group, having support, high work and life satisfaction levels, and several work stressors were correlated. These findings strongly suggest that to maintain and improve the mental health of nurses who assume the role of wives and/or mothers, greater support, higher satisfaction, reduced stressors, and maintenance and improvement of the sense of comprehensibility are required.

A Pilot Study of Healthy Living Options at 16 Truck Stops Across the United States.

PURPOSE: There is a growing body of evidence that the built environment influences diet and exercise and, as a consequence, community health status. Since long-haul truck drivers spend long periods of time at truck stops, it is important to know if this built environment includes resources that contribute to the emotional and physical well-being of drivers. SETTING: The truck stop environment was defined as the truck stop itself, grocery stores, and medical clinics near the truck stop that could be accessed by a large truck or safely on foot. DESIGN: Researchers at the National Institute for Occupational Safety and Health (NIOSH) developed and utilized a checklist to record the availability of resources for personal hygiene and comfort, communication and mental stimulation, health care, safety, physical activity, and nutrition at truck stops. SUBJECTS: The NIOSH checklist was used to collect data at a convenience sample of 16 truck stops throughout the United States along both high-flow and low-flow truck traffic routes. MEASURES: The checklist was completed by observation within and around the truck stops. RESULTS: No truck stops offered exercise facilities, 94% lacked access to health care, 81% lacked a walking path, 50% lacked fresh fruit, and 37% lacked fresh vegetables in their restaurant or convenience store. CONCLUSION: The NIOSH found that most truck stops did not provide an overall healthy living environment.

Long working hours, job satisfaction, and depressive symptoms: a community-based cross-sectional study among Japanese employees in small- and medium-scale businesses.

Although long working hours have been suspected to be a risk factor for depressive symptoms (DS), it is not well understood the conditions under which long working hours are associated with it. This study investigated the moderating effect of job satisfaction on the relationship between working hours and DS. A total of 2,375 full-time non-shift day workers (73% men), aged 18-79 (mean 45) years, in 296 small- and medium-scale businesses were surveyed using a self-administered questionnaire evaluating working hours, job satisfaction, DS and covariates. The Center for Epidemiologic Studies Depression scale (CES-D) was used to assess DS. Risk of DS (CES-D ≥ 16) by working hours, job satisfaction, and both combined was estimated by multivariable logistic regression analysis. Compared to participants working 6-8 hrs/day, those working 12+ hrs/day had significantly higher odds of DS (adjusted odds ratio [aOR] 1.49), while participants with low satisfaction, as opposed to high satisfaction, had increased odds of DS (aOR 1.81). Furthermore, compared to those working 6-8 hrs/day with high satisfaction (reference group), participants working 6-8 hrs/day, > 8 to 10 hrs/day, and > 10 hrs/day combined with low satisfaction had dose-response increase of DS (aOR 1.48, 2.21 and 2.31, respectively, p < 0.05), whereas those working > 8 to 10 hrs/day and > 10 hrs/day combined with high satisfaction had not (aOR 0.93 and 1.39, respectively, p > 0.10). The results suggest that long working hours are associated with increased risk of DS only under reduced job satisfaction condition, which highlights the importance of improving job satisfaction, particularly among those working excessive hours.

Occupational safety and health aspects of corporate social responsibility reporting in Japan from 2004 to 2012.

BACKGROUND: A number of companies publish corporate social responsibility (CSR) reporting in booklets and other publicly available formats. The purpose of this paper is to clarify the nine-year (2004-2012) trend of occupational safety and health (OSH) activities as described in CSR reporting (by industry sector and company size). METHODS: We investigated CSR reporting on the website in all Japanese companies listed on the first section of the Tokyo Stock Exchange. The data were extracted from CSR reporting of each company every year from 2004 to 2012. We counted the pages dedicated to information on OSH activities by industry sector and company size and calculated the rate of OSH divided by total CSR-related activities. RESULTS: The number of companies publishing CSR reports increased in all industry sectors, although the rate of inclusion of OSH activity within CSR reports increased only among sectors such as construction, manufacturing, transportation, and commerce. Among all company size, CSR reporting increased constantly throughout all observed years. The proportion of companies that had described OSH in CSR reporting increased from 2004 to 2012, and 76.5% companies had described OSH activities in 2012. The average number of pages of CSR-related report was 34.2 in 2004, increasing to 43.1 in 2012. The proportion of described pages of OSH activities in total CSR reporting increased gradually, and 2.7% in 2012. The focus of CSR reporting gradually shifted from 'environment' to 'social activity including OSH'. CONCLUSIONS: Majority of companies are putting more emphasis on OSH in CSR reporting in Japan.