Association Between Types of Chronic Disease and Receiving Workplace Accommodations: A Cross-Sectional Study of Japanese Workers.

OBJECTIVE: This study aimed to evaluate the association between the type of chronic disease and receiving workplace accommodations. METHODS: This online cross-sectional study analyzed a self-reported questionnaire administered in Japan. A total of 6775 full-time workers who reported needing work accommodations were included. RESULTS: Workplace accommodations were more likely to be provided for workers with cancer, mental illness, and benign gynecological disorders than for workers with no disease under treatment. In contrast, workplace accommodations were less likely for workers with low back pain and skin diseases. CONCLUSIONS: Receiving workplace accommodations depends on the type of chronic disease. Chronic diseases for which workers frequently receive workplace accommodations may be those for which support is encouraged by law. It is necessary to support workers with chronic diseases that do not receive adequate workplace accommodations.

Relationship between haematological data and radiation doses of TEPCO workers before and after the FDNNP accident.

We evaluated the correlation between radiation dose and the medical examination data of Tokyo Electric Power Company Holdings, Inc (TEPCO) employees working during the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident in 2011. This study included 2164 male TEPCO workers who received periodic medical examinations from March 2006 to January 2013. First, we conducted log-linear regression analyses using the haematological data of 585 emergency workers and confounding factors to examine the effect of internal radiation exposure in March 2011. Since external radiation exposure was a major influence, we then evaluated the correlation between both internal and external radiation dose and the haematological data of 1801 emergency workers and confounding factors before and after the accident. Among 585 workers, internal radiation exposure in March 2011 alone was mainly due to thyroid doses (0.1-10 Gy) but not to bone marrow (BM) doses (0.01-1 mGy). Compared to before and after the accident, we found that the levels of monocytes, eosinophils (Eos) and basophils increased slightly, whereas the frequency of smoking and alcohol consumption decreased substantially. External dose exposure was positively correlated with haemoglobin (Hb), red blood cell and Eos but negatively correlated with age, haematocrit and frequency of alcohol consumption. Among these variables, Hb exhibited the strongest correlation with external dose. Regarding the correlation with Hb, although there is a possibility that confounding factors other than exposure were not evaluated, our findings on emergency workers can serve as a reference for the evaluation of health conditions during the emergency period of future nuclear-related accidents.

Qualitative study of barriers and facilitators encountered by individuals with physical diseases in returning and continuing to work.

BACKGROUND: The number of employees with physical diseases is increasing, and there is a need for support to help them return and continue to work. To provide effective support, it is important to identify barriers and facilitators for individuals in returning and continuing to work. Previous studies have reported barriers and facilitators for specific diseases. However, few reports have dealt with these issues across various diseases. To identify a range of barriers and facilitators that may apply to different physical diseases, we conducted a qualitative analysis by interviewing patients with diverse characteristics being treated for diseases. METHODS: We conducted semi-structured interviews based on the criteria for qualitative research. We investigated three disease groups to obtain details of barriers and facilitators: impairments that were visible to other people (mainly stroke); impairments invisible to others (mainly heart disease); and impairments that changed over time (mainly cancer). Interview transcripts were analyzed and the results reported using systematic text condensation. RESULTS: We extracted 769 meaning units from 28 patient interviews. We categorized barriers and facilitators that were generalizable to various diseases into three themes (personal factors, workplace factors, and inter-sectoral collaboration and social resources) and 10 sub-themes (work ability, psychological impacts, health literacy, social status, family background, workplace structure, workplace system, workplace support, inter-sectoral collaboration, and social resources). CONCLUSIONS: This study identified 10 sub-themes that can be applied for workers with physical diseases; those sub-themes may be used as a basis for communicating with those individuals about returning and continuing to work. Our results suggest that various barriers and facilitators for workers with physical diseases should be understood and addressed at medical institutions, workplaces, and support sites.

[Use of a Guidebook for Stroke Patients to Promote Health and Employment Support].

