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Background: This longitudinal study aimed to investigate the effects of nonrestorative sleep on developing metabolic syndrome (MetS) and related diseases in a general Japanese middle-aged population. Methods: Overall, 83,224 adults without MetS (mean age: 51.5 ± 3.5 years) from the Health Insurance Association in Japan were followed up for a maximum of 8 years between 2011 and 2019. The Cox proportional hazard method was used to determine whether nonrestorative sleep, assessed using a single-item question, was significantly associated with the respective development of MetS, obesity, hypertension, diabetes, and dyslipidemia. The MetS criteria were adopted by the Examination Committee for Criteria of Metabolic Syndrome in Japan. Results: The mean follow-up duration was 6.0 years. The incidence rate of MetS was 50.1 person-years/1,000 during the study period. Data suggested that nonrestorative sleep was associated with MetS (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.08–1.16) and other disorders, such as obesity (HR: 1.07, 95% CI: 1.02–1.12), hypertension (HR: 1.07, 95% CI: 1.04–1.11), and diabetes (HR: 1.07, 95% CI: 1.01–1.12) but not with dyslipidemia (HR: 1.00, 95% CI: 0.97–1.03). Conclusions: Nonrestorative sleep is associated with the development of MetS and many of its core components in the middle-aged Japanese population. Therefore, assessing nonrestorative sleep may help identify individuals at a risk of MetS development. [ABSTRACT FROM AUTHOR]

We conducted a randomized controlled trial to investigate the efficacy of the sleep education program based on the principles of cognitive behavioral therapy for insomnia (CBT-I) in reducing psychological distress among workers with insomnia. Total of 130 daytime office workers in Japan with insomnia complaints were randomly assigned to an intervention or to a control group. Intervention consisted of a 60 min group session and a 30 min individual session for sleep hygiene, stimulus control, sleep restriction, and relaxation training. The occupational health physician of the workers' office led both sessions. The primary outcome was change in the K6 score for psychological distress between baseline and 3 months after the intervention. The secondary outcome was change in severity of insomnia measured with the insomnia severity index (ISI). Data were analyzed using linear mixed models with baseline value as covariates. A subgroup analysis was conducted among participants with clinically significant psychological distress at baseline (K6 score ≥5). Intention-to-treat (ITT) analysis with multiple imputation showed that the effect size of the intervention was very small (0.10 for psychological distress and 0.20 for insomnia, respectively). However, subgroup analyses of high-stress individuals showed significant improvement in psychological distress (effect size = 0.37) and insomnia (effect size = 0.39). Our results suggest that 90 min sleep education program based on CBT-I principles led by an occupational health physician alleviated psychological distress in workers with insomnia complaints and high stress levels. Brief sleep education can be widely implemented to reduce distress in workers with insomnia. [ABSTRACT FROM AUTHOR]

. Purpose: To identify symptoms potentially related to glaucomatous visual field abnormalities (VFAs) in a population-based setting, and to assess the applicability of using these symptoms to identify persons at risk of developing glaucoma. Methods: In this study, 10 214 Japanese male general workers (mean age, 45.3 ± 8.8 years) filled out a self-administered questionnaire and underwent frequency doubling technology (FDT) perimetry testing. The questionnaire inquired about whether the participant was suffering from any of nine symptoms, with scores for each response graded on a four-item Likert scale: 0 (none), 1 (rarely), 2 (sometimes), and 3 (always). Results from the questionnaire were compared among three groups: participants without any VFAs (9767), participants with VFAs as determined by the FDT test (FDT-VFA; 447), and 227 participants (of the 447 FDT-VFA participants) with glaucomatous VFAs who were newly diagnosed by ophthalmologic examinations. Results: The mean summed scores for the total items were significantly (p < 0.01) higher in FDT- and glaucomatous VFA groups than in normal subjects. In particular, responses citing the symptoms 'feeling of something in the front of the eye' and 'feeling of hardness to see in dark places' were significantly (p < 0.05) more frequent in subjects with FDT- and glaucomatous VFAs than among normal participants. However, the respective areas under the receiver operating characteristic curve of summed scores for the nine total items and for the two items which showed significant differences for the glaucoma groups were 0.57 (95% confidence interval = 0.53-0.60) and 0.58 (95% confidence interval = 0.54-0.61). Conclusion: Although the symptoms 'feeling of hardness to see in dark places' and 'feeling of something in the front of the eye' could be associated with glaucomatous VFA in a population-based setting, inquiring about symptoms is of little aid in identifying subjects with glaucomatous VFA as a strategy for public health. [ABSTRACT FROM AUTHOR]

