[Initiatives, outcomes, and facilitating factors to changing workplace environments in small- and medium-sized enterprises due to the COVID-19 pandemic: Interviews with employers and human resource managers].

OBJECTIVES: This study identified changes in the work environment due to the COVID-19 pandemic, subsequent initiatives and outcomes, and facilitating factors from the perspective of company officials in small- and medium-sized enterprises (SMEs). METHODS: In 2021, semi-structured interviews were conducted with employers or human resource managers of SMEs with less than 300 employees regarding changes in the work environment due to the pandemic, initiatives, outcomes, and facilitating factors. Thereafter, codes were extracted from verbatim transcripts or interview notes and categorized based on similarities in content. RESULTS: Based on interviews with 16 companies, the following four major categories of changes in the work environment were identified: "conflict and anxiety about infection when employees were forced to attend work despite the rapid transmission of the infection," "unfamiliarity and loneliness with the new working style that was suddenly imposed on them," "loss of emotional ties with workmates and opportunities for mood changes," and "future anxiety, feelings of alienation, and mental illness." The following seven initiatives were implemented to address these issues: "a hands-on approach to infection prevention and physical healthcare," "urgent introduction of telework for business continuity," "development and promotion of online information sharing," "establishment of a place and opportunity to maintain emotional connections within the company," "economic and management measures to protect employees and ensure company continuity," "support for employees for health maintenance," and "measures to respond to employees' needs and ideas, and support the continuation of activities." Four major categories of outcomes were: "increased efficiency of information sharing and enhanced performance," "maintenance and promotion of emotional ties and a sense of solidarity," "increased independence and sense of health among employees," and "adaptation of employees to novel situations." The initiatives were facilitated by factors classified into the following three major categories: "workplace culture wherein employees shared opinions and helped each other," "management's attitude and philosophy of valuing employees," and "proactive attitude toward information acquisition and resource utilization." CONCLUSIONS: The rapid introduction of teleworking as a new working style in response to the need to balance infection control and business continuity resulted in increased loneliness and other associated stressors. Many SMEs stated that they could maintain a sense of solidarity in the workplace and improve employee autonomy through their efforts to incorporate employees' opinions and maintain human connections.

[Examining competencies for labor and social security attorneys in the field of occupational mental health].

AIM: Labor and social security attorneys (LSSAs) are involved in the field of occupational mental health. However, little attention has been paid to the involvement of LSSAs in this field. This study investigated the occupational mental health competencies that are expected of LSSAs. SUBJECTS AND METHODS: Our investigation utilized the Delphi method. In Step 1, we conducted semi-structured interviews with LSSAs and then created an initial list of competencies based on the interviews and a previous investigation. In Step 2, we recruited LSSAs with 10 or more cases related to occupational mental health. They completed a questionnaire assessing the importance of their work (how important they felt it was to conduct work related to mental health) and level of achievement (how much they felt they had achieved). The respondents were also asked to provide additional competencies (not listed on the questionnaire) if they regarded them as necessary for their work, and these were later added to the list of proposed competencies. In Step 3, we presented the results of Step 2 to the same respondents and asked them to rate their agreement with the proposed competencies. Items with agreement of 80% or higher were set as competencies. We also asked LSSAs about the level of importance of their work and their perceived level of achievement with regard to the additional items created in Step 2. Items for which the level of achievement fell below the median were extracted even if the level of importance of the work fell at or above the median. RESULTS: We recruited 8 LSSAs in Step 1 and created a list of 68 preliminary competencies in 20 fields. We recruited 57 LSSAs in Step 2, and 45 LSSAs completed the survey (response rate: 78.9%). Seven competencies were added to the list as a result. We recruited 34 LSSAs in Step 3 (response rate: 75.6%) . Two items with an agreement rate of less than 80% were removed, resulting in 73 competencies in 20 fields. One of the items with an agreement rate of 100% was "The plan is based on the merits and disadvantages (risks) for both labor and management." CONCLUSIONS: This study identified the competencies required of LSSAs in the field of occupational mental health. Our findings suggest that specifying these competencies will enable efficient training of LSSAs.

The relationship between sleep disturbances and depression in daytime workers: a cross-sectional structured interview survey.

The aim of this study was to clarify the relationship between sleep disturbances and depression in daytime workers using a structured interview. A total of 1,184 daytime workers were enrolled. We evaluated difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), and global insomnia scores (ISs) in all participants. As a result, the prevalences of DIS, DMS, and EMA were 16%, 46%, and 22 %, respectively. IS was significantly correlated with depression score. Additionally, although all IS subscales (i.e., DIS, DMS, and EMA) were significantly associated with depression score, the main factor contributing to depression score was DIS. Thus, the present study reveals that sleep disturbances and especially DIS are associated with depression in daytime workers.

