Association between workaholism and headaches causing presenteeism: A cross-sectional study in Japan.

OBJECTIVES: This study investigates the association between workaholism and headaches causing presenteeism among Japanese employees. METHODS: Used data from self-reporting questionnaire and annual health checkups. Workaholism was assessed using the Dutch Workaholic Scale and headaches causing presenteeism were identified as the symptom hindering work. We performed a logistic regression analysis adjusted for covariates. RESULTS: Among 5,802 respondents, 3.7% cited headaches as the symptom hindering work. We found an association between workaholism and such headaches (Odds ratios [OR]: 1.05, 95% confidence intervals [CI]: 1.03-1.08). Both working excessively (OR: 1.08, 95% CI: 1.04-1.12) and working compulsively (OR: 1.10, 95% CI: 1.05-1.15) subscales were also related. CONCLUSIONS: Workaholism may lead to productivity loss due to headaches, and addressing workaholism can prevent this loss. Combining health examination data with work hours data may enable the early detection of workaholism.

Seeking Treatment Profile of Male Shift Workers With Hypertension and Diabetes.

OBJECTIVE: This study was identified seeking treatment for hypertension and diabetes among male shift workers. METHOD: This retrospective cohort study included nine large companies in Japan. Data were collected from health checkup, health insurance records, and self-administered questionnaires in 2017 and 2020. Data were analyzed using Kaplan-Meier curves and Cox regression. RESULT: Person-days shift workers and day workers seeking treatment for hypertension were 41,604 and 327,301, respectively and, for diabetes, were 7326 and 60,735, respectively. The log ranks were statistically significant. Shift workers were 46% and 56% less likely to seek treatment for hypertension and diabetes, respectively, than day workers were after adjustment for age, marital status, education level, and intention to modify lifestyle (model 2) ( P < 0.01). CONCLUSIONS: Male shift workers are less likely to seek treatment for hypertension and diabetes compared with day workers.

The Effect of Pre-Operative Verbal Confirmation for Interventional Radiology Physicians on Their Use of Personal Dosimeters and Personal Protective Equipment.

Interventional radiology (IR) physicians must be equipped with personal passive dosimeters and personal protective equipment (PPE); however, they are inconsistently used. Therefore, we aimed to explore practical measures to increase PPE usage and ascertain whether these measures could lead to an actual decrease in exposure doses to IR physicians. Dosimeters and PPE were visually inspected. Then, a pre-operative briefing was conducted as a direct intervention, and the use of dosimeters and PPE was verbally confirmed. Finally, the intervention effect was verified by measuring the use rates and individual exposure doses. Because of the intervention, the use rate markedly improved and was almost 100%. However, both the effective dose rate (effective dose/fluoroscopy time) and the lens equivalent dose rate (lens equivalent dose/fluoroscopy time) showed that the intervention led to a statistically significant increase in exposure (effective dose rate: p = 0.033; lens equivalent dose rate: p = 0.003). In conclusion, the proper use of dosimeters and PPE raised the radiation exposure values for IR physicians immediately after the intervention, which was hypothesized to be due to the inclusion of exposure overlooked to date and the changes in the dosimeter management method from a single- to a double-dosimeter approach.

The differences of the economic losses due to presenteeism and treatment costs between high-stress workers and non-high-stress workers using the stress check survey in Japan.

OBJECTIVES: This study sought to examine differences in the economic losses due to presenteeism and costs of medical and dental treatment between high-stress workers and non-high-stress workers using the stress check survey. METHODS: We conducted a cross-sectional study from April 1, 2018 to March 31, 2019 in a pharmaceutical company. High-stress workers were classified with the Brief Job Stress Questionnaire using two methods: the sum method and the score converted method. The incidence of presenteeism and its costs were determined using a questionnaire. The costs of medical and dental treatment were calculated according to claims. We compared the costs between high-stress and non-high-stress workers using Wilcoxon's rank-sum test. RESULTS: Of 3910 workers, 6.3% were classified as high-stress using the sum method and 6.6% were classified as high-stress using the score converted method. The costs associated with presenteeism and medical treatment among high-stress workers were higher than the costs among non-high-stress workers, whereas the costs associated with dental treatment were not. CONCLUSIONS: To motivate employers to improve stressful work environments, it is recommended that presenteeism measurement items be added to the stress check survey, and that the methods used in this study be used to calculate the loss associated with high-stress workers in Japanese companies. However, we must be careful in interpreting absolute presenteeism loss amounts because they are poorly reliable and valid.