The article offers information on a study in which a randomized controlled trial was conducted in order to evaluate the effect of sleep hygiene education and behavioral therapy among day-shift white-collar employees working for an information-technology service company in Japan. It informs that sleep hygiene education includes aspects of lifestyle and behavior. According to the study individual behavioral training has significantly improved the sleep quality of workers after three months.

The article offers information on a study to evaluate the effect of a combined sleep hygiene education and behavioral approach program on sleep quality in workers suffering from insomnia. The study consists of a randomized controlled trial at a design engineering unit in Japan which includes program on relaxation training, stimulus control and sleep restriction. The study concludes that education program significantly improved the sleep quality of workers suffering with insomnia.

The article focuses on near miss-based analysis which has been recently suggested to be more important in the medical field than to adverse events in the industrial field for Japanese nurses working at teaching hospitals. It validates the utility of near miss-based analysis in the medical fields by investigating predictors of near misses and adverse events. It suggests a negligible difference between choosing near miss or adverse event-based analysis in the medical field.

The article focuses on a study related to the organizational justice with regard to the promotion of employee health in Japan. The organizational justice scale (OJS) comprising 20 items in four dimensions were translated from English to Japanese language. Employees from manufacturing companies were asked to respond to the Japanese version of OJS questionnaires. The study found that the OJS in the Japanese version had higher reliability and construct validity as an employee health predictor.

The article discusses the impact of the effort-reward imbalance (ERI), a work-stress model, on the health-related quality of life (HRQL) of Japanese working men. Consequently, about 1,096 employees from a manufacturing plant in Japan were evaluated to assess the HRQL and ERL though the Japanese version of the Short-Form 8 Health Survey (SF-8). However, it is claimed that only 1,057 out of the 1,096 surveyed employees provided valid responses to the questionnaire.

The article focuses on the occupational physicians' study administered to Japanese steel workers on the relationship between sleep-disordered breathing (SDB) and hypertension. According to an animal experiment, a significant increase of the daytime blood pressure was observed after the intermittent airway occlusion on the nocturnal sleep. This, however, was regarded by the Joint National Committee (JNC) as sleep apnea syndrome which is claimed to be an identifiable cause of hypertension.

The purpose of this study was to determine the associations of effort–reward imbalance and social support with chronic fatigue among medical residents in Japan. A total of 104 men and 42 women at 14 teaching hospitals participated in this study. Chronic fatigue was measured by the checklist individual strength questionnaire. Effort, reward and overcommitment were determined by the effort–reward questionnaire developed by Siegrist. Social support was determined by a visual analog scale. Sleeping hours for the last 30 days were estimated based on the number of overnight shifts worked, the average number of sleeping hours, and the number of hours of napping during overnight work. Multiple regression analysis was used to examine the multivariate relationship between these variables and chronic fatigue. In both men and women, effort–reward imbalance was positively associated, and higher social support was negatively associated with chronic fatigue. In men, higher overcommitment was positively associated with chronic fatigue. In women, longer sleeping hours was negatively associated with chronic fatigue and an interaction between sleeping hours and social support was found. The adjusted variance in fatigue explained by the exposure variables was 34% in men and 51% in women. The result of this study suggested that it is desirable to take these factors into consideration in the management of chronic fatigue among medical residents. [ABSTRACT FROM AUTHOR]

The article investigates the association between various occupational stressors and heavy drinking among male workers in different age groups in Japan. For the 18-29 and 50-72 yr-old groups, heavy drinking is related to support from supervisor. For the 30-39 yr-old group, heavy drinking is blamed to intragroup conflict, job control and cognitive demands. While in the 40-49 yr-old group, heavy drinking was related to physical environment, quantitative workload, and underutilization of abilities.

