Relationship between financial distress and mistreatment of workers regarding the COVID-19 prevention measures: A 1-year prospective cohort study.

OBJECTIVE: A substantial number of workers' experience mistreatment in the workplace, impacting workers' health and companies' functioning. Vulnerability of those with lower income has been reported, yet little is known about mistreatment during COVID-19. This study aims to examine whether workers in financial distress are particularly prone to mistreatment at the workplace with reference to pandemic-related infection prevention measures. METHODS: An internet-based, year-long prospective cohort study was conducted from 2020 to 2021. Participants were recruited from workers aged 20 and 65 years and currently employed at baseline. In total, 27 036 were included in the analysis and 18 170 responded to the follow-up survey. The odds ratio (OR) of mistreatment at the workplace regarding COVID-19 associated with the financial condition at baseline was estimated using multilevel logistic regression analysis nested by participant residence. RESULTS: Compared with workers in a comfortable financial condition, those under financial stress showed significantly higher ORs of mistreatment (age- and sex-adjusted model: 2.08, 95% confidence interval [CI] 1.75-2.47, P < .001, model adjusted for socioeconomic factors: 2.14, 95% CI 1.79-2.55, P < .001). CONCLUSION: Workers in financial distress were shown to be vulnerable to mistreatment at work regarding infection prevention measures in the COVID-19 pandemic, underscoring a double burden of poverty and mistreatment. The perspective of vulnerable groups needs to be taken into account when implementing countermeasures against emerging infectious diseases, such as COVID-19. As unfair treatment in the workplace might distort vulnerable employees' reactions to infection control (e.g., hiding infection), financial deprivation should be considered a public health issue.

A cross-sectional study of socioeconomic status and treatment interruption among Japanese workers during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has caused interruptions to chronic disease and non-emergency treatment. The purpose of this study is to examine which socioeconomic status groups are most at risk of treatment interruption among Japanese workers. METHODS: This cross-sectional internet monitor study was conducted among Japanese workers on December 22-26, 2020. Out of a total of 33 302 participants in the survey, 9510 (5392 males and 4118 females) who responded that they required regular treatment or hospital visits were included in the analysis. A multilevel logistic model nested in the prefecture of residence was used to estimate the odds ratio (OR) for treatment disruption. We examined separate multivariate models for socioeconomic factors, health factors, and lifestyle factors. RESULTS: During a period of rapid COVID-19 infection, about 11% of Japanese workers who required regular treatment experienced interruptions to their treatment. The OR of treatment interruption associated with not being married compared with being married was 1.44 (95%CI: 1.17-1.76); manual labor work compared with desk work was 1.30 (95%CI: 1.11-1.52); loss of employment when the COVID-19 pandemic started and continued unemployment compared with being employed over the entire pandemic period was 1.62 (95%CI: 1.13-2.31) and 2.57 (95%CI: 1.63-4.07), respectively; and feeling financially unstable was 2.92 (95%CI: 2.25-3.80). CONCLUSION: Treatment interruption is a new health inequality brought about by COVID-19 with possible medium- and long-term effects, including excess mortality, morbidity, and productivity loss due to increased presenteeism. Efforts are needed to reduce treatment interruptions among workers who require regular treatment.

Emerging Occupational Health Needs at a Semiconductor Factory Following the 2016 Kumamoto Earthquakes: Evaluation of Effectiveness and Necessary Improvements of List of Postdisaster Occupational Health Needs.

OBJECTIVES: We sought to share our experiences with occupational health efforts at a manufacturing site after a large earthquake event, and to evaluate the effectiveness of our "List of Occupational Health Needs Following Disasters" (Needs List). METHODS: We implemented occupational health efforts following the 2016 Kumamoto earthquakes in Japan, with reference to the Needs List and a related manual, and analyzed the needs that arose. RESULTS: The instruments used enabled occupational health personnel to predict what needs would arise and facilitate their countermeasures. Among such needs that arose, 87.7% were in the Needs List, but seven undocumented needs were also observed. CONCLUSION: We confirmed that the Needs List could predict as many occupational health needs as we had expected at the disaster, though it is necessary to improve them by reflecting on our experiences.

[Development of a Crisis Management Manual for Occupational Health Experts].

When crises such as natural disasters or industrial accidents occur in workplaces, not only the workers who are injured, but also those who engage in emergency or recovery work may be exposed to various health hazards. We developed a manual to enable occupational health (OH) experts to prevent health hazards. The manual includes detailed explanations of the characteristics and necessary actions for each need in the list of "OH Needs During Crisis Management" developed after an analysis of eight cases in our previous research. We changed the endings of explanatory sentences so that users could learn how often each need occurred in these eight cases. We evaluated the validity of the manual using two processes: 1) Providing the manual to OH physicians during an industrial accident; 2) Asking crisis management experts to review the manual. We made improvements based on their feedback and completed the manual. The manual includes explanations about 99 OH needs, and users can learn how and what to do for each need during various crisis cases. Because additional OH needs may occur in other crises, it is necessary to collect information about new cases and to improve the comprehensiveness of the manual continuously. It is critical that this crisis management manual be available when a crisis occurs. We need to inform potential users of the manual through various media, as well as by posting it on our website.

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.

Review of health issues of workers engaged in operations related to the accident at the Fukushima Daiichi Nuclear Power Plant.