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.

Changes in Presenteeism Six Months After Returning from Sick Leave Due to Mental Illness.

This study examines how psychological distress (measured by the K10 screening test) and presenteeism (measured by the quality and quantity method) change in the six months after returning to work from having taken a sick leave because of a mental illness. In a manufacturing company with approximately 2,600 employees, 23 employees returned to work after experiencing mental illness between April 2015 and March 2016, and all 23 agreed to participate in the study. We analyzed 18 cases for which we had sufficient data. Two of the employees were absent from work in the sixth month. We performed multilevel analysis for K10 and presenteeism over time on the 16 without recurrence. A significant decreasing trend was observed for both K10 and presenteeism. Eleven of the 16 employees were consistently below the K10 cutoff value of 10 for six months, and 5 had zero presenteeism in the sixth month, whereas 6 employees showed improvement in presenteeism that stopped midway through the study. An occupational physician judged that the employees could work normally with presenteeism of zero. After returning to work, it is important to monitor not only psychiatric symptoms but also presenteeism.

Effects of an Artificial Intelligence-Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial.

BACKGROUND: Musculoskeletal symptoms such as neck and shoulder pain/stiffness and low back pain are common health problems in the working population. They are the leading causes of presenteeism (employees being physically present at work but unable to be fully engaged). Recently, digital interventions have begun to be used to manage health but their effectiveness has not yet been fully verified, and adherence to such programs is always a problem. OBJECTIVE: This study aimed to evaluate the improvements in musculoskeletal symptoms in workers with neck/shoulder stiffness/pain and low back pain after the use of an exercise-based artificial intelligence (AI)-assisted interactive health promotion system that operates through a mobile messaging app (the AI-assisted health program). We expected that this program would support participants' adherence to exercises. METHODS: We conducted a two-armed, randomized, controlled, and unblinded trial in workers with either neck/shoulder stiffness/pain or low back pain or both. We recruited participants with these symptoms through email notifications. The intervention group received the AI-assisted health program, in which the chatbot sent messages to users with the exercise instructions at a fixed time every day through the smartphone's chatting app (LINE) for 12 weeks. The program was fully automated. The control group continued with their usual care routines. We assessed the subjective severity of the neck and shoulder pain/stiffness and low back pain of the participants by using a scoring scale of 1 to 5 for both the intervention group and the control group at baseline and after 12 weeks of intervention by using a web-based form. We used a logistic regression model to calculate the odds ratios (ORs) of the intervention group to achieve to reduce pain scores with those of the control group, and the ORs of the subjective assessment of the improvement of the symptoms compared to the intervention and control groups, which were performed using Stata software (version 16, StataCorp LLC). RESULTS: We analyzed 48 participants in the intervention group and 46 participants in the control group. The adherence rate was 92% (44/48) during the intervention. The participants in the intervention group showed significant improvements in the severity of the neck/shoulder pain/stiffness and low back pain compared to those in the control group (OR 6.36, 95% CI 2.57-15.73; P<.001). Based on the subjective assessment of the improvement of the pain/stiffness at 12 weeks, 36 (75%) out of 48 participants in the intervention group and 3 (7%) out of 46 participants in the control group showed improvements (improved, slightly improved) (OR 43.00, 95% CI 11.25-164.28; P<.001). CONCLUSIONS: This study shows that the short exercises provided by the AI-assisted health program improved both neck/shoulder pain/stiffness and low back pain in 12 weeks. Further studies are needed to identify the elements contributing to the successful outcome of the AI-assisted health program. TRIAL REGISTRATION: University hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) 000033894; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000038307.

Relationship between impaired work function and coping behaviors in workers with low back pain.