Background: The stratum-specific likelihood ratio (SSLR) has been widely used as a convenient method to interpret the results of screening surveys. In the present paper, an SSLR analysis is applied to the results of a survey that used the Center for Epidemiologic Studies Depression Scale (CES-D) to identify depressive symptoms in a group of Japanese workers in an attempt to determine score categories that have predictive clinical values in a screening context.Methods: The self-reported CES-D and the Mini International Neuropsychiatric Interview (MINI) were administered to 2,219 workers (84.2% men; age 21-68 years) during a periodical medical examination. The SSLR was calculated to determine strata with optimal discrimination for major depressive disorder (MDD).Results: For MDD, the SSLR was 0.06 (95%CI: 0.02-0.18) for the CES-D score range 0-16, 1.90 (0.78-4.62) for the score range 17-19, and 12.4 (10.2-15.1) for the score above 20.Conclusions: The SSLR shown in this study proposes score categories that guide clinicians in selecting the workers most at risks of having MDD among Japanese workers. [ABSTRACT FROM AUTHOR]

The article offers information about a study which aims to determine the associations of depressive symptoms with regular leisure activity and family social support among the workers in Japan. The Center for Epidemiologic Studies Depression scale was used in evaluating depressive symptoms while multiple logistic regression analysis was used to adjust for potentially associated variables.

The Mini-International Neuropsychiatric Interview (MINI) is a short, structured diagnostic interview used as a tool to diagnose 16 axis I ( Diagnostic and Statistical Manual) DSM-IV disorders and one personality disorder. Its original version was developed by Sheehan and Lecrubier. We translated the MINI into Japanese, and investigated the reliability and validity of the Japanese version of MINI. Eighty-two subjects participated in the validation of the MINI versus the Structured Clinical Interview for DSM-III-R (SCID-P). One hundred and sixty-nine subjects participated in the validation of the MINI versus an expert's professional opinion. Seventy-seven subjects were interviewed by two investigators and subsequently readministered by a third interviewer blind to the results of initial evaluation 1–2 days later. In general, kappa values indicated good or excellent agreement between MINI and SCID-P diagnoses. Kappa values indicated poor agreement between MINI and expert's diagnoses for most diagnoses. Interrater and test–retest reliabilities were good or excellent. The mean durations of the interview were 18.8 min for MINI and 45.4 min for corresponding sections of SCID-P. Overall, the results suggest that the MINI Japanese version succeeds in reliably and validly eliciting symptom criteria used in making DSM-III-R diagnoses, and can be performed in less than half the time required for the SCID-P. [ABSTRACT FROM AUTHOR]

Objective: Nonrestorative sleep (NRS) is common in the general global population. This study surveyed the incident/remission rate of NRS and identified related lifestyle factors in a general Japanese adult cohort.Methods: Data from a Japanese health check-based cohort between the fiscal years 2011 and 2018 were obtained. NRS was assessed through a single item question, and socio-demographic and clinical data were assessed through self-reports. To identify potential correlates of NRS incidence/remission, Cox regression analysis (or survival analysis) was performed.Results: Among the 135 609 individuals surveyed at baseline, data from 93 548 were considered for analysis. NRS exhibited incidence and remission rates of 11.3% and 15.4%, respectively. New NRS incidence was predicted by eating fast (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.04-1.10), dining close to bedtime (HR: 1.33, 95% CI: 1.27-1.38), midnight snacking (HR: 1.09, 95% CI: 1.04-1.13), skipping breakfast (HR: 1.16, 95% CI: 1.10-1.22), non-regular exercise (HR: 1.12, 95% CI: 1.07-1.17), lower levels of physical activity (HR: 1.19, 95% CI: 1.14-1.24), and slow walking speed (HR: 1.34, 95% CI: 1.29-1.39), while heavy drinking was less predictive of NRS. However, the same factors (except for heavy drinking) were found to predict NRS remission.Conclusions: We found that unhealthy lifestyle behaviors, particularly dining close to bedtime and slow walking speed, were positively associated with NRS incidence, while they were negatively associated with NRS remission. These results can be useful in developing more effective health promotion policies to achieve good sleep. [ABSTRACT FROM AUTHOR]

