[Work environment that support workers with diseases to maintain a work-treatment balance in Ishikawa prefecture: relationship with company scale and type of industry].

OBJECTIVES: We investigated the support environments in companies in Ishikawa prefecture that aim to maintain a balance between work and treatment of their employees' diseases. The relationships between these strategies, company size, and type of industry were examined. METHODS: In 2016, as a part of a survey, questionnaires were sent to 1,491 companies with ≥ 50 employees. Of the 688 companies who responded (response rate, 46.1%), 624 companies who provided complete main survey data were included in the final analysis. The questionnaire acquired responses on systems for arranging working hours and sick leave, the role of occupational health physicians, and the outcomes of support that was offered over the last 3 years. The targeted diseases were mental health problems, such as depression, and physical diseases. Responses were compared according to the size of the company and type of industry. RESULTS: A total of 409 companies (65.5%) reported their experiences of helping employees maintain a balance between treatment and work over the last 3 years. Employees with depression received the most support. In 36.7% of the companies, some employees had retired due to their disease over the last 3 years, with the highest proportion in medical care and welfare businesses. Further, 66% of the companies had a support system to help employees with diseases, and the proportion of companies with flexible working hours and sick leave increased with the number of employees. The proportion of companies with shorter working hours and hourly paid leave was lower in the manufacturing industry and transportation/traffic business. The proportion of companies in which an occupational health physician interviewed employees who took sick leave and returned to work was 22%. CONCLUSIONS: Almost 70% of the companies reported supporting workers during their disease treatment. There were some differences in arranging these support systems between companies of varying sizes and type of industry. The enablement of companies to support workers with diseases so that they keep working and receive treatment requires consideration of company characteristics.

[Associations among physical condition, life hour, and dietary intake male Japanese shift workers: physical condition and lifestyle survey of male Japanese shift workers].

OBJECTIVES: The purpose of this study was to understand the actual state of life hours (working time, sleep time, and time of meal intake) and dietary habits of male shift work employees, and to elucidate the impact of working arrangements and dietary habits on their physical condition and health problems. METHODS: The subjects were 187 male employees (aged 18-64 years) working for an industrial company in Toyama prefecture. We used a self-administered questionnaire to assess dietary habit, lifestyle habits, and life hours at the time of a periodic health examination in April 2013. The subjects were grouped based on their working condition (i.e., day shift, late shift, and late-night shift) into two groups of day shift (n = 107) and shiftwork (n = 80). The proportion of time spent sleeping and feeding was determined in half hour increments, and the incidences of skipping meals (breakfast, lunch and dinner) and midnight snack intake were calculated for each working condition. We also examined the association between the frequency of eating and physical condition for each working condition. RESULTS: The state of life hours of the shiftwork group during the day was similar to that of the day shift group. However, the workers' state of life hours, incidences of skipping meals, and midnight snack intake varied considerably when working at the other shift times. In the shiftwork group, regardless of the working patterns, the BMI and % body fat of the group that ate more than three times a day were significantly lower than those of the group that ate less than twice a day. CONCLUSIONS: The results of the present study suggest that it is difficult to ensure the time and opportunity for meals for shift workers. We consider that it is necessary to prevent them skipping of meals, and to support a proper dietary intake during the night.

Distribution of and factors contributing to chronic kidney disease in a middle-aged working population.

OBJECTIVES: To clarify the distribution of chronic kidney disease (CKD) and the factors contributing to its development and progression in middle-aged Japanese workers/employees. METHODS: This was a retrospective study involving 3,964 men and 2,698 women aged 35-64 years in 2009 who had been followed-up until 2003. Data on proteinuria determined with a dipstick and glomerular filtration rate estimated from serum creatinine concentration (eGFR) were collected in the annual health check-ups. RESULTS: Proteinuria was detected in 2.9 and 1.1 % of the men and women, respectively, and total CKD was detected in 16.0 and 16.1 % of the men and women respectively. Moderate or severe CKD associated a high risk of cardiovascular diseases and end-stage kidney disease was found mostly in the male subjects [2.0 (men) vs. 0.6 % (women)]. High-risk CKD was found in 3.3 % of the men aged 55-64 years. A body mass index (BMI) of ≥30, hypertension, diabetes mellitus (DM), current smoking and some job types were independently related to the development of proteinuria, while age, BMI, hypertriglyceridemia, and job types were related to total CKD. The development of high-risk CKD was related to preceding mild CKD signs of reduced eGFR and proteinuria as well as to hypertension, DM, smoking, and job type. CONCLUSIONS: Chronic kidney disease was found in 16 % of middle-aged workers with an equal prevalence in both sexes, while high-risk CKD was found mostly in men, of whom 3.3 % were aged 55-64 years. Obesity, hypertension, DM, smoking and some job types were related to the development and progression of CKD.