OBJECTIVES: The aim of the present study was to clarify the relationship between work functional impairment levels and three coping behaviors of workers with low back pain, which were about seeking medical attention, taking over-the-counter drugs, and taking self-care. METHODS: We conducted a cross-sectional study on 14 Japanese companies in 2016. Work function impairment was measured using the Work Functioning Impairment Scale. Logistic regression analyses were conducted for the three coping behaviors and odds ratios (ORs) calculated for work functional impairment levels. RESULTS: We analyzed 2232 subjects; 226 were women and 790 worked on production lines. 688 workers had sought medical attention, 436 had taken over-the-counter medication, and 1225 had engaged in self-care. Those seeking medical attention were associated with severe work function impairment compared with no work function impairment (adjusted OR = 2.84, 95% confidence interval: 1.82-4.45, p < .001). We observed a trend for the association between over-the-counter drug use with high levels of work function impairment (adjusted OR: 1.19 for low, 1.35 for moderate, 1.65 for severe). There was no apparent relationship between self-care and the degree of work functional impairment. CONCLUSION: In workers with low back pain, severe work functional impairment may promote medical attention and over-the-counter medication use, but it would not encourage self-care, such as stretching or exercise. Therefore, workplaces need to provide special support to help them take care of themselves. Therefore, it is desirable to provide good support for self-care in the workplace.

Anticipated health effects and proposed countermeasures following the immediate introduction of telework in response to the spread of COVID-19: The findings of a rapid health impact assessment in Japan.

OBJECTIVES: The health effects of telework, which was introduced extensively in the immediate context of the COVID-19 pandemic crisis in Japan, on teleworkers, their families, and non-teleworkers, are unknown. Accordingly, we developed a rapid health impact assessment (HIA) to evaluate positive and negative health effects of telework on these groups and recommended easily implementable countermeasures. METHODS: Immediately after an emergency was declared in Japan, we implemented a rapid, five-step HIA. We screened and categorized health effects of telework for the three above-mentioned groups, extracting their content, directionality, and likelihood. Following a scoping exercise to determine the HIA's overall implementation, five experienced occupational health physicians appraised and prioritized the screened items and added new items. We outlined specific countermeasures and disseminated the results on our website. A short-term evaluation was conducted by three external occupational health physicians and three nurses. RESULTS: Following screening and appraisal, 59, 29, and 27 items were listed for teleworkers, non-teleworkers, and family members of teleworkers, respectively, covering work, lifestyle, disease and medical care, and home and community. Targeted countermeasures focused on the work environment, business management, communications, and lifestyles for teleworkers; safety and medical guidelines, work prioritization, and regular communication for non-teleworkers; and shared responsibilities within families and communication outside families for family members of teleworkers. CONCLUSION: The HIA's validity and the countermeasures' practical applicability were confirmed by the external evaluators. They can be easily applied and adapted across diverse industries to mitigate the wider negative effects of telework and enhance its positive effects.

Work functioning impairment in the course of pharmacotherapy treatment for depression.

This study investigated the association between the duration of pharmacotherapy treatment for depression, or discontinuation from treatment, and work functioning impairment. This was a retrospective cohort study examining 30,409 workers. Work functioning impairment was assessed using a questionnaire, and treatment status was assessed using medical claims data. Odds ratios (ORs) of workers with severe work functioning impairment compared with healthy workers (control group) were calculated using logistic regression analysis. Continuous medical treatment was associated with severely impaired work functioning regardless of treatment period [continuous medical treatment; 4 months <: OR = 3.2, 4 months ≥, 10 months <: OR = 2.6, 10 months ≥, 14 months <: OR = 2.3, 14 months ≥, 16 months <: OR = 2.3, which are all statistically significant (p < 0.05)]. Workers who initially received pharmacotherapy treatment but discontinued in < 11 months had a significantly higher OR (treatment discontinuation period; 3 months <: OR = 2.3, 3 months ≥, 8 months <; OR = 2.0, 8 months ≥, 11 months <; OR = 3.0), while those who discontinued at ≥ 11 months did not (OR = 1.4, 95% CI 0.6-3.5). The sensitivity analysis excluding participants with at least one psychiatric comorbidity other than depression did not change the final result. It is important for the occupational health practitioners and attending psychiatrists to follow up in cooperation with each other, paying attention to the decrease in work functioning in addition to the symptoms.