Background Effects of overtime work on health is a controversial issue. Aims To determine the effects of overtime work on blood pressure and body mass index (BMI) for male workers in Japan. Methods Participants were 323 male participants of three companies. Data were collected by occupational physicians at periodic physical examinations and additional examinations. The time courses for the development of definite hypertension and an increase in BMI were recorded. The Kaplan-Meier method was used to estimate the cumulative incidence rates of developing definite hypertension and increasing BMI, and the Cox proportional hazard model was used to determine the adjusted relative hazard of overtime work. Results The age-adjusted incidence rates of developing definite hypertension and increasing BMI were significantly lower among the participants whose mean overtime was ⩾50 h than among those whose mean overtime was <50 h/month (log-rank P <0.05). The Cox proportional hazard model indicated that those who worked a mean overtime of ⩾50 h/month had lower risks of developing definite hypertension (hazard ratio, 0.36; 95% CI, 0.15-0.88; P < 0.05) and increasing their BMI (hazard ratio, 0.44; 95% CI, 0.31-0.63; P < 0.01) after adjusting for age. Conclusions The results of this study indicate that workers whose mean overtime was ⩾50 h have lower risks of developing definite hypertension and increasing their BMI. Key words Body mass index; hypertension; karoshi; overtime. [ABSTRACT FROM PUBLISHER]

Abstract: The aim of this study is to develop and validate the Drinking-Related Cognitions Scale (DRCS). The DRCS is a brief measure designed to assess multidimensional cognitions of drinking, including perception of drinking problems, perception of impaired drinking control, readiness to change, decisional balancing, and self-efficacy in alcohol-dependent patients. This study was carried out in Japan, with 132 alcohol-dependent patients (mean age (SD): 49.4 (7.5) years) admitted to an inpatient treatment program. On the basis of prior studies of the rating scales of drinking-related cognitions, DRCS items were selected. Factor analysis was carried out to assess the selection of DRCS items and the factor structure. The factor analysis of the 15 DRCS items showed three factors, “expectancy and resignation,” “perception of impaired control,” and “perception of drinking problem.” The DRCS showed good reliability (Cronbach''s α-coefficients for the entire scale and subscales were 0.80 or higher, and the analysis of variance intraclass correlation coefficient for the test–retest method was 0.81 for the total score). The total DRCS and subscale scores predicted abstinence status at a 3-month follow-up, and the DRCS was considered to have satisfactory predictive validity. It was suggested that the DRCS would be useful for the easy measurement of multidimensional cognitions of drinking in alcohol-dependent patients. [Copyright &y& Elsevier]

The article discusses the risk for psychological distress and unwillingness to work brought by low organizational justice (OJ) in Japan. It notes that the seniority-based component for employee wages and the employee appraisal system has been replaced by a performance-based approach. It mentions that the relationship between OJ and psychological distress can be mediated by job satisfaction.

Background: Cognitive behavioral therapy for insomnia (CBT-I) has been shown to improve depressive symptoms in older adults with comorbid insomnia and depression. However, it remains unclear whether brief CBT-I is effective for improving depressive symptoms in community-dwelling older adults with insomnia symptoms of varying severity., Aim: This study sought to examine the effectiveness of a brief CBT-I intervention delivered by public health nurses to improve depressive symptoms among older adults recruited from a community setting., Methods: This randomized controlled study compared sleep status and depression at baseline and a 3-month follow-up using a wait-list control design. Depression was evaluated using the Geriatric Depression Scale short form (GDS-SF)., Results: The GDS-SF scores in the CBT-I group improved over time (p < .01), with an effect size (Cohen's d) of 0.34 (95% CI [0.16, 0.58]). The results demonstrated the effectiveness of a brief CBT-I intervention for depression, although the effect size was small., Linking Evidence to Action: A brief CBT-I intervention consisting of sleep hygiene education, stimulus control, sleep restriction, cognitive restructuring, and relaxation is effective for improving depressive symptoms among older adults in the community., (© 2019 Sigma Theta Tau International.)

