A comparison of the recognition of overwork-related cardiovascular disease in Japan, Korea, and Taiwan

Long working hours and risk of hypertensive intracerebral haemorrhage among Japanese workers claiming compensation for overwork-related intracerebral haemorrhage: an unmatched case-control study

OBJECTIVES

Overwork-related cerebrovascular and cardiovascular diseases (CCVDs) constitute a major occupational and public health issue worldwide. However, to our knowledge, few studies have reported the underlying pathophysiological mechanisms. We aimed to determine whether patients with extreme workload have a greater risk of developing hypertensive intracerebral haemorrhage (ICH) located in the deep brain areas than patients without extreme workload. We also determined the association between the number of hours of overtime work and the risk of developing hypertensive ICH.

DESIGN

Unmatched case-control study.

SETTING

Database of patients claiming compensation for overwork-related CCVDs in Japan.

PARTICIPANTS

A total of 1215 patients who claimed overwork-related ICH in Japan, of whom 621 had their compensation claim approved (patients with extreme workload) and 622 did not.

PRIMARY AND SECONDARY OUTCOME MEASURES

Logistic regression analysis was performed to calculate the risk of developing hypertensive ICH in patients with extreme workload compared with those without extreme workload, adjusted for confounders such as age, occupation, smoking status, alcohol consumption and medical history. We also calculated the risk of developing hypertensive ICH in compensated patients by average monthly overtime working hours.

RESULTS

Patients with extreme workloads had a significantly higher odds ratio (OR) for developing hypertensive ICH (1.44, 95% CI: 1.10 to 1.88) than those without extreme workloads. ORs for developing hypertensive ICH according to overtime working hours showed a dose-response relationship; an overtime of 100 hours/month was associated with a significantly higher OR (1.31, 95% CI: 0.89 to 1.91; 1.41, 95% CI: 0.95 to 2.11; and 1.50, 95% CI: 1.01 to 2.22 for 60-79.9, 80-99.9 and≥100 hours/month, respectively) than that for workloads of less than 60 hours/month.

CONCLUSIONS

Regarding Japanese workers, overtime work could be associated with the risk of developing hypertensive ICH, and hypertension may play an important role in overwork-related ICH.

The impacts of working time flexibilization on occupational safety and health: an expert survey

The policy proposal by the current Korean government that proposes flexible overtime rules is causing social controversy. This study has explored the 612 experts' opinions on the occupational safety and health impacts of the policy using an online self-report survey. They expected short-term overwork (87.25%), overwork inequality (86.44%), irregular working hours (84.31%), chronic overwork (84.15%), long working hours (83.66%), and unpredictability of working hours (81.86%) as a result of the policy change. They also responded that the policy change would increase industrial accident deaths (87.25%), mental illnesses (87.09%), deaths due to overwork or cardiovascular diseases (83.84%), and accidents (83.33%). They disagreed that the government's flexibilization policy, while agreeing that the necessity of policies on regulating night work (94.77%), guaranteeing wages to eliminate overtime (90.36%), establishing working time regulations for the bogus self-employed (82.84%), and applying the 52-hour workweek system to all workplaces (76.47%). These expert opinions are consistent with previous research on the health effects of working hours.

Hospital Occupational Health Service Network and Reporting Systems in Taiwan From 2008 to 2021

OBJECTIVE

To evaluate the provision of occupational health services at hospitals following the establishment of the Network of Occupational Disease and Injury Service in 2007.

METHODS

A review of occupational health services during 2008 to 2021 was conducted. The medical practice-based reporting system was compared with the database of compensated occupational diseases (ODs) from Taiwan's Labor Insurance.

RESULTS

First-time outpatient visits for occupational evaluation and total visits to Network of Occupational Disease and Injury Service health care institutions increased from 1777 and 9435 to 12,092 and 23,210, respectively. Reported ODs increased from 1626 to 2043 with a peak of 2791. Up to 1380 workers evaluated for work resumption in 2021. Similar to the increasing trend in reported ODs, the number of compensated ODs increased over years.