OBJECTIVES: The aim of this review was to summarize the lessons learned from the experience in protecting the health of workers engaged in operations following the accident at the Fukushima Daiichi Nuclear Power Plant (NPP). METHODS: We reviewed all types of scientific papers examining workers' health found in Medline and Web of Sciences as well as some official reports published by the Ministry of Health, Labour and Welfare of Japan and other governmental institutes. RESULTS: The papers and reports were classified into those investigating workers at the Fukushima Daiichi and Daini NPPs, workers engaged in decontamination operations in designated areas, and other workers. Regarding workers at the NPPs, many efforts were made to establish an emergency-care and occupational health system. Risk management efforts were undertaken for radiation exposure, heat stress, psychological stress, outbreak of infectious diseases, and fitness for work. Only a few reports dealt with decontamination workers and others; however, the health management of these workers was clearly weaker than that for workers at the NPPs. CONCLUSIONS: Many lessons can be learned from what occurred. That knowledge can be applied to ongoing decommissioning work and to future disasters. In addition, it is necessary to study the long-term health effects of radiation exposure and to accumulate data about the health of workers engaged in decontamination work and other areas.

How Occupational Health can contribute in a disaster and what we should prepare for the future--lessons learned through support activities of a medical school at the Fukushima Daiichi Nuclear Power Plant in Summer 2011.

BACKGROUND: A nuclear accident occurred at the Fukushima Daiichi Nuclear Power Plant of Tokyo Electric Power Company (TEPCO) as a result of a mega-earthquake and tsunami in March, 2011. A large number of workers were engaged in response and recovery operations under a complex structure of involved companies. They were exposed not only to radiation but also to other health hazards. TEPCO implemented programs to prevent radiation exposure, but had no effective systems for managing the other health risks and few occupational health (OH) professionals contributed to the health risk management. ACTIVITIES: The University of Occupational and Environmental Health (UOEH), Japan, dispatched physicians to a quake-proof building at the plant to provide first-aid services from mid-May, 2011, and took a strategic approach to protecting workers from existing health risks. UOEH presented recommendations on OH systems and preventive measures against heat stress to the Government and TEPCO. The Ministry of Health, Labour, and Welfare issued guidelines to TEPCO and contractors. TEPCO implemented a comprehensive program against heat stress according to the guidelines and in cooperation with UOEH. As a result, we successfully prevented severe heat illness during summer 2011. DISCUSSION: From our experiences, we believe that the following recommendations should be considered: (1) the role of OH and the participation of experts should be defined in emergency response plans; (2) regulations should allow the national government and main companies involved to lead safety and health initiatives for all workers at disaster sites; and (3) OH professionals, response manuals and drills should be organized at a national level.

[Qualitative research of contexts of occupational physician's advice].

OBJECTIVES: No consistent procedure has been established for advice given by occupational physicians concerning scope of disease, criteria of diagnosis and laboratory data, and basis of judgment. The aim of this study was to identify practice-based contexts of occupational physician's advice. METHODS: We interviewed 6 occupational physicians, and held focus group discussions (FGD) involving 19 occupational physicians, academic researchers, and clinical doctors. Scripts of the interview and FGD were coded to identify the contexts of occupational physician's advice. Additionally, to assure the generalizability of the proposed contexts of occupational physician's advice, we also conducted a survey to collect cases of advice, for which the fitness of the proposed contexts was confirmed. RESULTS: Four contexts of occupational physician's advice were identified from interviews and FGD, and an additional context was detected through the occupational physician's survey, namely Type 1, work potentially affects a worker's health; Type 2, risk management and prevention of accidents relating to disease; Type 3, recommendation to visit a doctor (referral); Type 4, communication to the head of the department/supervisor; and Type 5, fit for work with appropriate adjustment of work environment and/or conditions. All 48 cases collected could be classified into one or more of these five contexts. DISCUSSION: This study clarified that several contexts exist for occupational physician's advice in practice. The five proposed contexts reveal different responsibilities and judgments between occupational physician, worker, and employer. Understanding the contexts of occupational physician's advice is important for enhancing consensus-building between stakeholders.

[A review of assessment of fitness for work and adjustments for health and safety at worksites overseas].

OBJECTIVE: In this research, we reviewed studies about assessment of fitness for work and adjustments for health and safety at worksites overseas. METHODS: We systematically searched PubMed (1980-2010) using keywords related to fitness for work. The collected studies are discussed with respect to the country, timing of medical examinations, health problems of workers, occupations, categories of health level in workers, criteria for assessment of fitness for work, and the decision-making process related to accommodations at work. RESULTS: Seventy articles were identified that met the inclusion criteria. They focused on two key points related to assessing fitness for work: 1) safety and risk to workers themselves, to other workers and the public, and 2) ability to perform in potentially dangerous situations, such as those encountered by the military and firemen. Employers were required to provide reasonable accommodations for disabled or sick workers. The following steps were taken to make accommodation decisions: 1) analysis of job requirements; 2) worker analysis, including evaluation of work limitations or risks related to disabilities or illness; 3) choice of necessary adjustments at work, based on reasonable accommodations decided during talks between the disabled or sick workers and employers, including feasibility, effectiveness, and costs of such adjustments; 4) judgment of fitness for work based on steps 1 to 3, and opinions of specialists in various fields. CONCLUSION: In this investigation, we could not find any clear criteria for judgments about fitness for work or numerical criteria for adjustments at worksites after medical examinations of employees. However, we confirmed the following. Assessing fitness for work should be based on a comparison of workers' health with the risks and demands of the job. In addition, doctors should have the ability to offer opinions on adjustments at worksites. The employer's obligation to provide reasonable accommodations is attracting more attention in Japan. To make adjustments for health and safety at worksites for all workers, the procedures and important issues must be determined as well as criteria of judgments or numerical criteria. Moreover, doctors should provide opinions about adjustments at worksites. Therefore, they need more training in assessing fitness for work.