Although autonomic nervous system activity is reportedly related to diurnal glucose tolerance impairment, the relationship with glucose tolerance during sleep is unclear. Since work styles have recently diversified, it is important to assess the effect of sleep on workers' health. Elucidation of the relationship between autonomic nervous system activity during sleep and glucose tolerance in workers may facilitate preventive measures against diabetes using non-pharmacological means (e.g., sleep hygiene education, relaxation techniques and stress management). We examined whether autonomic nervous system activity during sleep is related to fasting glucose or glycated hemoglobin (HbA1c) in individuals with either normal or impaired fasting glucose tolerance. The subjects were 77 apparently healthy Japanese workers with normal or impaired fasting glucose. We used high frequency (HF) and the ratio of low frequency to high frequency (LF/HF) obtained by pulse wave analysis to estimate autonomic nervous system activity. The data were analyzed using a generalized estimating equation adjusted for potential confounders (age, gender, engagement in shift work, sleep duration, and body mass index). Fasting glucose was significantly negatively related to HF, the parasympathetic component during sleep. Our results suggest that parasympathetic activity during sleep is associated with fasting glucose in apparently healthy Japanese workers.

Study Objectives: To investigate the association between short sleep duration and elevated body mass index (BMI) and obesity in a large sample of Japanese adults over a short period., Design: Prospective design with baseline in 2006 and 1-year follow-up., Setting: Workplaces of an electric power company in Japan., Participants: 35,247 company employees (31,477 men, 3,770 women) distributed throughout Japan., Measurements and Results: Measured weight and height and self-reported sleep duration were obtained at annual health checkup in 2006 and 2007. Weight change was defined as the difference in body mass index (BMI) between the baseline and 1 year later. Relative to the reference category (sleep duration 7-8 h), short sleep duration (< 5 and 5-6 h) and long sleep duration > or = 9 h were associated with an increased risk of weight gain among men after adjustment for covariates. Of the non-obese (BMI < 25) men at baseline, 5.8% became obese (BMI > or = 25) 1 year later. Higher incidence of obesity was observed among the groups with shorter sleep duration. Adjusted odds ratios for the development of obesity were 1.91 (95% CI 1.36, 2.67) and 1.50 (95% CI 1.24, 1.80) in men who slept < 5 and 5-6 h, respectively. No significant association between sleep duration and weight gain or obesity was found for women., Conclusions: Short sleep duration was associated with weight gain and the development of obesity over 1 year in men, but not in women.

Shift work, including night work, has been regarded as a risk factor for medical safety. However, few studies have investigated the difference in medical error risk between two- and three-shift systems. A total of 1,506 registered nurses working shifts at teaching hospitals participated in this study to evaluate the difference in medical error risk between two- and three-shift systems. After adjustment for potential confounding factors using a log Poisson generalized estimating equation model, the results showed significantly higher frequencies of perceived adverse events over 6 months in the three-shift than in the two-shift system, with estimated mean numbers of adverse events of 1.05 and 0.74, respectively. Shorter intervals after night shifts and greater frequency of night shifts in three-shift systems, which reduce the recovery time from night shift work, may be linked to increased medical errors by nurses.

Background: Maternity blues and postpartum depression are common complications of childbearing. However, few studies have shown the relationship between the severity of maternity blues and the risk of postnatal depression. We carried out a longitudinal study among Japanese women to show that maternity blues is a useful factor for predicting postpartum depression., Methods: Two hundred and thirty-five women completed questionnaires before delivery, and five days, one month, and three months after delivery. They were required to answer the Stein's Blues Scale and Edinburgh Postnatal Depression Scale and other variables. A sequential logistic regression analysis was performed to estimate the association of maternity blues with postpartum depression. The stratum-specific likelihood ratio was then calculated., Results: The prevalence of postpartum depression was 12.8%. A Stein's Blues Scale of eight or above was significantly associated with postnatal depression. Likelihood ratios (95% CI ) for the Stein's Blues Scale of 0 to 3, 4 to 7, 8 to 11 and 12 or more were 0.33 (0.16-0.65), 1.06 (0.60-1.88), 3.42 (1.64-7.12) and 9.57 (3.41-26.86), respectively., Conclusions: These findings suggest that maternity blues is a strong predictor of postpartum depression. The higher the blues score, the higher the risk of postpartum depression.