When stroke patients consider a return to work, several difficulties are encountered regarding the promotion of support for both their health and employment due to the different perspectives of the patients, their families, and medical institutions. The Japanese Ministry of Health, Labour and Welfare has published a guideline for medical institutions and offices, but not for stroke patients or their families. As a result, patients and their families do not know how to process both medical treatments and their work after the occurrence of a stroke. We have therefore published the "Guidebook for Stroke Patients to Promote Health and Employment Support" based on the concept of the previously published "Guidebook for Cancer Patients for Promoting Health and Employment Support". This publication offers an overview of stroke and the flow from stroke onset to return to work. Patients can confirm how they should be handled at different phases of stroke. A stroke affects the patient, their family, and the individuals providing support, so this publication offers an information tool to facilitate the participation of stroke patients in society. The guide can thus be expected to contribute to an increased rate of return to work by stroke patients.

Factors Related to Oncologists' Use of the Disease Treatment and Employment Support Guidance Fee.

The purpose of this study is to examine the factors related to oncologists' use of the disease treatment and employment support guidance fee in Japan. A cross-sectional online survey was conducted in January 2021 among all the diplomates of the subspecialty board of medical oncology in the Japanese Society of Medical Oncology (n = 1,452), using the official mailing list. Logistic regression analysis was used to investigate the association between demographic and other factors and use of the disease treatment and employment support guidance fee. In total, 146 individuals participated in the study (response rate 10.0%). Experience of using the fee was associated with medical specialty and knowledge of the Guideline for Workplace Patient Coordination and Disease Treatment. It may be possible to increase the use of the disease treatment and employment support guidance fee among oncologists by raising awareness of the Guideline for Workplace Patient Coordination and Disease Treatment.

[Achievements and Future Challenges in the Support of the Balance of Work and Medical Treatment at the Hospital of the University of Occupational and Environmental Health, Japan, in 2018-2020].

The Japanese government is making full-scale efforts to support working people who suffer from cancer and/or other diseases, as it seeks to support a balance of work and receiving medical treatment. The Hospital of the University of Occupational and Environmental Health, Japan, opened its Support Center of Treatment and Work Balance in 2018. This is a multi-disciplinary department for supporting the balance of work and medical treatment. It also opened its Department of Occupational Medicine, the first such department in Japan to provide medical diagnosis and treatment dedicated to supporting that same balance. Our team has supported 704 patients through our activities over the past 3 years. The number of patients supported has increased each year, while the number of departments providing support has also trended upward. There has also been an increase in opinions by attending physicians regarding employment, as well as the number of cases covered by public medical insurance. Here we suggest two factors in our hospital's growth in these activities: (1) many of the clinicians are qualified as occupational physicians, and (2) the organizational strength of our team, which has a vision for balancing support and subsequently promotes that vision. We hope that this report will lead to the balance of support activities in Japan and contribute to the model internationally.

Association Between Time Spent With Family and Loneliness Among Japanese Workers During the COVID-19 Pandemic: A Cross-Sectional Study.

Background: The current coronavirus (COVID-19) pandemic has had large impacts on society, including people practicing social distancing. This behavioral response has increased loneliness. Loneliness not only increases the risk of psychiatric disorders, but also affects occupational mental health. To avoid the negative effects of isolation, it is important to have social contact with other people, especially family members. Employment and economic instability caused by COVID-19 may have also affected family relationships. It is important to understand the association between family relationships and loneliness in workers under the pandemic. Methods: We collected usable data from 27,036 Japanese workers who completed an online survey during the COVID-19 pandemic. Participants were asked how long they spend with members of their family during mealtimes or at home, and if they experienced loneliness; the latter was assessed by a single question. Other questions included whether participants lived with their spouse, or with someone in need of care. To estimate the odds ratios (ORs) of time with family associated with loneliness we used a multilevel logistic model nested in the prefecture of residence, with adjustments for age, sex, marital status, presence of a cohabitant requiring care, equivalent income, educational level, number of employees in the workplace, frequency of remote work, availability of someone for casual chat, smoking, drinking, time for leisure interests, and cumulative rates of COVID-19 in the prefecture. Results: Ten percent (2,750) of the 27,036 participants reported loneliness. The survey showed a significant negative correlation between time spent with family and loneliness (p < '0.001): participants who spent more time with family were less likely to feel loneliness. In addition, not living with a spouse and living with someone in need of care were associated with loneliness (not living with a spouse: p < 0.001; living with someone in need of care: p < 0.001). Conclusion: Loneliness under COVID-19 pandemic conditions was negatively associated with time spent with family members, with the converse result found for participants cohabiting with someone in need of care. These associations suggest the potential value of changes to working practices and interventions to combat loneliness.

Association between loneliness and psychological distress: A cross-sectional study among Japanese workers during the COVID-19 pandemic.