The effects of continuing and discontinuing smoking on the development of chronic kidney disease (CKD) in the healthy middle-aged working population in Japan.

OBJECTIVES: The strength of the association between smoking and the development of chronic kidney disease (CKD) in the healthy middle-aged working age population has not been established. METHODS: This was a retrospective 6-year observational study involving 4,121 male and 2,877 female workers who were free of primary kidney disease, diabetes mellitus, severe hypertension, and the signs and symptoms of CKD. Proteinuria was detected by a dipstick method, and glomerular filtration rate (GFR) was estimated by the equation of the Japan Society of Nephrology. RESULTS: Sixty men (1.5 %) and 21 women (0.7 %) developed proteinuria over the 6 years of the study. Irrespective of sex, in comparison with non-smokers, those who continued smoking showed an odds ratio (OR) of 2.52 with a 95 % confidence interval (CI) of 1.50-4.25 for developing proteinuria while those who quit smoking showed an OR of 1.29 (95 % CI 0.48-3.42), following adjustment for confounders. Among the study population, 443 men (10.7 %) and 356 women (12.4 %) developed a GFR of <60 mL/min/1.73 m(2), corresponding to stage III CKD. Continuing smokers had a low OR (0.74, 95 % CI 0.60-0.90) for developing a low GFR, as well as a higher mean GFR than non-smokers. The reduction in GFR during the 6-year study period was not different between smokers and non-smokers, but it was larger in those who developed proteinuria than in those who did not, irrespective of smoking. CONCLUSIONS: Continuing smokers showed a twofold or more higher risk of developing proteinuria. Discontinuation of smoking substantially reduced the risk. A longer observational period may be required to detect the smoking-induced risk of developing stage III CKD in the middle-aged working population.

Occupational class inequalities in behavioral and biological risk factors for cardiovascular disease among workers in medium- and small-scale enterprises.

The aim of this cross-sectional study was to examine whether occupational class inequalities existed in the behavioral and biological risk factors for cardiovascular disease among workers in medium- and small-scale enterprises. We asked 1,900 enterprises in the Ishikawa prefecture who were users of an external heath check-up facility to supply anonymous individual data in 2009. The 446 enterprises consented to the invitation. The study population was 12,625 individuals (8,104 males and 4,521 females) 16-59 yr of age. We compared indices among occupational classes. The indices of lipid and glucose metabolism were used only for subjects 40-59 yr of age. The results of this study revealed occupational class inequalities in the prevalence of current smoking, heavy drinking and hypertension in men. These inequalities were more prominent among men in the younger age group than in the older age group. In men, the most disadvantaged occupational class was transportation workers, followed by laborers. Occupational class inequalities in smoking were also found among female workers. However, the influences of occupational class on obesity and indices of lipid or glucose metabolism were inconsistent. A strategy for health promotion that targets the disadvantaged population is necessary for the prevention of cardiovascular disease.

Cigarette smoking, proteinuria, and renal function in middle-aged Japanese men from an occupational population.

OBJECTIVES: To clarify the renal effects of cigarette smoking in a middle-aged occupational population because the effects have previously been demonstrated mainly in community populations that included many elderly people who are thought to be vulnerable to such effects. METHODS: In 990 middle-aged men recruited from a chemical plant, proteinuria was measured by a dipstick method and the glomerular filtration rate was estimated (eGFR) using a formula proposed by the Japanese Society of Nephrology. RESULTS: Proteinuria was found in 4.6% of the current smokers and 1.5% of the never-smokers. It was found in 4.8% of the subjects having a Brinkman index (BI) of 400-599 and 6.3% of those having a BI of 600 or above. The odds ratio for proteinuria in them was 2.94 (CI: 1.01-8.55) and 3.61 (CI: 1.29-10.1), respectively, adjusting for possible confounders. The mean eGFR was higher in smokers than in nonsmokers throughout middle age up to 64 years. Normal but high eGFR was found in 6.7% of the current heavy smokers and subnormal eGFR in 5.7% of the largest cumulative cigarette consumers in contrast to 3.0% or less of the never-smokers. Proteinuria was found in 13.3% of the subjects showing subnormal eGFR, specifically in 16.7% of the smokers and 8.3% of the nonsmokers. CONCLUSIONS: Smoking causes proteinuria in working middle-aged men. Smokers tend to have a high eGFR, but those with subnormal eGFR showed proteinuria most frequently. Whether the high eGFR in smokers will eventually decrease and cause proteinuria remains an important focus for further studies.