CONCLUSION

The health service needs of Taiwanese workers from OD evaluation to vocational rehabilitation are increasing.

An Index to Assess Overwork-Related Adverse Effects on Employees Under the Occupational Safety and Health Act in Taiwan

Background

The present study aimed to digitally evaluate the risk of overwork-related adverse effects (OrAEs) among employees from various occupational categories in Taiwan.

Methods

Anonymous data of employees from seven companies/factories providing occupational health services were analyzed. The studied population comprised 5505 employees, and the data analyzed included employment duration, working hours, shift work schedules, and health checkup results. The risk for OrAEs was assessed by an index, Karo index (0-4, the larger the value, the higher the risk for OrAEs) obtained using a risk matrix made up of cardiocerebral and occupational risk factors. Karo index values of 3 and 4 were categorized as at high risk for OrAEs (h-OrAEs).

Results

The 5505 employees had an average employment duration of 8.5 years and a mean age of 39.4 years. The prevalence rates for h-OrAEs of the seven companies/factories ranged from 3.9% to 34.2%. There were significant differences in prevalence rates for h-OrAEs between employees of retail stores and high-tech manufacturing factories. Multivariate analysis results indicated that workers of high-tech manufacturing factories had significantly higher risk for h-OrAEs compared with retail store workers.

Conclusion

In terms of satisfying health risk management and legal requirements in Taiwan, the newly issued Karo index, which covers a wide range of occupational risk factors, can serve as an assessment and a warning tool for managing the risk of OrAEs in workplaces. To reduce risks for h-OrAEs, active and prudent control of cerebrocardiovascular risks and working hours is recommended.

Mortality of Suicide and Cerebro-Cardiovascular Diseases by Occupation in Korea, 1997-2020

Although studies on occupational mortality have been conducted in Korea, the results for occupations with high mortality around 2010 are inconsistent. This study aimed to examine occupational mortality from overwork-related suicide and cerebro-cardiovascular diseases (CCVD) from 1997 to 2020. We used microdata of the Causes of Death Statistics (CDS) and Economically Active Population Survey (EAPS) to obtain indirect standardized mortality ratio (SMR) and standardized proportional mortality ratio (PMR) of suicide (X60-X84) and CCVD deaths (I20-I25 and I60-I69) by gender and eight occupational categories. The trend of SMR of suicide and CCVD by occupation was similar within individual genders. The SMR of managers (MNG) was the highest for men and women in 2012-2017 and 2008-2020, respectively, whereas the SMR of professionals and related workers (PRF) was consistently low. Despite the similar socioeconomic status of MNG and PRF, we suggest that their mortality should be analyzed separately in Korea. SMR of suicide and CCVD in female MNG were consistently highest, although the PMR was low. Female MNG may have been more directly affected by the economic crisis. There is a need for work-related stress management, early intervention, and prevention policies in occupations vulnerable to mortality.

Current Diversity Issues in Cardiovascular Workplaces in the Chugoku District ― Results From 2 Questionnaire Surveys ―

Background: Various issues, such as gender diversity and overwork, need to be considered in cardiovascular workplaces. Here, we report the results of 2 questionnaire surveys conducted among members of the Chugoku branch of the Japanese Circulation Society.

Methods and Results: The first questionnaire was posted to all 194 female members in 2018. Of the 73 respondents, 61.6% reported feeling that it would be difficult to continue in cardiovascular care. The second questionnaire was completed by participants of the Chugoku Regional Meeting in 2019. Of the 133 respondents, 42.4% reported difficulties continuing in cardiovascular care. Respondents reporting difficulties had a significantly lower mean age, a higher frequency of day and night shifts, and a higher rate of working >80 h/week than respondents who did not report such difficulties. In logistic regression analysis, working >80 h/week was the only independent factor associated with difficulties continuing in cardiovascular care (odds ratio 4.16; 95% confidence interval 1.46–11.9; P=0.008). Although 47.4% of respondents worked >960 h overtime per year (considered a risk factor for death from overwork), 59.6% of these respondents reported being satisfied with their current situation.

