Depressive and anxiety symptoms among Japanese cancer survivors: Japan cancer survivorship research project.

BACKGROUND: This study aimed to clarify predictors of depressive symptoms and anxiety symptoms after cancer diagnosis among Japanese cancer survivors (CSs). METHODS: As part of a Japanese cancer survivorship research project commissioned by the Ministry of Health, Labour and Welfare (MHLW) of Japan, we conducted a web-based nationwide survey of CSs in 2018. We analyzed the risk factors for depressive and anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale Japanese version (HADS). RESULTS: Of 1,234 Japanese CSs, mean score of HADS-depression and HADS-anxiety were 4.08 and 4.78, respectively. At the time of the study, the number of CSs with symptoms of depression and anxiety were 111 (9.0%) and 269 (21.8%), respectively. After multivariable analysis, CSs ≥ 60 years old (reference: ≤ 39 years old, odds ratios (OR): 0.39, 95%CI: 0.17-0.90) and those ≥ 10 years from cancer diagnosis (reference: 0-4 years, OR: 0.55, 95%CI: 0.32-0.96) had lower odds for depressive symptoms. And CSs ≥ 60 years old (reference: ≤ 39 years old, OR: 0.27, 95%CI: 0.15-0.49) and those ≥ 10 years from cancer diagnosis (reference: 0-4 years, OR: 0.62, 95%CI: 0.42-0.90) also had lower odds for anxiety symptoms. CSs who received chemotherapy (OR: 1.56, 95%CI: 1.10-2.20) had higher odds for anxiety symptoms. CONCLUSIONS: Based on manifestation of symptoms, CSs who were younger, closer to the time of cancer diagnosis, had advanced-staged cancer, or received chemotherapy may be at higher risk for depressive or anxiety symptoms. Those CSs who have higher risk for depression and anxiety symptoms, should be followed-up more carefully for better cancer survivorship, by medical professionals, companies, and society.

Predictors of resignation and sick leave after cancer diagnosis among Japanese breast cancer survivors: a cross-sectional study.

BACKGROUND: In Japan, 55.5% of breast cancer survivors (BCSs) are of working age, so various perspectives regarding return to work (RTW) after cancer diagnosis need to be considered. Therefore, this study aimed to clarify the risk factors for resignation and taking sick leave (SL) among BCSs in continued employment at the time of diagnosis. METHODS: A web-based retrospective cross-sectional survey was conducted on BCSs using data from a 2018 Japanese national research project (Endo-Han) commissioned by the Ministry of Health, Labour and Welfare of Japan. The subjects were women aged 18-69 years who had been diagnosed with breast cancer for the first time at least 1 year previously. The risk factors for resignation and taking SL after breast cancer diagnosis, including age at diagnosis, education level, cancer stage, surgery, chemotherapy, radiotherapy, employment status, and occupational type, were then analyzed using a logistic regression model. RESULTS: In total, 40 (14.9%) of 269 BCSs quit their jobs at least 1 year after being diagnosed with breast cancer. The results of the multivariable analysis indicated that lower education level (odds ratio [OR]: 3.802; 95% confidence interval [CI]: 1.233-11.729), taking SL (OR: 2.514; 95%CI: 1.202-5.261), and younger age at diagnosis (OR: 0.470; 95%CI: 0.221-0.998) were predictors of resignation. Of 229 patients who continued working, SL was taken by 72 (31.4%). In addition, undergoing surgery was found to be a predictor of taking SL (OR: 8.311; 95%CI: 1.007-68.621). CONCLUSIONS: In total, 40 (14.9%) of 269 BCSs quit their jobs at least 1 year after being diagnosed with breast cancer. The results of this study indicated that younger age, lower education level, and taking SL were predictors of resignation after breast cancer diagnosis.

Transcription factor Smad-independent T helper 17 cell induction by transforming-growth factor-ß is mediated by suppression of eomesodermin.

