Overwork-related disorders in Japan: recent trends and development of a national policy to promote preventive measures.

Overwork-related disorders, such as cerebrovascular/cardiovascular diseases (CCVD) and mental disorders due to overwork, are a major occupational and public health issue worldwide, particularly in East Asian countries. This report discusses the recent trend of overwork-related disorders in Japan from the perspective of workers' compensated occupational diseases, as well as the development of a national policy for preventive measures against overwork-related disorders in Japan. Recently, the number of claimed and compensated cases of occupational mental disorders has increased substantially, particularly among young workers, as compared to those of occupational CCVD. In response to these situations and action from society, the Japanese Government passed the "Act on Promotion of Preventive Measures against Karoshi and Other Overwork-Related Health Disorders" in June 2014 to develop a national initiative towards the prevention of overwork-related disorders. Changes in the trend of overwork-related disorders in Japan under a legal foundation and an initiative by the central government should be closely monitored so that other countries can benefit from the experiences.

[Which comes first for interpersonal stress, coping or support?].

This study used structural equation modeling to investigate directional relationships between coping with interpersonal stress and received support. One hundred and seventy-seven undergraduates who had experienced interpersonal stress during the past month answered questions about coping with interpersonal stress and received support. Structural equation modeling based on third-order moment structures was used to examine the directionality of the relationship between these two variables. The results revealed interactive associations between distancing and emotional support. Received support affected coping with interpersonal stress in terms of active coping, planning and monitoring, and positive reappraisal. These results suggest that received support functions as a coping resource.

[Examination of role of personality and the effects of stress coping in stress process as within process].

This study used daily diary methods to investigate if fear of interpersonal stress in daily affect could be explained by coping strategies, and if daily affect and coping would vary randomly across personality traits. Every day for one week, 103 undergraduates recorded their daily events, perceived interpersonal stress, cognitive appraisal, coping strategies, positive events, and positive and negative affect twice a day. A hierarchical linear model and multilevel structural equation modeling were used to examine the relationships between variables. Results, suggest that problem-focused coping was associated with within-level maladjustment, while positive reappraisal was associated with within-level adjustment. In addition, neuroticism appeared to moderate the relationship between coping and daily affect. Furthermore, there is evidence that higher fear of interpersonal stress predicts greater active coping, and positive affect.

[Examination of the effects of stress coping on later affect using daily diary methods].

In response to recent calls in the literature for within-person examination of coping processes over time, this study used daily diary methods to investigate the relationships between daily events, coping, and daily affects. Every day for two weeks, 62 undergraduates recorded their perceived interpersonal stress, most troublesome events, how they coped, positive events, and positive and negative affect. A hierarchical linear model was used to examine the relations between these variables. The results suggested that both positive and negative events made significantly influenced current-day positive and negative affect. In addition, avoidance thinking was associated with within-level adjustment, while emotional sharing with others, distancing and positive reappraisal were associated with within-level maladjustment.

[The effect of coping and appraisal for coping on mental health and later coping].

This study examined the effect of coping and appraisal for coping on mental health and later coping in two longitudinal studies. In Study 1 (Time 1: n = 342, Time 2: n = 367) investigated the influence of selected coping and coping for appraisal on mental health and assumed coping. In Study 2 (Time 1: n = 161, Time 2: n = 154) investigated the influence of selected coping and coping for appraisal on mental health and later coping. The results indicated that coping and coping for appraisal affected mental health and later coping. However, the influence of the coping for appraisal was more limited than selected coping.

[Development of the coping scale for interpersonal stress events related to the goals of the coping].

This study developed the coping scale for interpersonal stress events, and evaluated its validity. This scale is composed of the following subscales based on the goals of the coping: problem-focused coping, emotion-focused behavioral coping, and emotion-focused cognitive coping. Based on previous research, a pilot study was used to construct scale items, considering the goals of coping to reduce measurement error. In study 1 (N=348), the validity of the scale was examined using several statistical analyses. Study 2 (N=182) and study 3 (N=161) report correlations between the coping scale for interpersonal stress events and several theoretically relevant scales. Based on these results, it was concluded that the scale and subscales are valid for measuring interpersonal stress coping.

[Immunological studies in cases of pulmonary Mycobacterium avium complex infection without predisposing conditions].

