Associations between work-related stressors and QALY in a general working population in Japan: a cross-sectional study.

OBJECTIVE: To investigate an association between quality-adjusted life years (QALY) and work-related stressors (job strain, effort/reward imbalance, and poor support from supervisor and coworkers), and estimate loss in QALY caused by these stressors. METHODS: A cross-sectional study investigated data from a third-wave survey (in December 2017) of a 2-year prospective cohort study of Japanese workers. At baseline (first-wave survey), 5000 participants were recruited from workers who registered with an internet survey company. A total of 2530 participants responded to the second-wave survey 1 year later. Participants were then further recruited to the third-wave survey. An online questionnaire collected information regarding health-related quality of life (measured by EQ-5D-5L), job strain, supervisor and coworker support (Brief Job Stress Questionnaire), effort/reward imbalance (Effort/reward Imbalance Questionnaire), and demographic variables (age, sex, education, occupation, work contract, smoking, and alcohol drinking). Multiple linear regression analysis of the QALY score calculated from responses to EQ-5D-5L was employed on standardized scores of the work-related stressors and adjusted for demographic variables (SPSS version 26). RESULTS: Data of 1986 participants were analyzed. Job strain (unstandardized coefficient, b = - 0.013, p < 0.01) and effort/reward imbalance (b = - 0.011, p < 0.01) and coworker support (b = 0017, p < 0.01) were significantly associated with QALY score in the fully adjusted model. CONCLUSION: Job strain, effort/reward imbalance, and poor coworker support may be associated with a reduced QALY score among workers. A substantial impairment in QALY associated with the work-related stressors indicates that workplace interventions targeting work-related stressors may be cost-effective.

[Examination of the Prevention of Severe Hand Trauma Injury Cases due to Occupational Accidents--An Expert Opinion Gathering Meeting].

We gathered seven specialists from various fields who are interested in worker injury prevention programs, based on cases of patients who had suffered refractory injuries requiring hand surgery because of industrial accidents. The patients were asked to write their thoughts and ideas on the theme, "Measures that must be implemented to prevent arm injuries." The content obtained was classified into different categories, using the KJ method, and was scripted to sort out the items. As a result, the following eleven points were identified as measures to prevent serious hand surgery-related injuries: 1. Purchase safe machinery, 2. Create a list of machines that require caution, 3. Enclose a machine's various rotating parts, 4. Carry out periodic maintenance work on the machines, 5. Indicate dangerous areas by putting up signs that attract attention, 6. Illuminate the rotating parts more brightly and avoid placing objects around them, 7. Systematically carry out safety education that creates a strong impact, 8. Encourage workers to look after their own health, 9. Announce policies on health and safety, 10. Re-examine the operational procedures, and 11. Be prepared in case an accident occurs. A perspective based on the results of this research is deemed important in creating a workplace improvement manual in the future.

[Competencies required for occupational health professionals in disaster management based on their personal experiences of workplaces damaged by the Kumamoto earthquakes].

OBJECTIVES: This study aimed to clarify the competencies required for occupational health professionals in disaster management based on their personal experiences of workplaces damaged by the Kumamoto earthquakes. METHODS: This study adopted a qualitative descriptive design using semi-structured interviews. The study participants included eight occupational health professionals who had been engaged in occupational health practice at workplaces affected by the Kumamoto earthquakes and subsequently employed at the same workplace. Data analyses were performed using a qualitative data analysis method. The researcher read transcripts of the interviews verbatim and extracted subcategories and categories, seeking points of commonality among homogeneous and heterogeneous elements while identifying content related to the competencies of the professionals during a disaster. RESULTS: Nine categories and 29 subcategories were extracted. The following competencies were identified as skills required for occupational health professionals when a disaster occurred: "perceiving the essentials of the situation through a comprehensive understanding of the health impacts caused by disasters," "prioritizing tasks while appropriately understanding a situation that is changing over time," "starting from what one can do while ensuring one's own health and safety," "continuing occupational health practice by devising efficient approaches while flexibly responding to the situation," "creating an environment that enables each occupational health team member to fulfill their role," and "adjusting the positions of occupational health departments within organizations to utilize networks." The following competencies were identified as skills required for occupational health professionals' disaster response and preparedness: "having the essential personal qualities of occupational health professionals," "establishing relationships of trust with employees and companies," and "linking one's experience of a disaster to future occupational health practice." CONCLUSIONS: The competencies required for occupational health professionals in disaster management are disaster response and preparedness. Moreover, these aspects in disaster response and preparedness suggest that occupational health professionals are required to have strategic and creative thinking skills including organizational approaches such as boosting networking in the workplace and establishing employer-employee relationships based on multifaceted assessment and situational flexibility.