Transforming growth factor-ß (TGF-ß) has been shown to be required for Th17 cell differentiation via Smad-independent mechanisms. The molecular mechanism underlying this pathway remains to be clarified, however. We searched for genes regulated by TGF-ß through the Smad-independent pathway by using Smad2 and Smad3 double-deficient T cells and identified the transcription factor Eomesodermin (Eomes), whose expression was suppressed by TGF-ß via the c-Jun N-terminal kinase (JNK)-c-Jun signaling pathway. Inhibition of JNK strongly suppressed disease in an in vivo EAE model as well as in vitro Th17 cell induction. Overexpression of Eomes substantially suppressed Th17 cell differentiation, whereas ablation of Eomes expression could substitute for TGF-ß in Th17 cell induction in primary T cells. Eomes suppressed Rorc and Il17a promoters by directly binding to the proximal region of these promoters. In conclusion, the suppression of Eomes by TGF-ß via the JNK pathway is an important mechanism for Smad-independent Th17 cell differentiation.

Recurrent sick leave and resignation rates among female cancer survivors after return to work: the Japan sickness absence and return to work (J-SAR) study.

BACKGROUND: To date, there have not been any workforce-based Japanese cohort studies investigating work sustainability after return to work (RTW). The objective of this study was to investigate the post-RTW cumulative recurrent sick leave rate and cumulative resignation rate among female cancer survivors. METHODS: Among Japanese employees who were registered in the Japan sickness absence and return to work (J-SAR) study, the subjects were those female employees who returned to work after sick leave due to newly clinically diagnosed cancer (C01-C99; ICD-10), based on a physician's certificate, between 2000 and 2011. The last day of the follow-up period was December 31, 2012. The recurrent sickness leave rate and resignation rate were calculated using competing risk survival analysis. RESULTS: Of 223 cancer survivors, 61 took further physician-certified sick leave after their RTW. The median duration of the post-RTW work period among all cancer survivors was 10.6 years. The work continuance rates of the female cancer survivors were 83.2 and 60.4% at 1 and 5 years after they returned to work, respectively. There was a steep reduction in the work continuance rate during the first post-RTW year. There were considerable differences in the work continuance rate according to the primary cancer site. Cumulative recurrent sick leave rates of 11.8 and 28.9% were seen at 1 and 5 years after the subjects returned to work. The cumulative resignation rate was 5.0 and 10.7% at 1 and 5 years after the subjects returned to work. Most recurrent sick leave occurred in the first year after the subjects returned to work, followed by the second year. CONCLUSIONS: Sixty percent of female cancer survivors were still working at 5 years after returning to work, although the work continuance rates for different types of cancer varied significantly.

For making a declaration of countermeasures against the falling birth rate from the Japanese Society for Hygiene: summary of discussion in the working group on academic research strategy against an aging society with low birth rate.

In 1952, the Japanese Society for Hygiene had once passed a resolution at its 22nd symposium on population control, recommending the suppression of population growth based on the idea of cultivating a healthier population in the area of eugenics. Over half a century has now passed since this recommendation; Japan is witnessing an aging of the population (it is estimated that over 65-year-olds made up 27.7% of the population in 2017) and a decline in the birth rate (total fertility rate 1.43 births per woman in 2017) at a rate that is unparalleled in the world; Japan is faced with a "super-aging" society with low birth rate. In 2017, the Society passed a resolution to encourage all scientists to engage in academic researches to address the issue of the declining birth rate that Japan is currently facing. In this commentary, the Society hereby declares that the entire text of the 1952 proposal is revoked and the ideas relating to eugenics is rejected. Since the Society has set up a working group on the issue in 2016, there have been three symposiums, and working group committee members began publishing a series of articles in the Society's Japanese language journal. This commentary primarily provides an overview of the findings from the published articles, which will form the scientific basis for the Society's declaration. The areas we covered here included the following: (1) improving the social and work environment to balance between the personal and professional life; (2) proactive education on reproductive health; (3) children's health begins with nutritional management in women of reproductive age; (4) workplace environment and occupational health; (5) workplace measures to counter the declining birth rate; (6) research into the effect of environmental chemicals on sexual maturity, reproductive function, and the children of next generation; and (7) comprehensive research into the relationship among contemporary society, parental stress, and healthy child-rearing. Based on the seven topics, we will set out a declaration to address Japan's aging society with low birth rate.

Work Sustainability Among Male Cancer Survivors After Returning to Work.