Conclusions: In the Chugoku region, the work-life balance of medical personnel engaged in cardiovascular care has not been sufficiently secured. In order to promote diverse human resources, we need to recognize the current situation and continue to take countermeasures.

Effect of implementing an overwork-prevention act on working hours and overwork-related disease: A mediation analysis

OBJECTIVES

Overwork has been recognized as a risk factor for cerebrovascular and cardiovascular disease (CCVD). To our best knowledge, Japan is the first country in the world to implement an independent act (the 2014 Act) for the prevention of overwork-related disease, which was promoted through application of preventive measures, such as reductions in working hours. We assessed changes in working hours and overwork-related CCVD before and after introduction of the 2014 Act.

METHODS

We calculated the overwork-related CCVD incidence rate and average monthly working hours for 10 industry groups in Japan with data from 2012 to 2018. We applied a causal mediation analysis to estimate the total effect of implementing the 2014 Act on the overwork-related CCVD and the effect mediated by working hours.

RESULTS

An average of 271 for every 48 million employees developed overwork-related CCVD per year. After introducing the 2014 Act, the incidence rate ratio of overwork-related CCVD was 0.881-fold lower (95% CI 0.780-0.995) compared with before the policy change. The 2014 Act contributed to a decrease of 26% (78 cases per year; 95% CI 29-173) of the overwork-related CCVD incidence per year. Approximately 41% (32 cases per year) of this effect could be explained by reduced working hours.

CONCLUSIONS

Our study highlights the impact of the 2014 Act in Japan on the reduction in working hours, which further contributes to the reduction in overwork-related CCVD. Policymakers should consider adopting our innovative approach to assess the mediation effect underlying the implementation of new policies.

Work-Related Accumulated Fatigue among Doctors in Tertiary Hospitals: A Cross-Sectional Survey in Six Provinces of China

Objectives: “Karoshi” (death due to overwork) of doctors occurred frequently and attracted increasing attention in recent years in China. This study aimed to determine the prevalence of work-related accumulated fatigue of doctors and its associated factors in tertiary hospitals of China. Methods: A cross-sectional questionnaire survey was conducted on 1729 full-time doctors employed by 24 tertiary hospitals across eastern developed, central developing, and western underdeveloped regions of China. Accumulated fatigue was categorized into four levels using the “Self-diagnosis Checklist for Assessment of Workers’ Accumulated Fatigue” rated on a scale matrix considering both overwork and fatigue symptoms. Ordinal logistic regression analyses were performed to identify factors associated with work-related accumulated fatigue. Results: About 78.8% of respondents reported a “high level” of work-related accumulated fatigue, including 42.0% at a “very high” level. Male doctors and those aged between 30 and 45 years and who had a professional title were found to have higher levels of accumulative fatigue than others. Low salary and poor working conditions (in the western region) were also significantly associated with high levels of work-related accumulated fatigue (p < 0.05). Conclusion: High levels of work-related accumulated fatigue are prevalent in doctors working in tertiary hospitals in China. Male doctors establishing their early- and mid-careers are the high-risk group. Poor working conditions are associated with work-related accumulated fatigue.

Mediation analysis for new recognition criteria, working hours and overwork-related disease: a nationwide ecological study using 11-year follow-up data in Taiwan

OBJECTIVES

Taiwan revised its criteria for overwork-related cerebrovascular and cardiovascular disease (CCVD) in 2010. A new definition of overwork increased the number of recognised cases. Meanwhile, actual average working hours decreased. We estimated the effects of the revised criteria on the number of overwork-related CCVD cases and the mediation effect through reduced working hours.

METHODS

From the Labor Insurance of Taiwan, we collected data on the total number of overwork-related CCVD cases from 2006 to 2016 and average monthly working hours for 13 industry groups. We conducted causal mediation analysis to investigate the mechanism of the effect of new criteria on CCVD mediated by working hours.