Support for balancing cancer treatment and work by occupational health nurses: support structures and implementation status.

This study aimed to quantitatively grasp the structure of support for balancing cancer treatment and work among occupational health nurses (OHNs) with the current implementation status. The anonymous questionnaire was designed based on the findings of our previous qualitative study and distributed to OHNs. The degrees of support implementation for workers with cancer, superiors and colleagues, and human resource managers were assessed for each item. Factor analysis of support items was conducted, and Wilcoxon signed-rank test was carried out to compare the support scores between the factors. Support for workers with cancer comprised six factors in which the factor, concerning the provision of information regarding resources inside and outside the company, showed the lowest score. Support for superiors and colleagues was divided into three factors, and that for human resource managers comprised two factors. By Mann-Whitney's U-test, it was found that OHNs, who worked without full-time occupational health physicians for smaller companies, showed significantly higher implementation for several support factors, such as support to human resource managers. This study revealed the structure as well as implementation status of OHNs' support for balancing cancer treatment and work, which will provide suggestions for developing training programs for OHNs to promote these activities.

[A two-year program to promote participatory workplace environmental improvements at small enterprises with fewer than ten employees].

OBJECTIVE: This study aimed to determine the influence of participatory workplace environmental improvement program on reducing job stress and workers' psychological distress at small enterprises (i.e., less than 10 employees). Furthermore, this study aimed to clarify important factors for success of this program as well. METHODS: The model program was tested in a small enterprise with eight employees between October 2014 and January 2017. Moreover, five employees participated in the annual work environment improvement workshops for two consecutive years. During both years, the New Brief Job Stress Questionnaire (80-item version) was used to measure work-related stress before (baseline) and after (post-three months and post-12 months) the workshops. To assess the extent of an intervention effect, the questionnaire data were analyzed using the Friedman test and the multiple comparison test annually. In addition, continuous data were analyzed during the two years. The statistical significance of the differences across time was determined at the p < .10 cutoff value because the number of participants was small. The effect size was also calculated. The participants were interviewed regularly. RESULTS: For both years, the employees implemented action plans within one month of completing the workshops. In the first year, the data for the Friedman test indicated a significant change in role conflict, job resources (workgroup-level), respect for individuals, fair personnel evaluations, work-self balance (positive), workplace social capital, and job satisfaction. In the multiple comparison test, significant changes manifested in role conflict and workplace social capital. In the second year, significant changes were found regarding role conflict and fair personnel evaluations for the Friedman test, demonstrating significant changes in role conflict in the multiple comparison test. As per the two-year survey results, the Friedman test indicated significant changes in role conflict, respect for individuals, and fair personnel evaluations, while the multiple comparison test demonstrated no significant changes. Over time, favorable changes were found regarding role conflict in the first year; however, undesirable changes were found regarding the other statistically significant items. The interviews revealed both positive and negative opinions. CONCLUSIONS: This study found the effects of the participatory workplace environment improvement program to be limited. Thus, the program should be improved to reduce its adverse effects as well as the participants' negative opinions.

Outcomes for facilitators of workplace environment improvement applying a participatory approach.

OBJECTIVES: The purpose of this study was to determine changes in awareness, behavior, and relationships among facilitators who were involved in facilitating the conduct of the participatory workplace improvement program and to examine the facilitators' outcomes as a result of their active involvement in the program. The outcome components were also examined in relationship to their associations with various factors. METHODS: An anonymous self-administered questionnaire survey was conducted for 83 facilitators. Exploratory factor analysis was applied to determine the facilitators' outcomes. The relationship between those elements which influenced the outcomes was taken into account by means of hierarchal multiple regression analysis. RESULTS: The outcomes for facilitators consisted of four sub-concepts: "knowing practical ways and strategies to ensure full participation," "building confidence and self-development," "improving safety and health-risk sensitivity," and "gaining better-than-expected results based on developing relationships with workers." According to the results of hierarchal multiple regression analysis, facilitators' outcomes were significantly associated with the realization of creativity, sense of solution for safety and health issues, and facilitators' involvement. CONCLUSIONS: It is suggested that the role of a facilitator dynamically changes through a participatory workplace improvement program as a key person in the workplace. Supporting acting facilitators' initiatives in the process of workplace improvement programs, as well as promoting the active involvement of workers and managers were considered useful for effective implementation of workplace improvement programs.

[Education systems for occupational health nursing in the basic education course for public health nurses in Japan].