BACKGROUND: Few studies have investigated the work continuance rate among cancer survivors after return to work (RTW). The objective of this study was to clarify work sustainability after RTW among Japanese male cancer survivors. METHODS: We collected data on male cancer survivors from an occupational health register. Inclusion criteria were as follows: employees who returned to work after an episode of sick leave due to clinically certified cancer diagnosed between January 1, 2000 and December 31, 2011. RESULTS: Of 1,033 male employees who were diagnosed with cancer, 786 employees (76.1%) returned to work after their first episode of sick leave due to cancer. Work continuance rates among all subjects were 80.1% 1 year after RTW and 48.5% 5 years after RTW. The mean duration of work after RTW was 4.5 years. The work continuance rates varied significantly by cancer type. The "Lung" and "Hepatic, Pancreatic" cancer groups had the shortest duration of work (0.9 year after RTW). CONCLUSIONS: Of workers who returned to work after their first episode of leave after cancer, 50% continued to work after 5 years in large-scale companies. There was a steep decrease in work continuance rates during the first year after RTW, with considerable differences according to cancer site.

Employment sustainability after return to work among Japanese stroke survivors.

PURPOSE: Few studies have investigated the work continuance rate among stroke survivors who return to work (RTW). The objective of this study was to investigate work sustainability after RTW and the causes of recurrent sickness absence (RSA) among Japanese stroke survivors. METHODS: Data on stroke survivors were collected from an occupational health register. The inclusion criteria were as follows: employees who were aged 15-60 years old and returned to work after an episode of sick leave due to a clinically certified stroke that was diagnosed during the period from 1 January 2000 through 31 December 2011. RESULTS: 284 employees returned to work after their first episode of stroke-induced sick leave. The work continuance rate for all subjects was 78.8 and 59.0% at one and 5 years after the subjects' RTW, respectively. After returning to work, the subjects worked for a mean of 7.0 years. Of 284 employees who returned to work, 86 (30.3%) experienced RSA. The RSA were caused by recurrent strokes in 57.0% (49/86) of cases, mental disorders in 20.9% (18/86) of cases, and fractures (often due to accidents involving steps at train stations or the subject's home) in 10.5% (9/86) of cases. 21 employees resigned after returning to work. The resignation rates at 1 and 5 years were 4.9 and 7.6%, respectively. According to the multivariate analysis including all variables, the subjects in the ≥ 50 year group were at greater risk of work discontinuation than the ≤ 49 year (reference) age group (HR: 2.26, 95% CI 1.39-3.68). CONCLUSIONS: Occupational health professionals need to provide better RTW support to stroke survivors and should pay particularly close attention to preventing recurrent strokes, mental disorders, and fractures.

Large vessel vasculitis in elderly patients: early diagnosis and steroid-response evaluation with FDG-PET/CT and contrast-enhanced CT.

Large vessel vasculitis (LVV) is an often-reported cause of inflammation of unknown origin (IUO) in elderly people. The objective of this study was to describe the usefulness of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and contrast-enhanced CT in early diagnosis and treatment follow-up of patients with LVV presenting as elderly onset IUO. We retrospectively compared contrast-enhanced CT findings and FDG-PET/CT findings of the patients diagnosed with LVV and 11 controls; all subjects were 50 years of age or older. We evaluated maximum standardised uptake value (SUV(max)) and PET score of the aortic wall for quantitative comparison of FDG-PET/CT findings. We measured the aortic wall thickness (W) and its ratio against the radius (W/R) for quantitative comparison of aortic wall thickening by contrast-enhanced CT. After steroid treatment, we compared these values with those pre-treatment. Of 124 patients who were hospitalised due to advanced age and IUO, 88 underwent FDG-PET/CT and contrast-enhanced CT. Abnormal findings were observed on images from 78 patients. The findings were indicative of LVV in 13 patients (10.5 %), of whom more than half had only non-specific symptoms. Patients with LVV had significantly higher aortic wall SUV(max) (3.85 vs. 1.95), PET scores by FDG-PET/CT, and aortic wall thicknesses by contrast-enhanced CT (3.8 vs. 2.6 mm) than controls. Significant improvement in aortic wall thickening was evidenced by reduced PET scores and by contrast-enhanced CT findings in patients who were followed up after treatment. LVV is an important cause of IUO with non-specific symptoms in elderly patients. Imaging examination comprising contrast-enhanced CT and FDG-PET/CT is useful for early diagnosis and early treatment evaluation of LVV, allowing for amelioration of reversible aortic wall thickening.

Association of community-level social capital with dementia: A multilevel nine-year longitudinal study using data from the Japan Gerontological Evaluation Study.