Peripheral blood mononuclear cells (PBMCs) taken from 39 primary pulmonary MAC patients and 11 control subjects were stimulated in vitro with a protein antigen PPD-B derived from M. intracellulare. Then, the activated response of the peripheral blood lymphocytes (PBLs) and the production of interferon-gamma (IFN-gamma) and interleukin-10 (IL-10) were measured. The 39 primary pulmonary MAC patients were divided into A and B groups the former patients satisfying all of the criteria for the diagnosis of nontuberculous mycobacterial disease proposed by the American Thoracic Society, with the exception of the bacteriologic criteria, and the latter, who satisfied all without exception. The 39 patients were also divided into 3 groups according to disease severity judged from chest CT features. Severity in grades 1, 2 and 3 groups were mild, moderate and severe, respectively. We compared the activated response of PBLs and the production of IFN-gamma and IL-10 by PBMCs of the control group and each patient group. The number of lymphocytes and activated T cells and the concentration of the IFN-gamma after stimulation with PPD-B were lower in each group of primary pulmonary MAC patients than in the control group. IL-10 was significantly higher in each group of primary pulmonary MAC patients than in the control group (36.6 +/- 11.8 pg/ml), and higher in group B (131.6 +/- 14.9) than in group A (81.1 +/- 31.5). There was no significant difference in the IL-10 concentration between the grade 1, 2 and 3 groups. These results suggested that the cell-mediated immunity of primary pulmonary MAC patients was suppressed as the disease progressed, and the increased production of IL-10 was related to this suppression.

[A clinical study on cases with pulmonary M. avium complex (MAC) disease followed up for more than 10 years].

We performed a clinical study on 22 cases with pulmonary M. avium complex disease followed up for more than 10 years. The mean age of these patients at the first visit was 60.1 years old and the extent of the disease among them was minimum or moderate. The progression of the disease was relatively slow. There were 5 cases of tuberculosis-like type and 11 cases of nodular-bronchiectasis type among the primary infection type and 6 cases of the secondary infection type. Classifying these cases by the grade of progression on chest X-ray findings, 2 cases improved, 11 cases slightly progressed, 4 cases moderately progressed and 5 cases severely progressed. Seven cases of the nodular-bronchiectasis type of the primary infection type were observed among 11 slightly progressed cases. This suggested that the prognosis of cases with nodular-bronchiectasis type was relatively good. The frequency of a reaggravation of chest X-ray findings was significantly higher in the severely progressed cases than in the slightly and moderately progressed cases. Generally, the number of used drugs was more and the duration of treatment was longer in the severely progressed cases. This suggested that these cases were intractable. The results of sputum culture for M. avium complex were consistent with the progression of the disease shown on chest X-ray findings among many cases. However, sputum culture negative was observed in some cases with the nodular-bronchiectasis type in spite of the reaggravation on chest X-ray findings. On the other hand, there were some cases in which few reaggravation was observed in spite of continued sputum culture positive. Based on these results, we made some remarks on the treatment and management of pulmonary M. avium complex disease.

[A case of pulmonary mucormycosis diagnosed through video-assisted thoracoscopic surgery--report of a case].

We report a case of pulmonary mucormycosis successfully treated by medical methods only. The patient was a 51-year-old man with diabetes mellitus who presented with general fatigue and appetite loss. His chest radiograph and CT scan showed multiple thin-walled cavities in the left upper lobe. Because we could arrive at a clear diagnosis, video-assisted thoracoscopic surgery was performed. Lung biopsy of the left upper lobe revealed pulmonary mucormycosis. Our diagnosis was pulmonary mucormycosis with diabetes mellitus and alcohol addiction. The patient was treated with antifungal drugs--mainly amphotericin-B--while the diabetes mellitus was well controlled, and his diet and nutritional state was improved, resulting in the disappearance of symptoms, improvement of the radiological findings, and the absence of any relapse of the disease of at least 3 years.

[A clinical study of deceased cases of pulmonary M. Avium complex (MAC) disease--: in contrast with survived cases followed-up for 5 years or longer].

We performed a clinical study of pulmonary M. avium complex (MAC) disease comparing decreased cases and survived cases followed-up for 5 years or longer. The results were as follows: 1. At the time of starting the initial medical treatment for pulmonary MAC disease, the deceased cases were older than the survived cases, and the deceased cases were severe than the survived cases in clinical conditions. The spread of the lesions was more extensive and cavities were more frequently observed in the deceased cases than in the survived cases. 2. We classified the clinical pattern of pulmonary MAC disease into a primary infection type and a secondary infection type. Then, we subclassified the primary infection type into a localized type, which contained a tuberculosis-like type and middle, lingular or other lobar pneumonia type, and a diffuse type. The secondary infection type was more frequent in the deceased cases than in the survived cases, and any middle, lingular or other lobar pneumonia type was not observed in the deceased cases. 3. We classified the mode of progression of pulmonary MAC disease in the deceased cases into a tuberculosis-like progression and a diffuse progression. The tuberculosis-like type and the secondary infection type frequently showed the tuberculosis-like progression and the diffuse type frequently showed the diffuse progression. The patients who showed the tuberculosis-like progression were frequently sputum culture positive for MAC, while all patients showing the diffuse progression were culture negative at the time of death. An interval from the estimated onset of the disease to death was shorter in the tuberculosis-like progression type than in the diffuse progression type.