RESULTS

From 2006 to 2016, 594 overwork-related cases of CCVD were recognised across 13 industry groups. After introducing the new criteria, overwork-related CCVD increased by 8.40 cases (per one million person-years) (95% CI 4.53 to 15.05), which resulted from a decrease of 1.54 (95% CI 0.22 to 3.82) cases due to reduced working hours (mediation effect) and an increase of 9.93 (95% CI 5.24 to 18.17) cases related to the effect of the criteria change and other covariates excluding working hours (alternative effect).

CONCLUSIONS

Working hours are an important mediator of the effect of policy on the rate of overwork-related CCVD. Introducing new criteria for recognising overwork-related disease might raise awareness and prompt reductions in working hours, which also help to reduce CCVD. Our findings suggest that understanding mediation effects is important to evaluating national health policies.

The Effect of Long Working Hours and Overtime on Occupational Health: A Meta-Analysis of Evidence from 1998 to 2018

There has been no subsequent meta-analysis examining the effects of long working hours on health or occupational health since 1997. Therefore, this paper aims to conduct a meta-analysis covering studies after 1997 for a comparison. A total of 243 published records were extracted from electronic databases. The effects were measured by five conditions, namely, physiological health (PH), mental health (MH), health behaviours (HB), related health (RH), and nonspecified health (NH). The overall odds ratio between long working hours and occupational health was 1.245 (95% confidence interval (CI): 1.195-1.298). The condition of related health constituted the highest odds ratio value (1.465, 95% CI: 1.332-1.611). The potential moderators were study method, cut-point for long weekly working hours, and country of origin. Long working hours were shown to adversely affect the occupational health of workers. The management on safeguarding the occupational health of workers working long hours should be reinforced.

Significant Impacts of Work-Related Cerebrovascular and Cardiovascular Diseases among Young Workers: A Nationwide Analysis

Background: While occupational factors linked to the onset of cerebrovascular and cardiovascular diseases (CVDs) have been reported among workers, much remains unknown about the impacts that occupation has on the onset of CVDs in various age groups. We attempted to describe temporal trends in total and work-related CVDs (WRCVDs) rates stratified by age and year and explore the relative contributions of work to the CVD risk. Methods: This study was conducted using two populations from the Labor Insurance Database as the working population and the National Health Insurance Research Database as the general population. We included all people aged 15⁻75 years from 2006 to 2013. All CVD events and WRCVD events were identified. A Poisson regression was used to estimate the morbidity rate ratio (RR) stratified by age and period, and an RR adjusted for residual confounding was also used. Results: Incident CVD rates increased with aging in the general population (from 1113.55 to 1853.32 per 100,000 persons), and WRCVD rates increased in the working population over time (from 2.10 in 2006 to 8.60 in 2013 per 100,000 persons). In the age and period analysis, CVD attacks showed disparities in different populations. The RR of the WRCVD risk was mainly in the working population aged >45 years, and the RR of the CVD risk occurred in the oldest group (aged 55⁻64 years) of the general population. The population-attributable risk of working exposure was 13.5%. After eliminating residual confounding factors, higher population attributed risk (PAR) work-related excessive CVD risk mainly occurred in workers aged 25⁻34 and 35⁻44 years. A decreasing PAR trend was found in the age groups as follows: 15⁻24, 25⁻34, 35⁻44, 45⁻54, and 55⁻64 years, with percentages of 17.64%, 16.89%, 16.46%, 10.6%, and 0.65%, respectively. Conclusions: There is evidence that period and age trends of CVD rates differed between the working population and general population. Relative effects attributed to work were more severe in younger workers, particularly in workers aged <55 years.

Policy changes for preventing and recognizing overwork-related cardiovascular diseases in Taiwan: An overview

Objective

Overwork‐related cardiovascular and cerebrovascular disease (CVD) has a large impact on workers' rights and labor standards across East Asian countries. This article describes the background and impact of policies regarding overwork‐related CVD in the past decades in Taiwan.