Organizational justice, psychological distress, and work engagement in Japanese workers.

PURPOSE: To investigate the cross-sectional association between organizational justice (i.e., procedural justice and interactional justice) and psychological distress or work engagement, as well as the mediating roles of other job stressors (i.e., job demands and job control, or their combination, effort-reward imbalance [ERI], and worksite support). METHODS: A total of 243 workers (185 males and 58 females) from a manufacturing factory in Japan were surveyed using a self-administered questionnaire including the Organizational Justice Questionnaire, Job Content Questionnaire, Effort-Reward Imbalance Questionnaire, K6 scale, Utrecht Work Engagement Scale, and other covariates. Multiple mediation analyses with the bootstrap technique were conducted. RESULTS: In the bivariate analysis, procedural justice and interactional justice were significantly and negatively associated with psychological distress; they were significantly and positively associated with work engagement. In the mediation analysis, reward at work (or ERI) significantly mediated between procedural justice or interactional justice and psychological distress; worksite support significantly mediated between procedural justice or interactional justice and work engagement. CONCLUSION: The effects of organizational justice on psychological distress seem to be mediated by reward at work (or ERI) while those regarding work engagement may be mediated by worksite support to a large extent, at least in Japanese workers.

Intragroup and intergroup conflict at work, psychological distress, and work engagement in a sample of employees in Japan.

The possible associations of intragroup and intergroup conflict at work with psychological distress and work engagement were investigated in a cross-sectional study in a manufacturing factory in Japan. A self-administered questionnaire was sent to all employees, and 255 responses were returned (a response rate of 84%). Data from 247 workers (187 males and 60 females) with no missing values were analyzed. Intragroup and intergroup conflict at work, psychological distress, and work engagement were measured by the NIOSH-GJSQ, K6, and Utrecht Work Engagement Scale (UWES-9), respectively. An ANCOVA was conducted to compare K6 and UWES-9 scores among the tertiles on intragroup conflict or intergroup conflict scores, adjusting for demographic and occupational variables as well as worksite social support, separately for males and females. Intragroup conflict was associated with greater psychological distress for males (p for trend=0.009). Intergroup conflict was marginally significantly associated with psychological distress for both males and females (p for trend=0.050 and 0.051, respectively). Contrary to expectation, intergroup conflict was significantly associated with greater work engagement for females (p for trend=0.024). For males, intragroup and intergroup conflict at work may increase psychological distress; for females, intergroup conflict may increase both psychological distress and work engagement.

Three job stress models/concepts and oxidative DNA damage in a sample of workers in Japan.

OBJECTIVE: Three job stress models/concepts (the job demands-control [DC] model, the effort-reward imbalance [ERI] model, and organizational justice) have been linked to coronary heart disease (CHD) at work. In recent years, oxidative DNA damage has been identified as a new risk factor for CHD. However, evidence for the association between these job stressors and oxidative DNA damage is limited. The present cross-sectional study investigated the association between these job stress models/concepts and oxidative DNA damage as a possible mediator of the adverse health effects of job stress. METHODS: A total of 166 male and 51 female workers of a manufacturing factory in Japan were surveyed using a mailed questionnaire regarding job stressors and demographic, occupational, and lifestyle variables. Urinary concentrations of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a biomarker of oxidative DNA damage, were also measured. RESULTS: In male subjects, the urinary concentrations of 8-OHdG were significantly higher among the group with lower interactional justice, one of the two components of organizational justice; however, no association was observed with the DC model or the ERI model. In female subjects, high job demands/control ratio was significantly and positively associated with the urinary concentrations of 8-OHdG. CONCLUSION: Interactional justice among male workers and the DC model-based strain among female workers may be associated with increased urinary concentrations of 8-OHdG which possibly reflects oxidative DNA damage.