BACKGROUND: Individual-level social capital prevents cognitive decline. However, a few studies have focused on the effects of community-level social capital on dementia. Therefore, we investigated the association between community-level social capital and dementia onset based on longitudinal study data on older adults in Japan. METHODS: We used longitudinal data from the Japan Gerontological Evaluation Study, obtained over nine years (2010-2019). In total, 35,921 physically and cognitively independent individuals (16,848 males and 19,073 females) aged ≥65 years and nested within 308 communities in seven municipalities participated in the study. Dementia onset was assessed using the public long-term care insurance registration. Social capital was assessed using three dimensions: civic participation, social cohesion, and reciprocity. We performed a two-level multilevel survival analysis stratified by sex, calculated hazard ratios (HRs), and 95% confidence intervals (CIs). RESULTS: During the follow-up, 6245 (17.4%) dementia onset cases were identified. The cumulative incidence of dementia was 16.2% in males and 18.4% in females. After adjusting for covariates, individual-level civic participation was associated with a lower incidence of dementia in both males and females (HR, 0.84; 95% CI, 0.77-0.92; HR, 0.78; 95% CI, 0.73-0.84). Community-level civic participation and social cohesion were associated with a lower incidence of dementia among females (HR, 0.96; 95% CI, 0.93-0.99; HR, 0.93; 95% CI, 0.88-0.98) and cross-level interaction on social cohesion among females (HR, 0.95; 95% CI, 0.90-0.99). CONCLUSIONS: Living in a community with high civic participation and social cohesion is associated with a lower incidence of dementia among older females. Therefore, promoting civic participation and social cohesion in the community may be a useful population-based strategy to delay or prevent the onset of dementia.

TGF-ß function in immune suppression.

Transforming growth factor-ß (TGF-ß) has been shown to play an essential role in establishing immunological tolerance, yet recent studies have revealed the pro-inflammatory roles of TGF-ß in inflammatory responses. TGF-ß induces Foxp3-positive regulatory T cells (iTregs), while in the presence of IL-6, it induces pathogenic IL-17 producing Th17 cells. TGF-ß inhibits the proliferation of T cells as well as cytokine production via Foxp3-dependent and independent mechanisms. On the one hand, little is known about molecular mechanisms involved in immune suppression via TGF-ß; however, recent studies suggest that Smad2 as well as Smad3 play essential roles in Foxp3 induction and cytokine suppression, whereas Th17 differentiation is promoted via the Smad-independent pathway. Mutual suppression of signaling between TGF-ß and inflammatory cytokines has been shown to be necessary for the balance of immunity and tolerance.

Smad2 and Smad3 are redundantly essential for the TGF-beta-mediated regulation of regulatory T plasticity and Th1 development.

Although it has been well established that TGF-beta plays a pivotal role in immune regulation, the roles of its downstream transcription factors, Smad2 and Smad3, have not been fully clarified. Specifically, the function of Smad2 in the immune system has not been investigated because of the embryonic lethality of Smad2-deficient mice. In this study, we generated T cell-specific Smad2 conditional knockout (KO) mice and unexpectedly found that Smad2 and Smad3 were redundantly essential for TGF-beta-mediated induction of Foxp3-expressing regulatory T cells and suppression of IFN-gamma production in CD4(+) T cells. Consistent with these observations, Smad2/Smad3-double KO mice, but not single KO mice, developed fatal inflammatory diseases with higher IFN-gamma production and reduced Foxp3 expression in CD4(+) T cells at the periphery. Although it has been suggested that Foxp3 induction might underlie TGF-beta-mediated immunosuppression, TGF-beta still can suppress Th1 cell development in Foxp3-deficient T cells, suggesting that the Smad2/3 pathway inhibits Th1 cell development with Foxp3-independent mechanisms. We also found that Th17 cell development was reduced in Smad-deficient CD4(+) T cells because of higher production of Th17-inhibitory cytokines from these T cells. However, TGF-beta-mediated induction of RORgamma t, a master regulator of Th17 cell, was independent of both Smad2 and Smad3, suggesting that TGF-beta regulates Th17 development through Smad2/3-dependent and -independent mechanisms.

Relationship between occupational injury and gig work experience in Japanese workers during the COVID-19 pandemic: a cross-sectional internet survey.