Overwork-related disorders in Japan: recent trends and development of a national policy to promote preventive measures.

Overwork-related disorders, such as cerebrovascular/cardiovascular diseases (CCVD) and mental disorders due to overwork, are a major occupational and public health issue worldwide, particularly in East Asian countries. This report discusses the recent trend of overwork-related disorders in Japan from the perspective of workers' compensated occupational diseases, as well as the development of a national policy for preventive measures against overwork-related disorders in Japan. Recently, the number of claimed and compensated cases of occupational mental disorders has increased substantially, particularly among young workers, as compared to those of occupational CCVD. In response to these situations and action from society, the Japanese Government passed the "Act on Promotion of Preventive Measures against Karoshi and Other Overwork-Related Health Disorders" in June 2014 to develop a national initiative towards the prevention of overwork-related disorders. Changes in the trend of overwork-related disorders in Japan under a legal foundation and an initiative by the central government should be closely monitored so that other countries can benefit from the experiences.

[Development of a Tool for Training and Evaluation of the Competencies in Occupational Mental Health Necessary for Labor and Social Security Attorneys].

Labor and Social Security Attorneys (LSSAs) advise their clients about occupational mental health, but the competencies necessary in this field are not clear to them. We standardized the necessary competencies as a counseling guide for LSSAs, and we also designed a related discussion training program. These competencies were summarized in a brainstorming session at a research conference comprised of physicians, an occupational health nurse, LSSAs, an instructional design expert, and a management consultant, and then a training program (lasting 9 hours 30 minutes) was developed. Nineteen trainees who were introduced by members of the research conference collectively completed a seven-question written test, both before and after the training, in order to assess its effectiveness. Sixteen trainees who completed the training were surveyed, with a recovery rate of 100%. The necessary competencies that they identified were: information about circular notices from the Ministry of Health, Labor and Welfare; behavior such as the gathering of information; and dealing with the reinstatement of employees. The scores were subjected to the Wilcoxon signed-rank test in order to evaluate the training, and the answers from the pre-training were compared with those from the post-training. A significant difference (P < 0.05) was seen for each question. These results show the effectiveness of the developed training program for the learning of the competencies necessary for LSSAs.

[Current status of occupational health activities and the way that occupational health services should be offered to small- and medium-scale enterprises].

Activating occupational safety and health activities among Small- and Medium-scale Enterprises (SMEs) is a major issue because more than 80% of Japanese workers belong to these enterprises, in which the number of workers are less than 300 people. However, as the size of the enterprise decreases, the occurrence of problems of safety and health management systems and safety and health activities increases. Reasons for this include both the limitations of investments shortages of human resources. Occupational health services in SMEs has been provided by the cooperation of the following institutions: public associations (such as Regional Occupational Health Centers, Occupational Health Promotion Centers, Japan Industrial Safety and Health Association (JISHA)), occupational health agencies which provide checkup services, health insurance associations, and regional medical services. In contrast to the low coverage of occupational health services among SMEs in Japan, there are some countries in Europe in which this coverage is almost 100%. This is because of the development of occupational health services outside the company. To show the benefits of the safety and health activities to managers of SMEs, and to motivate them to take advantage of the services, it is important to consider measurements. Also, establishing systems that provide those services, improving the quality of specialists such as occupational physicians, and educating human resources, are all necessary.

[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.

[Effect of the occupational health practical training course offered by the Occupational Health Training Center].

The Occupational Health Training Center offers the Occupational Health Practical Training Course (PTC) as a part of the postgraduate education of the University of Occupational and Environmental Health (UOEH). In this study, we evaluated the effect of the PTC on its trainees by signed questionnaires handed out before and after the course. Three PTCs are offered annually, and the curriculum consists of 4 divisions: General Health Management, Health Care and Promotion, Work Conditions and Ergonomics, and Work Environment Control. There was an significant affirmative difference in "General interest in Occupational Health Practice (OHP)" between before and after the PTC, but not in "Interest in OHP related to one's clinical specialty". This result implies that, in some clinical fields, it may be difficult to realize a common subject with OHP. We confirmed the presence of significant affirmative differences between before and after the PTC on all questions categorized in both "Acquisition of Knowledge and Skill Related to OHP" and "Awareness of Occupational Physicians' Mission". The results suggested that the PTC had a positive effect on the subjects.

[Qualitative evaluation of employer requirements associated with occupational health and safety as good practice in small-scale enterprises].