The purpose of this study was to examine the association between loneliness and psychological distress during the COVID-19 pandemic in Japan. We conducted a cross-sectional online study from 22 to 26 December 2020. A total of 27,036 participants, all employed at the time, were included in the analysis. Participants were asked if they felt loneliness in a single-item question. The Kessler 6 (K6) was used to assess psychological distress, defined as mild for K6 scores of 5 to 12 and severe for 13 or higher. The odds ratios (ORs) of psychological distress associated with loneliness were estimated using a multilevel logistic model nested in the prefecture of residence, with adjustment for age, sex, marital status, equivalent income, educational level, smoking, alcohol consumption, job type, number of workplace employees, and cumulative incidence rate of COVID-19 in the prefecture. Communication with friends, acquaintances, and family was strongly associated with psychological distress, so we adjusted for these factors and eating meals alone. Results showed a significant association between loneliness and psychological distress (OR = 36.62, 95% CI = 32.95-40.69). Lack of friends to talk to, lack of acquaintances to ask for help, and lack of people to communicate with through social networking sites were all strongly associated with psychological distress, as were family time and solitary eating. Even after adjusting for these factors, loneliness remained strongly associated with psychological distress (OR = 29.36, 95% CI = 26.44-32.98). The association between loneliness during the COVID-19 pandemic and psychological distress indicates the need for intervention.

Gender differences in the determinants of willingness to get the COVID-19 vaccine among the working-age population in Japan.

Many factors are related to vaccination intentions. However, gender differences in the determinants of intention to get the coronavirus disease 2019 (COVID-19) vaccine have not been fully investigated. This study examined gender differences in the determinants of willingness to get the COVID-19 vaccine among the working-age population in Japan. We conducted a cross-sectional study of Japanese citizens aged 20-65 years using an online self-administered questionnaire in December 2020. Logistic regression analysis was performed. Among 27,036 participants (13,814 men and 13,222 women), the percentage who were willing to get the COVID-19 vaccine was lower among women than among men (33.0% vs. 41.8%). Age and education level showed a gender gap regarding the association with willingness to get the COVID-19 vaccine: men who were older or had a higher level of education were more willing to get the vaccine, whereas women aged 30-49 years and those with a higher level of education showed a relatively low willingness to get the vaccine. For both men and women, marriage, higher annual household income, underlying disease, current smoking, vaccination for influenza during the current season, and fear of COVID-19 transmission were linked to a higher likelihood of being willing to get the COVID-19 vaccine. These findings give important insight into identifying target groups in need of intervention regarding COVID-19 vaccination, especially among women. Providing education about COVID-19 and influenza vaccination in the workplace may be an effective strategy to increase COVID-19 vaccine uptake.

[Questionnaire Survey of Fukushima Daiichi Nuclear Power Plant Workers in 2016 on Knowledge and Anxiety About Radiation].

The results of a survey of radiation workers suggest that they are worried about the effects of radiation exposure on health, and approximately 30% of Fukushima Daiichi Nuclear Power Plant (FDNPP) workers have anxiety. This questionnaire survey reveals that the higher the frequency of radiation education, the higher the knowledge of radiation the workers will have, and that the higher the level of knowledge, the lower the anxiety. To reduce anxiety, it is important to increase knowledge about radiation through radiation education. However, even those workers who had radiation education several times still had anxiety. According to the Ordinance on the Prevention of Ionizing Radiation Hazards, the time spent on education about the effects of radiation on the human body is only about 30 minutes. This education is not enough to reduce anxiety. FDNPP workers needed more effective education to increase their knowledge and to reduce their anxiety.

Continuous improvement of fitness-for-duty management programs for workers engaging in stabilizing and decommissioning work at the Fukushima Daiichi Nuclear Power Plant.