OBJECTIVES: This study aimed to clarify the education systems for occupational health nursing (OHN) in the basic education course for public health nurses (PHNs) in Japanese nursing universities. METHODS: An anonymous self-administered questionnaire survey was conducted among 234 nursing universities with PHN courses. We surveyed the outline of PHN/OHN curricula, clinical practicum in OHN, and the skill achievement levels of students in OHN clinical practicum according to the "Minimum Requirements in PHNs Education 2004" (MR2004) developed by the Japan Association of PHN Educational Institutions. The data were analyzed using a t-test and Mann-Whitney U test. All statistical analyses were carried out using IBM SPSS ver. 21.0. RESULTS: In the analysis, we used data from the 80 respondent schools (response rate 34.2%). In 39 schools (48.1%), lectures related to a clinical practicum in OHN were offered as independent subjects in the school curriculum; of these 39, two schools (2.5%) offered OHN as multiple independent subjects. In 49 schools (60.5%), clinical practicum in OHN was designated as a part of PHN training. In colleges that had a clinical practicum in OHN, the number of lecture hours related to OHN was 9.7 ± 11.6 hours, which was more than that in colleges without such a practicum, although the difference was not significant. We compared the skill achievement levels between the groups where the number of days in the OHN clinical practicum was up to two and up to three or more. There was a tendency for the skill achievement level to be higher in the group with the greater number of days, with a significant difference in 16 of 19 items. CONCLUSIONS: We clarified that the PHN curriculum is offered with many variations in colleges, and that the lectures and clinical practicum in OHN are developed according to each college's policy. We observed the following tendency: the more days in the OHN clinical practicum, the higher the student's skill achievement level. These findings suggest that guaranteeing a certain number of days in a clinical practicum in OHN is important for realizing high-quality PHN training.

Development and evaluation of a training program for occupational health nurses regarding support for workers with cancer and their workplaces.

OBJECTIVES: This study aimed to develop and evaluate a training program for occupational health nurses (OHNs) regarding support for workers with cancer and their workplaces. METHODS: Based on our prior research, we engaged in multiple discussions on the development of training program for OHNs. For examining the effectiveness of the developed training program, we collected and analyzed the data from three repeated surveys conducted before, immediately after, and 3 months after the training on self-confidence levels of the participants regarding 23 items associated with support for workers with cancer and their workplaces. RESULTS: We made a 3-hour training program including a lecture and a group work. First, we gave a lecture explaining the support scheme consisting of 4 parts and the 12 hints in action phrase while using the guidebook. Second, we conducted the group work regarding the case of a female worker diagnosed with breast cancer. Of the participants who supported workers with cancer in actuality during the 3-month post-training, 86% acknowledged the utility of the training in implementing support. As for the pre-post evaluation of the training program, most items of the participants' self-confidence significantly increased from pretraining to immediately after and 3 months post-training. DISCUSSION: This study demonstrated that the developed training program was effective in that the participants learned the support schemes and skills and gained self-confidence in implementing supports in real-work settings. We hope that this training program will be extensively used in the future, enabling OHNs to contribute toward balancing cancer treatment and work.

[Development process of Evidence-based "Return-to-work Guidance in Occupational Health 2017"].

OBJECTIVE: "Return-to-work Guidance in Occupational Health 2017 (RTW Guidance 2017) " is the first occupational health guide in Japan that evaluates the quality of evidence and offers recommendations based on results of the systematic review of randomized controlled trials. Details of the systematic review of each review question (RQs) will be described separately. This article presents an overview of the method and process of developing the "RTW Guidance 2017." MATERIALS AND METHODS: The guidance was developed following the previously-published "Method for developing evidence based occupational health guidance," which included the composition of a highly-transparent guidance developing group as well as the recruitment and selection of RQs. Using the Cochrane Library, PubMed, and Ichushi-Web, a literature search for the six RQs was conducted in January 2016 by partly modifying the search terms of the existing systematic review. Articles were selected according to the inclusion criteria, and the quality of evidence was evaluated using the GRADE approach. Meta-analysis was conducted for RQ2 and RQ4, and a qualitative systematic review was conducted for RQ5, RQ6, and cost-effectiveness. Recommendations were subsequently made after a thorough consideration for feasibility in Japan by examining the costs and available resources. RESULTS: Based on a comprehensive literature search, eleven RQ2, four RQ4, one RQ5, and three RQ6 were selected. Support program for returning to work, such as "Re-work" for those who are temporarily not working due to musculoskeletal disorders or mental health disorder, was recommended based on moderate evidence (RQ2). For RQ4, the collaboration between occupational health practice and clinical practice was weakly recommended based on low evidence. For RQ5 that evaluated the usefulness of social support, intervention by the manager/co-worker was proposed as a "best practice statement" without indicating it as a recommendation. Work accommodation was weakly recommended based on low evidence in RQ6. DISCUSSION AND CONCLUSION: From the result of systematic reviews, it was recommended for workers on sick leave more than four weeks regardless of sick leave and sickness absence that interventions during leave would improve work-related outcomes, such as earlier reinstatement. Although there is limited evidence regarding occupational health in Japan, it is important for many occupational health professionals to learn the method of developing guidance and to identify issues for future studies with priority in Japan.