Aim: A retrospective study was conducted to assess the relationship between patient characteristics and psychiatric day care outcomes in 430 Japanese schizophrenic patients., Methods: The patients were divided into psychiatric day care completers and non-completers. Patients who could not be included in these groups were categorized as unclassifiable. The completers were subdivided into four outcome groups: (i) patients who obtained a part-time job, (ii) patients who began working at community workshops for mentally disabled persons, (iii) patients who obtained a full-time job or returned to their former positions, and (iv) patients who entered or returned to school. The non-completers were subdivided into two outcome groups: (i) patients who discontinued psychiatric day care because of worsened schizophrenia, and (ii) patients who were rehospitalized because of worsened schizophrenia. Age, sex, age of onset of schizophrenia, number and duration of previous psychiatric hospitalizations, number of persons living with the patient, educational background, previous employment type, marital status, chlorpromazine-equivalent doses of antipsychotic drugs used, and psychiatric day care outcomes were compared among the outcome groups with logistic regression analysis using the outcomes as target variables., Results: A later onset of schizophrenia and fewer previous psychiatric hospitalizations were significantly related with better outcomes. A higher educational background was related with the outcomes without statistical significance., Conclusions: Our results suggest that the assessment of the relationship between patient characteristics and psychiatric day care outcomes is essential to enhance therapeutic effectiveness of psychiatric day care by beginning appropriate communication, support, and programs for individual patients at the initiation of the care.

Depressive symptoms among medical residents are common. The objective of this study was to determine the association of depressive symptoms with needlestick injury among first-year medical residents (so-called "intern"). We conducted a prospective cohort study among 107 medical residents in 14 training hospitals. The baseline survey was conducted in August 2005 and the follow-up survey was conducted in March 2006. Depressive symptoms were based on the Center for Epidemiological Study of Depression. Factors associated with depressive symptoms were examined using logistic regression analysis. For medical residents without depressive symptoms at the baseline survey, needlestick injury events were associated with depressive symptoms at the follow-up survey (corrected odds ratio [cOR]=2.98; 95% confidence interval [CI], 1.16-3.70). Because it was not possible to determine when the medical residents developed depressive symptoms, it is not possible to definitely determine causality between needlestick injury and depressive symptoms, although these findings are suggestive. Therefore, it would seem prudent to suggest the provision of mental health services to medical residents sustaining a needlestick injury since this may be helpful in identifying and treating depression.

Despite long-standing concerns regarding the effects of working hours on the performance and health of medical residents, and the patients' safety, prior studies have not shown an association of excessive sleepiness with the number of sleeping hours and days of overnight work among medical residents. In August 2005, a questionnaire was mailed to 227 eligible participants at 16 teaching hospitals. The total number of sleeping hours in the last 30 d was estimated from the average number of sleeping hours during regular days and during days with overnight work, and the number of days of overnight work. Multiple logistic regression analysis was used to adjust for potentially associated variables. A total of 149 men and 47 women participated in this study. The participation rate was 86.3%. Among the participants, 55 (28.1%) suffered from excessive sleepiness. Excessive sleepiness was associated with sleeping for less than 150 h in the last 30 d (corrected odds ratio [cOR]=1.57; 95% confidence interval [CI], 1.02-2.16). The number of days of overnight work in the last 30 d showed no association with excessive sleepiness. Excessive sleepiness was also associated with smoking (cOR, 1.65; 95%CI, 1.01-2.32). Medical residents who slept for less than 150 h in the last 30 d and smoked had a significantly higher risk of excessive sleepiness on duty.

The aims of the present study were to develop and validate the Japanese version of the checklist individual strength questionnaire (CIS) which is used to measure prolonged fatigue not only in the general population but also in the working population. We obtained permission to use CIS from its author and translated the questionnaire into Japanese. Then, the Japanese version of the questionnaire was translated back into English by a bilingual person. The author of the original version agreed that the back-translated version was conceptually and linguistically equivalent to the original CIS. To validate CIS, 399 workers (66.7% were men) from different companies answered the Japanese version of the CIS (CIS-J), Maslach burnout inventory-general survey (MBI-GS), Beck Depression Inventory-II (BDI-II), visual analogue scale (VAS) questionnaires for subjective fatigue, number of overtime hours and number of hours of sleep. Cronbach's alpha for the total CIS-J score was 0.91. The test-retest reliability assessed with an intra-class correlation coefficient was 0.82. Although confirmatory factor analysis did not show an ideal model fit, the correlation coefficients between the total CIS score and the MBI-GS exhaustion score, the BDI-II score and the VAS score were 0.58 (p<0.01), 0.66 (p<0.01) and 0.63 (p<0.01), respectively. The less workers slept and the longer they worked, the higher their total CIS score became. CIS-J showed good reliability and acceptable validity in the working population. Thus, it could be useful for studying fatigue among Japanese working populations.

