[Factors associated with unemployment or job change due to the treatment of designated intractable diseases].

OBJECTIVES: Unemployment or job change due to treatment for a disease is affected by various factors such as disease type, degree of disability, and workplace patient support. This study aimed to clarify the factors affecting the unemployment/job-change rate among workers who had designated intractable diseases. METHODS: A questionnaire survey was administered to 3,210 designated patients with intractable diseases who underwent applications for renewal of medical care subsidies at the Hirakata City Public Health Center during fiscal year 2019 (July-December). Of these patients, 539 workers aged 20-59 years who were employed as regular workers, temporary contract worker/dispatched workers, and part-time workers when they became designated intractable diseases were subjects of the analysis. Unemployment/job-change due to the treatment for a designated intractable disease was treated as an event occurrence, while the absence of unemployment/job-change due to disease at the time of the survey were considered censored cases. The Kaplan-Meier method was used to determine the trend of the unemployment/job-change rate associated with the duration of work. The Cox proportional hazard model was used to examine the relationship between unemployment/job-change and factors such as gender, age at onset, disease groups, activities of daily living, types of employment, experienced workplace supports (e.g., reduced working hours and hourly paid leave), and existence of insoluble medical difficulties at the workplace. RESULTS: The unemployment/job-change rate due to treatment for designated intractable disease was 19.4%. Significantly independent factors of unemployment/job-change were the following: 50s at onset (compared to those in their 30s, HR = 2.55, 95% CI (1.21-5.37)), requiring outing assistance (compared to going out alone, 2.31 (1.13-4.71)), being a temporary contract worker/dispatched worker (compared to a regular worker, 2.66 (1.20-5.89)), existence of insoluble medical difficulties at workplace (4.15 (2.43-7.09)). Experienced workplace support was not a significant factor in preventing unemployment/job-change. CONCLUSIONS: Age at onset, degree of disability, form of employment, and existence of insoluble medical difficulties at the workplace were significantly associated with unemployment/job change due to treatment for designated intractable diseases. The relationship between workplace patient supports and unemployment/job-change was not clear, but to reduce medical difficulties in the workplace, workplace supports must be expanded. Given that workplace support is not an obligatory effort for employers, it is necessary to establish a system where employers can easily promote workplace support.

[Epidemiological study of factors associated with quitting a job among pregnant working women].

OBJECTIVE: More women in Japan continue to quit a job when they find out they are pregnant than in other industrialized countries. The purpose of this study was to clarify factors affecting the quitting rate among female workers who become aware they are pregnant. METHODS: All pregnant women visiting or admitted to seven obstetrics medical institutions in Nara Prefecture between November and December 2004 for examination or delivery were surveyed. Of these women, 603 who were working when they discovered their pregnancy were subjects of the analysis. Quitting a job was treated as an event occurrence, and those working at the time of the survey were considered censored cases. The Kaplan-Meier method was used to determine the trend of the quitting rate associated with gestational weeks. The Cox proportional hazard model was used to examine the relationship between quitting a job and workplace factors such as number of staff at the workplace, types of employment, and availability of a legal maternity protection system, and individual factors such as age and thoughts (both subject's and husband's) on continuing work. RESULTS: The quitting rate up to delivery was 63.1%, but this increased to 69.8% when limited to pregnancy with a first child. Significantly independent factors behind continuation of work after discovering pregnancy were the following: receiving time off for medical examinations (HR=0.59, 95% CI (0.41-0.83)), availability of a child care leave system (0.37 (0.22-0.63)), arranged support system after returning from maternity and child care leave (0.60 (0.42-0.87)), workplace ambience is supportive of working after marriage and childbirth (0.59 (0.43-0.81)), and the subject (0.63 (0.43-0.93)) or husband (0.50 (0.30-0.86)) considers it good to continue working during pregnancy. In contrast, a non-regular employee (1.93 (1.46-2.56)) and being young (1.74 (1.10-2.75)) were factors behind quitting a job. CONCLUSIONS: Key conditions that encourage work continuation after becoming aware of pregnancy include creative adjustments at the workplace, motivating women and their husbands to consider work intentions, and having an established legal maternity protection system in the workplace. Moreover, comprehensive implementation of a child care leave system that is not available to all non-regular employees is also desirable.

Work-related aggression and violence committed by patients and its psychological influence on doctors.

OBJECTIVES: To determine the incidence rate of work-related aggression and violence (WRAV) against doctors and investigate risk factors and psychological influences of WRAV doctors. METHODS: We sent a self-administered questionnaire on WRAV committed by patients and their associates to 1,148 doctors in Nara Prefecture, Japan. We calculated the incidence rate of WRAV using the number of incidents encountered during the previous 12 mo and the doctor's average weekly working hours. Risk factors for the incidence WRAV were analyzed by Poisson regression, and the influence of WRAV on the symptoms of post-traumatic stress disorder (PTSD) was evaluated by multiple logistic regression analysis. RESULTS: A total of 758 (66.0%) doctors returned the questionnaire. The incidence rate of WRAV was 0.20 [95% CI: 0.17-0.24]×10(-3) per practice hour. Adjusted incidence rate ratios of WRAV were significantly increased among doctors 1) with a shorter career (11.0; 95% CI: 5.0-24.2), 2) working in a region with the lowest average taxable income (1.6; 1.1-2.4), and 3) whose specialties were dermatology (3.8; 2.3-6.3), psychiatry (2.7; 1.3-5.6) and ophthalmology (1.9; 1.2-3.2). Of 289 subjects who had encountered WRAV at least once during their career, 26 doctors (8.2%) had symptoms suggestive of PTSD due to the most severe incident. CONCLUSIONS: Doctors encountered WRAV at an incidence rate of 0.20×10(-3) per practice hour, and some of them might develop PTSD. Countermeasures are required to maintain sound health and safe workplaces for doctors.