Methods

We reviewed government policies, guidelines, literature, and news addressing the problems and impact of policy changes to prevent and recognize overwork‐related CVD since the 1990s, and collected data on overwork‐related CVD cases in Taiwan from 2006 to 2017.

Results

In 2017, overwork‐related CVD accounted for 13% of all cases of occupational diseases, but 79% of all deaths due to occupational diseases. Guidelines for recognizing overwork‐related CVD cases were established in 1991; however, under‐recognition exists in Taiwan due to poor exposure data on working hours and psychological factors and because most medical expenses are covered by the national health insurance system. Amendments on the guidelines, and stricter policies on overwork prevention were enforced following calls from labor unions, nongovernmental organizations, and legislators, but health disparities were introduced when certain industries were exempted from restrictions.

Conclusions

Long working hours and other work characteristics increase the risk of overwork‐related CVD. By reviewing the changes in policy for preventing overwork and recognizing overwork‐related disease, we identified the need for clearly defined guidance on evaluating overwork‐related CVD, with specific criteria for working hours and other risk factors regarding work characteristics. National policies that lead to better working conditions and prevent overwork‐related diseases must be developed.

Sociomedical problems of overwork-related deaths and disorders in Japan

Objectives

Cerebrovascular and cardiovascular diseases (CCVDs) and mental disorders, including suicide, are prevalent among overworked individuals in Japan. The 2014 legislation regarding the prevention of overwork‐related deaths and disorders has accelerated the research in this field and ultimately the implementation of preventive actions.

Methods

To understand the current problematic situations, the Research Center for Overwork‐Related Disorders of the National Institute of Occupational Safety and Health, Japan, conducted analyses of compensated claims for overwork‐related CCVDs and mental disorders that were recognized from January 2010 to March 2015.

Results

The majority of CCVD cases were the men in their 50s. Transport and postal activities was the highest risk industry. Cerebrovascular cases were higher than cardiovascular ones. Long working hours was the principal factor for CCVDs. The mental disorder cases comprised approximately 70% men and affected younger age groups (peak in the third decade) with various industries at risk. In men, there was an almost equal number of F3 (Mood [affective] disorders) and F4 (Neurotic, stress‐related, and somatoform disorders) diagnoses according to the 10th revision of the International Classification of Diseases and Related Health Problems. A larger number of women were diagnosed to have F4. The mental disorder cases were associated not only with long working hours, but also with injuries and disasters as well as interpersonal conflict at work.

Conclusions

Multiple, simultaneous actions need to be made by employees, employers, researchers, and the authorities to achieve the goal of reducing the number of workers suffering from the overwork‐related CCVDs and mental disorders.

The history of occupational health in South Korea

South Korea has experienced rapid economic development over a 60-year period, since the 1960s, rising up from the ruins of the 1950-1953 Korean War. During this short period, South Korea experienced a wide range of occupational safety and health (OSH) problems, similar to that experienced in most developed countries about 100-200 years previously. In response, the South Korean government established a national OSH services system that is on par with most developed countries. In recent years, South Korea now faces a new collection of OSH challenges, such as mental health issues, microenterprise issues, precarious workers, and the promotion of work ability in a rapidly changing socioeconomic structure. This study evaluates the establishment of South Korea's OSH services system, including the socio-politico-economic contexts that have had a profound influence on the system during each historical period.

The impact of occupational psychological hazards and metabolic syndrome on the 8-year risk of cardiovascular diseases-A longitudinal study

There was little information concerning the combined effect of occupational psychosocial hazards such as long working hours, high job stress, and high fatigue on the risk of cardiovascular and cerebrovascular diseases (CVD). The aim of this study was to investigate the interaction among occupational psychosocial hazards and the impact of metabolic syndrome (MetS) on the risk of CVD among bus drivers. The Taiwan Bus Driver Cohort Study involving 1014 professional drivers was established in 2005 and comprehensively studied. The interactions among occupational psychosocial hazards and the impact of MetS on the risk of CVD were measured. A working pattern questionnaire, job stress questionnaires, the Swedish occupational fatigue inventory, the stress satisfaction offset score, biochemical measurements, and physical examinations were used to assess psychosocial hazards and the presence of metabolic syndrome. There were 707 eligible bus drivers with a mean age of 43.5years old. During the 8-years of follow-up, 77 drivers were diagnosed with CVD. Long working hours, high job stress, and high fatigue were associated with an increased risk of cardiovascular disease incidence in the multivariate analysis. There were synergistic effects among long working hours, high job stress, and high fatigue only in drivers with MetS. A combination of long working hours, high job stress, and high fatigue increased the risk of developing CVD in bus drivers with MetS.