This study evaluated the relationship between occupational injury risk and gig work, which included the exchange of labor for money between individuals or companies via digital platforms. As Japan has experienced a severe economic decline during the coronavirus disease 2019 (COVID-19) pandemic, an increasing number of individuals have engaged in gig work. While few studies have evaluated occupational risks in gig work, several traffic accidents associated with food delivery gig work have been reported in the mass media. In this study, 18,317 individuals completed an internet survey that collected information pertaining to their involvement in gig work and experience of related occupational injuries; data regarding several confounding factors were also recorded. Multiple logistic regression analysis showed that workers involved in gig work had a greater risk of any minor occupational injuries (odds ratio, 3.68; 95% confidence interval, 3.02-4.49) and activity-limiting injuries (odds ratio, 9.11; 95% confidence interval, 7.03-11.8) than those not involved in gig work, after adjusting for age, sex, household income, lifestyle factors, and work-related factors. The results of this study indicate that gig workers are exposed to greater occupational hazards during the COVID-19 pandemic. Additional studies are warranted to clarify the causal mechanism for this relationship.

Mortality risk in older Japanese people based on self-reported dyslipidemia treatment and socioeconomic status: The JAGES cohort study.

Few studies consider socioeconomic status when assessing mortality risk in dyslipidemia cases. This study used cohort data from the 2010 Japan Gerontological Evaluation Study (JAGES), which contains data on older Japanese people, to associate socioeconomic status with mortality risk in patients treated for dyslipidemia. In this 6-year longitudinal study, we examined 47,275 older Japanese people aged ≥ 65 years who could independently perform activities of daily living. Patients' background characteristics were classified based on their dyslipidemia treatment status and were assessed using the chi-squared test. The mortality risk was assessed using the Cox proportional hazards model, wherein the objective and explanatory variables were total mortality and self-report of dyslipidemia treatment, respectively. The participants were stratified by sex and age into younger (aged 65-74 years) and older (aged ≥ 75 years) groups of men and women. The results were adjusted, with health condition, health behavior, and socioeconomic status as confounding factors. The adjusted hazard ratios of 5514 people who died during the follow-up who had self-reported dyslipidemia treatment were 0.49 [95% confidence interval (CI) 0.35-0.69] for younger men; 0.57 (95% CI 0.42-0.76) for older men; 0.52 (95% CI 0.34-0.80) for younger women; and 0.47 (95% CI 0.33-0.67) for older women. Older people undergoing treatment for dyslipidemia had factors beneficial for health, such as good socioeconomic status. Despite considering these factors, individuals undergoing dyslipidemia treatment had a negative association with mortality risk.

Characteristics of COVID-19 infection clusters occurring among workers in several Asia-Pacific countries.

The types of workplaces and occupations with coronavirus 2019 (COVID-19) clusters vary between countries and periods. We aimed to characterize major occupational groups with mass outbreaks of COVID-19 infections in several Asia-Pacific countries. Data on the major occupations or workplaces reporting COVID-19 cases in workplaces from January 2020 to July 2021 was collected from industrial hygiene professionals in nine countries. The proportion of workers accounted for 39.1 to 56.6% of the population in each country. The number of workers covered in the national statistics varies among nations based on their definition of a worker. None of the countries examined here have systematically collected occupational data on COVID-19 illnesses and deaths classified by type of industry, occupation, or job. Most countries experienced COVID-19 clusters among health and social care workers (HSCW) in hospitals or long-term care facilities. The types of occupations or workplaces with virus clusters in some participating countries included prisons, call centers, workplaces employing immigrants, garment facilities, grocery stores, and the military, which differed among countries, except for a few common occupations such as HSCW and those populated by immigrants. Further study is necessary in order to seek ways to control infection risks, including revisions to industrial-health-related laws.

A patient with intravascular lymphoma presenting with cerebral infarction and a high serum MPO-ANCA level.

A 74-year-old woman presented with multiple brain infarctions, an inflammatory reaction, and a high serum titer (414 U/ml) of myeloperoxidase-specific antineutrophil cytoplasmic antibody (MPO-ANCA) with no hematological abnormalities. After the inflammation and ANCA titers were resolved with steroid therapy for suspected microscopic polyangiitis, hemophagocytic syndrome developed. Biopsies revealed non-Hodgkin's intravascular lymphoma (IVL). The flare of IVL with negative serum ANCA suggested that the initial high serum MPO-ANCA had not originated from tumor cells.