Reliability and validity of the Japanese version of the Organizational Justice Questionnaire.

OBJECTIVES: Previous European studies reporting low procedural justice and low interactional justice were associated with increased health problems have used a modified version of the Moorman's Organizational Justice Questionnaire (OJQ, Elovainio et al., 2002) to assess organizational justice. We translated the modified OJQ into the Japanese language and examined the internal consistency reliability, and factor-based and construct validity of this measure. A back-translation procedure confirmed that the translation was appropriate, pending a minor revision. METHODS: A total of 185 men and 58 women at a manufacturing factory in Japan were surveyed using a mailed questionnaire including the OJQ and other job stressors. RESULTS: Cronbach alpha coefficients of the two OJQ subscales were high (0.85-0.94) for both sexes. The hypothesized two factors (i.e., procedural justice and interactional justice) were extracted by the factor analysis for men; for women, procedural justice was further split into two separate dimensions supporting a three- rather than two-factor structure. Convergent validity was supported by expected correlations of the OJQ with job control, supervisor support, effort-reward imbalance, and job future ambiguity in particular among the men. CONCLUSION: The present study shows that the Japanese version of the OJQ has acceptable levels of reliability and validity at least for male employees.

[The effects of nutrition and life-style on calcaneal bone mass in high school students].

OBJECTIVE: To clarify the effects of nutrient/food intake and lifestyle, especially exercise, on calcaneal bone mass in both male and female high school students. METHODS: A total of 798 healthy Japanese high school students (281 boys and 517 girls) were recruited, and their calcaneal bone was assessed by ultrasound using Lunar Achilles. The subjects were thereby divided into a lower bone mass group and a normal bone mass group according to stiffness at the cut-off level of 90 for the boys, and 77 for the girls. Information on lifestyle including frequency of food consumption and regular exercise during the period at junior high school and high school was collected by questionnaire. Nutrient intake was assessed by a semi-quantitative food frequency questionnaire. RESULTS: 1. The intake of total energy and fat in the lower bone mass group was lower than in the normal bone mass group in both sexes. 2. The frequency of subjects not consuming milk in the lower bone mass group was higher than in the normal bone mass group in both sexes. In the boys, the frequency of the subjects who liked to eat green vegetables in the lower bone mass group was lower in the normal bone mass group. 3. The mean stiffness for subjects undertaking exercise during junior high school was higher than in subjects not exercising, even after adjustment for age in both sexes. The frequency of subjects with a habit of sun bathing in the lower bone mass group was significantly lower than in the normal bone mass group in the girls. 4. An analysis using a logistic model was performed to select the factors related to lower bone mass without being confounded with other factors. Lower energy intake in boys and lower fat intake, no exercise during high school life and no milk consumption in girls were each independently related to lower bone mass. CONCLUSION: These results suggest that nutrition and exercise habit affect calcaneal bone mass in high school students of both sexes, especially milk consumption being an important factor related to bone mass in girls.

A cohort study on the active life expectancy of stroke patients using a community-based stroke registry in a Japanese rural district.

In order to support patients with a history of stroke, public health nurses, hospitals and ambulance stations in and around the Oyabe Health District (49 000 population, rural area) provided initial information for a community-based stroke registry starting from 1966. This stroke registry was established by the present authors to record the patients' status and provide social services at home. The information from 1032 stroke patients was compiled into a register during the period 1966-79. Of 494 patients identified as living at home in 1980, we were able to maintain contact with 452 patients (91.5%) and these 452 stroke patients were defined as the study cohort. They were asked several questions on physical status, mobility status, central nervous function, emotional problems and living conditions. These data were used to construct the baseline of this study cohort and we gathered information on mobility status every year until 1993. The risk factors reducing their active life expectancy were investigated using Kaplan-Meier's method, log-rank test and Cox's proportional hazard model. For active life expectancy, the end point was defined as commencement of immobile status or death. Emotional problems (P < 0.01), difficulty in bathing (P < 0.05) and disorder of memory function (P < 0.05) were shown to contribute to a reduction in their active life expectancy after adjustment for age, sex, years after stroke, types of stroke, mobility status and living with spouse.