BACKGROUND: Numerous workers have participated in recovery efforts following the accident that occurred at the Tokyo Electric Power Company (TEPCO) Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake. These workers, belonging to various companies, have been engaged in various tasks since the accident. Given the hazards and stress involved in these tasks and the relatively long time required to transport sick or injured workers to medical institutions, it became necessary to quickly implement a more stringent management program for fitness for duty than in ordinary work environments. CASE: It took considerable time to introduce and improve a fitness-for-duty program because of several concerns. Various efforts were conducted, sometimes triggered by guidance from the Ministry of Health, Labour and Welfare (MHLW), but the implementation of the program was insufficient. In April 2016, a new program was initiated in which all primary contractors confirmed that their subcontractors had achieved five conditions for workers' fitness for duty on the basis of guidance from the MHLW and occupational health experts. TEPCO confirmed that all primary contractors had implemented the program successfully as of the end of November 2016. CONCLUSION: Following a disaster, even though the parties concerned understand the necessity of fitness-for-duty programs and that companies in high positions have responsibilities beyond their legal requirements, it is highly possible that they may hesitate to introduce such programs without guidance from the government. It is necessary to prepare a governmental framework and professional resources that introduce these stringent management programs quickly.

Survey of Information Sharing Related to the Occupational Considerations of Working Cancer Patients Between Occupational Physicians and Treating Physicians.

OBJECTIVE: Although a vital element in providing career support to workers with medical ailments is coordination between the worker, the treating physician, and the company (the occupational health staff), little is known about factors that promote or impede coordination between these parties. This study aims to demonstrate what kinds of actions by treating physicians promote or impede the occupational considerations made by occupational physicians. METHODS: A total of 43 occupational physicians who had completed the postgraduate training course (4 years) at the University of Occupational and Environmental Health Japan and were current or former instructors at the Occupational Health Training Center were surveyed using a self-reported questionnaire form. The questionnaire asked about individual attributes (age, years of experience as an occupational physician, etc.) and actions taken by treating physicians that were useful in making occupational considerations in the workplace (good practice cases) or that impeded such considerations (trouble cases). Responses about cases were obtained as freely written descriptions. Case content was analyzed qualitatively according to the KJ method. RESULTS: During the survey period from December 17, 2013 to January 18, 2014, responses were received from 33 occupational physicians (valid response rate, 76.7%; mean age, 37.4±6.1 years). Of these, 60.6% exclusively specialized in occupational medicine. Respondents provided 32 good practice cases and 16 trouble cases. The timing of coordination was the period of rehabilitation in 35 of the 48 cases (72.9%). Actions by the treating physicians that influenced occupational considerations were divided into seven major categories: "providing treatment information," "providing physical information," "appropriateness of rehabilitation or occupational considerations," "consistency of information provided," "issuing documentation," "communication that was cognizant of the occupational physician's presence," and "providing information unknown to the worker." CONCLUSIONS: This study clarified the kind of actions by the treating physicians that were relevant to occupational support provided by occupational physicians. Additionally, this study clarified the need for information sharing with occupational physician and treating physician. The good practice cases and trouble cases presented by the respondents were inextricably linked, and actions by the treating physicians that are based on good practices are highly likely to lead to smooth information sharing and occupational considerations.

What Occupational Health Needs Arise in Workplaces Following Disasters? A Joint Analysis of Eight Cases of Disaster in Japan.

OBJECTIVE: To identify occupational health needs arising after disasters. METHODS: Using semistructured interviews with expert informants, we jointly analyzed the needs arising in eight disaster cases that threatened the lives or health of workers in Japan. RESULTS: Various types of health issues occurred in a wide range of employees. In total, we identified 100 needs in six phases after disasters and classified them across nine categories of worker characteristics. The proportion of health needs on the list that were applicable in each case varied from 13% to 49%. More needs arose when the companies were responsible for the disaster and when employee lives were lost. We also assessed the list as fairly comprehensive. CONCLUSIONS: The list developed in this study is expected to be effective for anticipating occupational health needs after disasters.

Transition of occupational health issues associated with stabilization and decommissioning of the nuclear reactors in the Fukushima Daiichi Nuclear Power Plant through 2013.

OBJECTIVE: To clarify the occupational health (OH) issues that arose, what actions were taken, and the OH performances during the disaster involving the Fukushima Daiichi Nuclear Power Plant and thus improve the OH management system with respect to long-term decommissioning work and preparation for future disasters. METHODS: We used information in advisory reports to the Tokyo Electric Power Company by an OH expert group, observation through support activities, and data officially released by the Tokyo Electric Power Company. RESULTS: Occupational health issues transitioned as work progressed and seasons changed. They were categorized into OH management system establishment, radiation exposure control, heat illness prevention, infectious disease prevention and control, and fitness for workers' duties. CONCLUSIONS: Occupational health management systems involving OH experts should be implemented to manage multiple health risks with several conflicts and trade-offs after a disaster.