Effect of the National Stress Check Program on mental health among workers in Japan: A 1-year retrospective cohort study.

OBJECTIVES: This retrospective cohort study evaluated the impact of the Stress Check Program, a recently introduced national policy and program aimed at reducing psychological distress among Japanese workers. METHODS: A baseline survey was conducted from November 2015 to February 2016, the period when Japan began enforcing the Stress Check Program. A one-year follow-up survey was conducted in December 2016. In the follow-up survey, two exposure variables were collected: having taken the annual stress survey, and experiencing an improvement in the psychosocial work environment. Psychological distress was assessed using the Brief Job Stress Questionnaire (BJSQ) at baseline and 1-year follow-up. The two exposure variables were used to define four groups: "Neither", "Stress survey (SS) only", "Psychosocial work environment improvement (WI) only", and "Both". BJSQ results were analyzed using repeated measures general linear modeling (GLM). RESULTS: The study included 2,492 participants: 1,342 in the "Neither" group, 1,009 in the "SS only" group, 76 in the "WI only" group, and 65 in the "Both" group. Overall time-group interaction effects were not significant. The "Both" group showed significantly greater improvements in psychological distress than the "Neither" group (p = 0.02) at the 1-year follow-up, although the effect size was small (d = -0.14). CONCLUSIONS: Combination of the annual stress survey and improvement in psychosocial work environment may have been effective in reducing psychological distress in workers, although the effect size was small.

Competencies required for occupational health nurses.

OBJECTIVES: For occupational health (OH) nurses to perform activities effectively, not only skills and knowledge but also competencies proposed by Dr. McClelland are indispensable. This study aimed to identify competencies required for OH nurses and to show their structure diagram. METHODS: Qualitative descriptive research was conducted from October 2010 to August 2011. Eight high-performing OH nurses participated, and data were collected from semi-structured interviews held for each nurse. Data were qualitatively and inductively analyzed using the KJ method. RESULTS: Seven competencies were identified: "self-growth competency," "OH nursing essence perpetuation competency," "strategic planning and duty fulfillment competency," "coordination competency," "client growth support competency," "team empowerment competency," and "creative competency." A structure diagram of the seven competencies was clarified. As the definitions of the competencies were different, the findings of competencies for OH nursing in the United States of America (USA) could not simply be compared with the findings of our study; however, all seven competencies were compatible with those in AAOHN model 1 and AAOHN model 2 in the USA. CONCLUSION: Our seven competencies are essential for OH nurses to perform activities that meet the expectations of employees and the employer.

Pokémon GO and psychological distress, physical complaints, and work performance among adult workers: a retrospective cohort study.

The effects of Pokémon GO, a new mobile game application which utilizes augmented reality, on risky behavior and health have already been discussed in anecdotal evidence. However, there have been no studies about its effects on mental health. This study investigated the relationships between Pokémon GO and psychological distress from an existing workers' cohort in Japan. Online surveys were conducted to 3,915 full-time workers, at baseline (Nov 26, 2015-Feb 18, 2016) and at follow-up (Dec 1-4, 2016), using a self-report questionnaire. Pokémon GO players were defined as participants who had played Pokémon GO for one month or longer. Psychological distress was measured using validated scales. Of the completers, 246 (9.7%) had continued to play Pokémon GO. They were significantly younger than non-players. From the results of the general linear modeling, improvement in psychological distress was significantly greater among Pokémon GO players than among non-players (p = 0.025). Cohen's d for the difference in psychological distress was -0.20 (95% CI, -0.33, -0.07). Pokémon GO may be effective for improving psychological distress among workers. Although its effect size is small, the game could have positive effects on the mental health of the adult working population.

Utility of action checklists as a consensus building tool.