Cardiovascular and cerebrovascular diseases risk associated with the incidence of presenteeism and the costs of presenteeism.

OBJECTIVES: The objective of this study was to estimate a risk of cardiovascular and cerebrovascular diseases for each worker and to determine whether this risk is associated with the incidence and costs of presenteeism, absenteeism, and medical/drug treatments. METHODS: Established risk equations were used to estimate the 10-year probability of developing coronary artery disease and ischemic stroke in male workers aged 40-65 years who were recruited from four pharmaceutical companies in Japan. The incidence of presenteeism was defined as existence of presenteeism for the past a month, and the incidence of absenteeism was defined as existence of sick-leave for the past three months by a self-administered questionnaire. Each cost was calculated based on the human capital method. Data on medical/drug treatments were collected from health insurance claims. RESULTS: The risks were calculated for 6047 workers. Individuals at moderate and high risk of coronary artery disease had a significantly higher rate of presenteeism and absenteeism than workers at low risk. Workers at moderate and high risk of ischemic stroke also had a significantly higher rate of presenteeism and absenteeism than workers at low risk. Mean costs for absenteeism and medical/drug treatments increased with the risk of developing coronary artery disease or ischemic stroke, while costs for presenteeism did not. CONCLUSIONS: To prevent the costs of presenteeism, workers not only at high risk but also at low and moderate risk of developing cardiovascular and cerebrovascular diseases should receive health care services.

[Systems and actual practices of occupational safety and health risk management in the People's Republic of China].

OBJECTIVES: To investigate the systems and actual practices of occupational safety and health risk management in China. METHODS: First, we gathered basic information through a literature review using an academic search engine (Japan Medical Abstracts society, Pubmed, and Google Scholar), as well as a general search on the Internet. Next, we conducted field surveys at a graduate school for public health, providers of occupational health services (e.g. medical examinations, working environment measurements), and local workplaces of a Japanese construction machinery company in China. This information was analyzed in terms of legal framework, professional staff, working environment measurements, medical examinations, occupational diseases, and occupational health service providers. RESULTS: Health and safety-related matters have become codified in Chinese workplaces as a result of safety laws and measures to prevent occupational diseases. While the country does have safety and hygiene officers, they lack official frameworks for occupational physicians and nursing professionals. The employers are not obligated to appoint medical professionals. While general medical examinations are not provided for under Chinese law, businesses are obligated to bring in external providers of occupational safety to perform special medical exams and working environment measurements. Occupational diseases are on the rise; pneumoconiosis comprises roughly 80% of cases. In addition, occupational health technical service providers have specialized staff and are not permitted to perform medical examinations or other services without government accreditation. DISCUSSION/CONCLUSION: There are great disparities in specialist knowledge about health and hygiene between company staff and external organizations, thus running the risk of corporate health and safety policies existing only on paper. This issue demands greater utilization of public health physicians in Chinese workplaces and support from Japanese professionals who understand how occupational safety and health risk management operate in China.

Developing a global occupational health and safety management system model for Japanese companies.

OBJECTIVES: To develop and validate a global occupational health and safety management system (OHSMS) model for Japanese companies. METHODS: In cooperation with a Japanese company, we established a research team and gathered information on occupational health and safety (OHS) practices in nine countries where the target company operated manufacturing sites. We then developed a model hypothesis via research team meeting. The model hypothesis was introduced to local factories in Indonesia and Thailand as trial sites. We evaluated the roles of the company headquarters, the implementation process, and any improvements in OHS practices at the sites. Based on the results, a global OHSMS model was formalized for global introduction. RESULTS: The model consisted of both headquarters and site roles. These roles were well-functioning, and OHS at the sites improved. Two issues concerning the functioning of the headquarters were identified: the need to establish a reporting system to the headquarters and the need to support the improvement of specialized human resources. By improving the model hypothesis to address these issues, the model was formalized for global introduction. CONCLUSIONS: The global OHSMS model was based on the use of methods and specialized human resources relevant to each region and their common objectives, as well as evaluation indicators based on the minimum requirements of the company headquarters. To verify the effectiveness of this model, the experiment should be extended to other countries.