The aim of this study was to identify factors related to the health-related quality of life (HRQOL) of caregivers providing continuing home care for the impaired elderly focusing mainly on care managers' support given to caregivers. Two interviews over a course of 12 months were conducted with 42 caregivers. The questionnaire items for the caregivers included demographic variables, HRQOL, the satisfaction level of care managers, coping ability, and depressive state. For the impaired elderly, the questionnaire items included demographic variables, abilities of activities of daily living, dementia assessment, and depressive state. The mean age of the caregivers was 66.1+/-8.8. By logistic regression analysis with HRQOL as a dependent variable, the caregivers' physical QOL was significantly related to the depressive state of impaired elderly and the caregivers' satisfaction with their care manager, whereas the caregivers' mental QOL was significantly related to the caregivers' sense of coherence and satisfaction with their care manager. These results suggest that the care managers' support to caregivers who provide continuing home care is important for caregivers' HRQOL.

Background: The Center for Epidemiologic Studies Depression Scale (CES-D) is used at workplaces to screen depressive disorders. The aim of this study was to examine the validity of the CES-D for depression in a workplace., Methods: The CES-D was administered to 2,219 workers (84.2% men; age 21-68 years) at a manufacturing company in Japan. Concomitantly all workers had an interview with the Mini International Neuropsychiatric Interview (MINI) as a gold standard for diagnosing major depressive disorder (MDD). The validity was evaluated by a receiver operating characteristic (ROC) curve., Results: The area under the ROC curve of the CES-D was 0.96 [95% Confidence Interval (CI): 0.94-0.99]. The optimal cut-off score of MDD was 19 for screening., Conclusions: The validity of CES-D is confirmed and it is a valid instrument for detecting MDD in working populations in Japan., ((c) 2006 Wiley-Liss, Inc.)

Background: There may be an increased risk of pulmonary thromboembolism (PTE) with antipsychotic drugs, so this association was investigated in autopsy cases of sudden unexpected death determined by the Department of Legal Medicine of a Japanese university hospital., Methods and Results: Records of 1,125 forensic autopsies (808 males, 317 females) performed during the study period for investigation of the cause of sudden unexpected death were reviewed and a logistic regression analysis was performed to explore whether age, gender, body mass index (BMI), and antipsychotic drug use were associated with fatal PTE. Among all records, 34 (3.0%; 14 males, 20 females) indicated the use of antipsychotic drugs and 28 (2.5%; 9 males, 19 females) indicated PTE as the cause of death. Of the 28 subjects who died from PTE, 8 had taken antipsychotic drugs (29%) and all were female. Female gender and antipsychotic drug use accounted for a significantly higher risk of PTE death with an odds ratio of 4.22 (95% confidence interval (CI), 1.82-9.78; p<0.01) and 10.49 (95% CI, 3.95-27.85; p<0.01), respectively., Conclusions: Japanese women taking antipsychotic drugs may be at particular risk for PTE.

Recently the EAP has received much attention in Japan. The first EAP service in the US was conducted by employees who had recovered from alcohol problems. In the early days EAP providers focused on addiction, but mainly after 1980 they expanded their service areas to include mental health, marital problems, legal problems and financial problems. In Japan the EAP was first received attention as a counseling resource outside the workplace where employees could seek professional help confidentially, but the main reasons why this system now interests employers are as a risk-management tool and an outsourcing of mental health services, since the growing number of mental health cases in the workplace has been a big issue for employers. Two movements have also contributed to more recognition of the EAP: one is guidelines on compensation for mental health cases in the workplace and the other is guidelines on mental health promotion in the workplace. There are four types of EAP systems: internal EAP, external EAP, combination EAP, and consortium EAP. EAP core technology consists of 8 functions including problem identification, Crisis intervention, Short-term intervention, Consultation with work organization leader. The literature on cost-benefit analysis of the EAP is very limited. Although the available data suggest that the EAP is highly cost-effective, further studies are needed with the sufficient statistical quality. In Japan the most important issues in the EAP are the standardization and quality assurance of EAP services. For this purpose development of a good educational system for EAP professionals is needed.