Social participation and mortality according to company size of the longest-held job among older men in Japan: A 6-year follow-up study from the JAGES.

OBJECTIVES: The purpose of this study was to examine the relationship between social participation (type/pattern) and mortality according to company size of the longest-held job among older men in Japan who have worked in the company. METHODS: Longitudinal data from the Japan Gerontological Evaluation Study were used in this study. Functionally independent individuals aged 65 years and older in Japan were surveyed. Work and community organizations (local community, hobbies, and sports) were used as social participation. A Cox proportional hazards model was used to calculate mortality hazard ratios. RESULTS: Analysis was carried out on 19 260 participants. A total of 2870 deaths occurred during the 6-year follow-up period. Those in companies with 49 or fewer employees had the highest prevalence of work participation and the lowest participation in any community organization. Regardless of company size, the mortality risk was significantly lower for participants in any social participation (eg, the hazard ratio for participation in a hobby organization among those with a company size of 49 employees or fewer was 0.74, 95% CI: 0.65-0.85) compared to nonparticipants whose company size was 49 or fewer employees. CONCLUSIONS: In Japan, although older men who have worked for small companies may have fewer benefits, their social participation may reduce their mortality risks. To avoid increasing health inequalities, it is necessary to create an environment in which they are more likely to participate in social activities.

Erratum: Correction of the received and accepted dates: Exposure to paraben and triclosan and allergic diseases in Tokyo: A pilot cross-sectional study.

[This corrects the article e5 in vol. 9, PMID: 30740353.].

Increased Prevalence of Atopic Dermatitis in Children Aged 0-3 Years Highly Exposed to Parabens.

The prevalence of allergic diseases, such as bronchial asthma, atopic dermatitis, nasal allergies (pollinosis), and food allergies, has been increasing in many countries. The hygiene hypothesis was recently considered from the perspective of exposure to antimicrobial agents and preservatives, such as parabens (CAS number, 94-13-3). It currently remains unclear whether parabens, which are included in many daily consumer products such as cosmetics, shampoos, and personal care products as preservative antimicrobial agents, induce or aggravate allergies. Therefore, the aim of the present study was to examine the relationship between exposure to parabens and the prevalence of allergic diseases in Japanese children. The cross-sectional epidemiology of 236 children aged 0-3 years who underwent health examinations in Shika town in Japan assessed individual exposure to parabens using urinary concentrations of parabens. The results obtained showed that the prevalence of atopic dermatitis was significantly higher in children with high urinary concentrations of parabens than in those with low concentrations (p < 0.001). This relationship remained significant after adjustments for confounding factors, such as age, sex, Kaup's index, and passive smoking (p < 0.001). In conclusion, the present results from a population study suggested a relationship between atopic dermatitis and exposure to parabens. A longitudinal study using a larger sample number and a detailed examination of atopic dermatitis, including EASI scores and exposure to parabens, will be necessary.

Overview of Legal Measures for Managing Workplace COVID-19 Infection Risk in Several Asia-Pacific Countries.

BACKGROUND: Despite the lack of official COVID-19 statistics, various workplaces and occupations have been at the center of COVID-19 outbreaks. We aimed to compare legal measures and governance established for managing COVID-19 infection risks at workplaces in nine Asia and Pacific countries and to recommend key administrative measures. METHODS: We collected information on legal measures and governance from both general citizens and workers regarding infection risks such as COVID-19 from industrial hygiene professionals in nine countries (Indonesia, India, Japan, Malaysia, New Zealand, Republic of the Philippines, Republic of Korea, Taiwan, and Thailand) using a structured questionnaire. RESULTS: A governmental body overseeing public health and welfare was in charge of containing the spread and occurrence of infectious diseases under an infectious disease control and prevention act or another special act, although the name of the pertinent organizations and legislation vary among countries. Unlike in the case of other traditional hazards, there have been no specific articles or clauses describing the means of mitigating virus risk in the workplace that are legally required of employers, making it difficult to define the responsibilities of the employer. Each country maintains own legal systems regarding access to the duration, administration, and financing of paid sick leave. Many workers may not have access to paid sick leave even if it is legally guaranteed. CONCLUSION: Specific legal measures to manage infectious disease risks, such as providing proper personal protective equipment, education, engineering control measures, and paid sick leave are recommended to be stipulated in Industrial safety and health-related acts.