The purpose of this study was to identify what motivates employers to promote good occupational health and safety practices in small-scale enterprises. Previous studies have shown that small-scale enterprises generally pay insufficient attention to issues of occupational health and safety. These findings were mainly derived from questionnaire based surveys. Nevertheless, some small-scale enterprises in which employers exercise good leadership do take a progressive approach to occupational health and safety. Although good practices can be identified in small-scale enterprises, it remains unclear what motivates employers in small-scale enterprises to actively implement occupational health and safety practices. We speculated that identifying employer motivations in promoting occupational health would help to spread good practices among small-scale enterprises. Using a qualitative approach based on the KJ methods, we interviewed ten employers who actively promote occupational health and safety in the workplace. The employers were asked to discuss their views of occupational health and safety in their own words. A semi-structured interview format was used, and transcripts were made of the interviews. Each transcript was independently coded by two or more researchers. These transcripts and codes were integrated and then the research group members discussed the heading titles and structural relationships between them according to the KJ method. Qualitative analysis revealed that all the employers expressed a strong interest in a "good company" and "good management". They emphasized four elements of "good management", namely "securing human resources", "trust of business partners", "social responsibility" and "employer's health condition itself", and considered that addressing occupational health and safety was essential to the achievement of these four elements. Consistent with previous findings, the results showed that implementation of occupational health and safety activities depended on "cost", "human resources", "time to perform", and "advisory organization". These results suggest that employer awareness of the relationship between good management and occupational health is essential to the implementation of occupational health and safety practices in small-scale enterprises.

Immunoreactivities for glutathione S-transferases and glutathione peroxidase in the lateral wall of pigmented and albino guinea pig cochlea.

Dark-skinned people are known to be more tolerant of ototraumatic noise than are light-skinned people, and pigmented animals are more tolerant of ototraumatic noise and aminoglycoside ototoxicity than are albino animals. Such tolerance may be dependent on the local ability of detoxification and antioxidant enzymes, including glutathione S-transferase (GST) and glutathione peroxidase (GSPx). In the present study, we examined the difference in GST/GSPx expression in the lateral wall of the cochlea between pigmented and albino guinea pigs. Eight-week-old male pigmented and albino guinea pigs were killed by transcardiac perfusion with 2% paraformaldehyde. The cochlear ducts were isolated, further fixed with 4% paraformaldehyde, decalcified, and then embedded in paraffin. Sections prepared at 5-microm thickness were incubated with anti-GST-alpha,-mu,-pi, or anti-GSPx antibody, reacted with Alexa Fluorconjugated secondary antibody, and examined under a Carl Zeiss Axioskop 2 plus fluorescence microscope. The cochlea ducts were also subjected to immunoelectron microscopy for GST-pi by the postembedment method. The stria vascularis of pigmented guinea pigs was strongly immunoreactive for GST-alpha,-mu,-pi, and GSPx, whereas no or only weak immunoreactivities were seen in the stria vascularis of albino guinea pigs. The spiral ligament showed positive but different immunoreactivities for these enzymes between the strains. Double-stained immunofluorescence micrographs for GST-pi and GSPx showed a close resemblance of localization between the two enzymes in both pigmented and albino guinea pigs. At the ultrastructural level, immunoreactivity for GST-pi was localized preferentially in the melanin cells of pigmented guinea pigs. These results suggest that correlation between pigmentation and inner ear susceptibility is, at least partially, attributed to the different distribution of GST/GSPx in the stria vascularis.

Antioxidant enzyme immunoreactivity in rat von Ebner gland after nickel treatment.

Our study was designed to clarify the role of antioxidant enzymes in the rat von Ebner gland during acute nickel toxicity. After treatment with nickel acetate, we monitored ultrastructural alterations in acinar and ductal cells, immunohistochemical staining for glutathione peroxidase (GPx) and glutathione S-transferases (GST mu and GST pi), and immunoreactivity for malondialdehyde (MDA). Immunoreactivity for MDA was present only in the acinar cells, and it was enhanced at 3 h after Ni treatment. In contrast, immunoreactivities for GPx and GSTs did not change in acinar cells but significantly increased in ductal cells after Ni treatment. Cytoplasmic vacuoles increased in acinar cells at 3 h after Ni treatment, but they almost completely disappeared at 24 h. No morphological changes were observed in taste bud cells from Ni-treated rats. Because lipid peroxidation, as monitored by immunoreactivity for MDA, was only transiently increased in the acinar cells, the enhanced antioxidant enzyme immunoreactivity in ductal cells of the von Ebner gland plays a crucial role in the self-defense system against nickel toxicity in the rat oral cavity.