The present study's objective was to determine the mechanisms for enhancing the utility of action checklists applied in participatory approach programs for workplace improvements, to identify the benefits of building consensus and to compare their applicability in Asian countries to find the most appropriate configuration for action checklists. Data were collected from eight trainees and 43 trainers with experience in Participatory Action-Oriented Training. Statistical analysis was performed in SPSS using the package PASW, version 19.0. The difference in the mean score for the degree of the utility of action checklists between countries was analyzed using ANOVA methods. Factor analysis was performed to validate the action checklists' utility. Pearson Correlation Coefficients were then calculated to determine the direction and strength of the relationship between these factors. Using responses obtained from trainees' in-depth interviews, we identified 33 key statements that were then classified into 11 thematic clusters. Five factors were extracted, namely "ease of application", "practical solutions", "group interaction", "multifaceted perspective" and "active involvement". The action checklist was useful for facilitating a participatory process among trainees and trainers for improving working conditions. Action checklists showed similar patterns of utility in various Asian countries; particularly when adjusted to local conditions.

Barriers to continuing education and continuing professional development among occupational health nurses in Japan.

As Japan's industries pursue technical innovations, the responsibilities of occupational health nurses are becoming increasingly complex. With such change, continuing professional development (CPD) and continuing education (CE) are crucial to the provision of appropriate care for workers. This study examined current practices of occupational health nurses and identified barriers to conducting occupational CPD and CE activities. A survey questionnaire was sent to 2,077 occupational health nurses late in 2010, asking about factors affecting attendance at and participation in CPD and CE activities, including challenges for occupational health nurses in practice. Findings demonstrated that many occupational health nurses do not work for companies that support CPD and CE. A significant finding was that occupational health nurses in Japan desire CPD activities and recognize the importance of attending CE activities. Continuing education is viewed by occupational health nurses as essential for their professional development and advancement with broader practice responsibilities and authority. Findings from this study are useful in crafting recommendations to increase occupational health nurse participation in both CPD and CE, leading to improvement in overall workplace health and safety in Japan.

[Concept analysis of a participatory approach to occupational safety and health].

PURPOSE: The purpose of this study was to analyze a participatory approach to occupational safety and health, and to examine the possibility of applying the concept to the practice and research of occupational safety and health. METHODS: According to Rodger's method, descriptive data concerning antecedents, attributes and consequences were qualitatively analyzed. A total of 39 articles were selected for analysis. RESULTS: Attributes with a participatory approach were: "active involvement of both workers and employers", "focusing on action-oriented low-cost and multiple area improvements based on good practices", "the process of emphasis on consensus building", and "utilization of a local network". Antecedents of the participatory approach were classified as: "existing risks at the workplace", "difficulty of occupational safety and health activities", "characteristics of the workplace and workers", and "needs for the workplace". The derived consequences were: "promoting occupational safety and health activities", "emphasis of self-management", "creation of safety and healthy workplace", and "contributing to promotion of quality of life and productivity". CONCLUSIONS: A participatory approach in occupational safety and health is defined as, the process of emphasis on consensus building to promote occupational safety and health activities with emphasis on self-management, which focuses on action-oriented low-cost and multiple area improvements based on good practices with active involvement of both workers and employers through utilization of local networks. We recommend that the role of the occupational health professional be clarified and an evaluation framework be established for the participatory approach to promote occupational safety and health activities by involving both workers and employers.

Shortened red blood cell lifespan is related to the dose of erythropoiesis-stimulating agents requirement in patients on hemodialysis.

Renal anemia is an important complication of chronic kidney disease (CKD). One of the most important complications of renal anemia is reduced red blood cell (RBC) lifespan, but there has been little research conducted into the causes of and treatments for this anemia. We measured alveolar carbon monoxide (CO) and then estimated RBC lifespan in patients on hemodialysis (HD). We also examined their requirement for erythropoiesis-stimulating agents (ESA), HD dose, nutrition factors, iron metabolism factor, reticulocyte counts and % reticulocytes. We enrolled 140 patients undergoing intermittent HD; among this group, 31 were not administered ESA and the others were on ESA therapy. Twelve healthy volunteers served as controls. The RBC lifespans in the healthy volunteers and in the HD patients were 128 ± 28 and 89 ± 28 days (mean ± SD), respectively. The RBC lifespan significantly and negatively correlated with ESA requirement (r = -0.489, P < 0.0001) in the HD patients. Other factors suspected to influence the RBC lifespan did not significantly correlate with the RBC lifespan in HD patients, in contrast to the correlation observed for S-Cr, BUN, S-ALB and total cholesterol vs. RBC lifespan. A shortened RBC lifespan seems to rather significantly affect the ESA requirement. Better nutritional status or active HD patients also seem to have longer RBC lifespans and lower ESA requirement.