[Systems and human resource development for occupational health in India: Effective occupational health management for Japanese enterprises with overseas branches].

OBJECTIVES: This study aimed to collect and assess information about occupational health in India, for Japanese enterprises. METHODS: We conducted a preliminary survey through literature reviews and internet search engines. We then conducted interview-based surveys at a central government agency, an international organization, the Japanese embassy, educational and research institutions, and Japanese enterprises in India. This information was categorized into: (1) organizations, legal and inspection systems in occupational health, (2) occupational health management and specialists in workplaces, (3) occupational health-related activities in workplaces resulting from legal obligations, and (4) healthcare and workers' compensation systems. RESULTS: The Indian Ministry of Labour and Employment is primarily responsible for occupational safety and health. There are four main acts of legislation covering occupational safety and health in the factories, ports, mines, and construction sites. The Factories Act, 1948, mandates the establishment of an occupational health center and a safety committee in the factories; the appointment of factory medical officers and safety officers. These medical officers must possess an Indian medical degree, and undertake a three months' course to obtain an Associate Fellow of Industrial Health certificate. The rules and regulations under this act differ in each Indian state. Low-wage workers are registered with a medical insurance scheme. Most workers are covered by workers' compensation schemes, although the number of reported occupational injuries are low. CONCLUSIONS: Japanese enterprises should consider the local conditions of occupational health in India because of the different legalities and occupational health status in each state. Regardless of the Factories Act, 1948, stipulating a variety of occupational health-related activities, inadequate legal compliance is suspected to be common because of the ineffective labor inspection requirements and a shortage of specialists on human resources. The study also revealed a deficient social security system. Therefore, the internal educational support for specialists, external support from the company headquarters in Japan, and the local institutions in India; and the systemic support for effective occupational health-related activities are required for improving the status of occupational health in the factories in India.

Potential Work Time Lost Due to Sickness Absence and Presence Among Japanese Workers.

OBJECTIVE: The current study aimed to quantify the overall sickness absence and sickness presence in five Japanese companies. METHODS: Two indicators were calculated: worktime lost rates and average working days lost per employee per annum. RESULTS: In total, 1.1% of working days per annum were lost due to sick leave. The average number of annual sick-leave days per employee was 2.58. Sickness presence accounted for a total worktime loss of 6.55% and an average of 15.36 work days lost per employee per annum. Overall, employees lost 7.65% of their total working days, or an average of 17.92 days were lost per employee per annum, due to sickness leave and sickness presence combined. CONCLUSION: Sickness-absence rate among Japanese workers is quite lower than other countries; however, sickness presence is more critical than absenteeism, which is in line with other countries.

Characteristics of self-reported daily life note (LN) users in return-to-work judgment for workers on sick leave due to mental health conditions, and usefulness of the tool.

A self-reported daily life note (LN) is an effective tool used by occupational physicians to assess the capacity of workers on sick leave due to mental illness to return to work (RTW). We aimed to clarify whether there were differences in the criteria used to define recovery for RTW between LN users and non-users, whether LN users were satisfied with LN, and whether non-users wanted to use LN. In total, 363 occupational physicians (238 LN users, 125 non-users) completed self-reported questionnaires covering demographic and occupational variables, and RTW assessment criteria. We investigated which of the 10 assessment criteria were considered most important for RTW. The proportion of LN users was higher among women, younger physicians, and occupational physicians with more working days per month. LN users emphasized four criteria in assessing RTW: 1) constant wake-up time, 2) constant bedtime, 3) no midnight waking, and 4) no feeling of drowsiness during the day. LN users regard regular sleep rhythm and the absence of drowsiness during the day as important criteria for RTW. Ninety-seven percent of users regarded LN as useful. Seventy-four percent of non-users had interest in using LN.

[The System and Human Resources for Occupational Health in Thailand - For Japanese Enterprises to Manage Proper Occupational Health Activities at Overseas Workplaces].

We collected information necessary for conducting occupational health activities in Thailand with regard to occupational safety and health management systems (OSHMS). Based on an information collection check sheet developed in our previous research, we conducted a literature research and visited four local business bases, one ISO certification body and two higher educational institutions. The legal framework concerning occupational health in Thailand consists of the Occupational Safety, Health and Environment Act of 2011 and 13 ordinances from the Ministry of Labor under that act. The original OSHMS standards for Thailand have been published, and the number of companies, especially large ones, introducing systems conforming to these standards has increased in recent years. For occupational health specialists, there are training programs for specialized occupational health physicians, professional safety officers and occupational nurses. Professional safety officers also play a central role in occupational health in the workplace. In Thailand, it is necessary to ensure compliance with related acts and regulations, and to conduct voluntary activities that satisfy workplace conditions as based on the OSHMS standards. Additionally, to improve occupational health performance, it is essential to use high-quality external services and/or occupational health professionals. Headquarters of Japanese companies have considered taking countermeasures such as recommending active use of professional safety officers, as well as issuing global standards.

Total Health-Related Costs Due to Absenteeism, Presenteeism, and Medical and Pharmaceutical Expenses in Japanese Employers.

OBJECTIVE: This study aimed to examine a detailed breakdown of costs (absenteeism, presenteeism, and medical/pharmaceutical expenses), of the employees in four pharmaceutical companies in Japan. METHODS: This is a cross-sectional study. Absenteeism and presenteeism were measured by a self-administered questionnaire for workers, and their costs were estimated using the human capital approach. Presenteeism was evaluated by the degree affected quality and quantity of work. Medical and pharmaceutical expenses were obtained by insurance claims. RESULTS: The monetary value due to absenteeism was $520 per person per year (11%), that of presenteeism was $3055 (64%), and medical/pharmaceutical expenses were $1165 (25%). Two of the highest total cost burdens from chronic illness were related to mental (behavioral) health conditions and musculoskeletal disorders. CONCLUSION: A total cost approach can help employers set priorities for occupational health, safety, and population health management initiatives.

[Examination of factors for promoting cooperation using documents between occupational health physicians and psychiatrists].

OBJECTIVES: There is little specific information concerning the method and the efficacy of sharing information between occupational health physicians and psychiatrists regarding the employment status and medical history of their patients with mental illnesses. To promote cooperation between occupational health physicians and psychiatrists, we examined the points necessary to be included on medical information request forms exchanged between them. METHODS: We conducted focused group discussion (FGD) to identify the points that need to be described on the request form and the concerns in cooperation between occupational health physicians and psychiatrists. We conducted FGDs twice, with two different groups of nine psychiatrists participating in each round. We extracted and organized FGD results and determined the necessary request form points. Next, we assumed two different cases of workers with mental illnesses and created three request form templates with differing item descriptions and lengths. We also conducted a questionnaire survey among clinical psychiatrists to determine their impression of the templates. We performed logistic regression analysis on the obtained results. RESULTS: On the basis of the FGD results we extracted the situation in the workplace, clarification of points to be confirmed, representation of the occupational health physician's position, and handling of information provided by the doctor as points required for the request form. On the basis of these results and the opinions of occupational health specialists, we created a new request form using these points. Additionally, the results from the questionnaire survey about the prescribed items revealed the proportion of favorable answers regarding sufficient information written on the request form and a feeling of security for information provision increased (p < 0.01). Conversely, the proportion of favorable responses for readability decreased. CONCLUSIONS: Psychiatrists are concerned about the possibility that their patient may be at a disadvantageous situation by providing their personal medical information and believe the clinical information required by the occupational health physicians is unclear. This suggests that there are factors impeding the cooperation between the occupational health physicians and psychiatrists. When an occupational health physician writes a request form, cooperation with psychiatrists may be promoted by enriching the request form contents and by including the representation of the occupational health physician's position and the intended purpose of the provided information by paying attention to the volume of sentences.