Latent class analysis to evaluate performance of plasma cortisol, plasma catecholamines, and SHSQ-25 for early recognition of suboptimal health status

Background

Chronic stress is associated with suboptimal health status (SHS) which is a new public health challenge in China and worldwide. Plasma stress hormones may act as potential objective biomarkers for SHS measure. This study was aimed to evaluate the diagnostic performance of plasma cortisol, catecholamine adrenaline/noradrenaline, and SHS questionnaires (SHSQ) for SHS using latent class analysis (LCA) in the absence of a gold standard.

Methods

A cross-sectional study was conducted among 868 employees in Beijing. The SHS questionnaires-25 (SHSQ-25) was distributed, and plasma cortisol, adrenaline, and noradrenaline were measured in the survey. LCA was used to assess the performance of both subjective and objective measures for SHS recognition.

Results

Akaike information criterion (AIC) and consistent AIC (CAIC) was 14.11 and 54.48 respectively, indicating that the model was well fitted. The sensitivity and specificity of plasma cortisol were 0.836 (95% CI 0.811-0.861) and 0.840 (95% CI 0.816-0.864), respectively. The area under curve (AUC) of receiver operating characteristic (ROC) of SHSQ-25 was 0.743 (95% CI 0.709-777), while the AUC of plasma adrenaline was 0.688 (95% CI 0.651-0.725). The prevalence of SHS in the investigated population was 34.78%.

Conclusion

Plasma cortisol is a valuable biomarker for SHS detection, whereas SHSQ-25 is more suitable for SHS screening in the population-based health survey. The accuracy and applicability of plasma adrenaline are inferior to cortisol and SHSQ-25, respectively. LCA has merit to evaluate performance of plasma cortisol, catecholamines, and SHSQ-25 for recognition of SHS in the absence of a gold standard test.

Healthy hearts at hectic pace: From daily life stress to abnormal cardiomyocyte function and arrhythmias

The hectic pace of contemporary life is a major source of acute and chronic stress, which may have a deleterious impact on body health . In the field of cardiovascular disease, acute emotional stress has been associated with coronary spasm and Takotsubo cardiomyopathy, whereas the manifestations of chronic stress have been overlooked, and most underlying pathophysiology remains to be elucidated. Chronic stress affects the neuronal circuitry composed of cortico-limbic structures and the nuclei regulating autonomic function, eliciting a sympatho-vagal imbalance, characterised by adrenergic activation and vagal withdrawal. Sympathetic terminals are connected to cardiomyocytes in a quasi-synaptic way, producing the so called 'neuro-cardiac junction'. During chronic stress, norepinephrine release is increased, leading to overstimulation of cardiomyocytes via β₁-adrenergic receptors, influencing mainly calcium dynamics, and β₂-adrenergic receptors, which control housekeeping functions. The circadian rhythm of cardiomyocytes is then impaired, with elongation of the catabolic ('light' phase) over the anabolic ('nocturnal') phase. This leads to a depletion of cell energy storage, and a decreased turnover of cell constituents. Even cell interactions are affected, as coupling between cardiomyocytes decreases while coupling between cardiomyocytes and fibroblasts increases. The ultimate results are changes in the shape and velocity of action potential, fibroblast activation and deposition of extracellular matrix. These alterations may predispose to arrhythmias and may favour the development of a stress-related cardiomyopathy. A better comprehension of this cascade of events may allow us to identify screening protocols and treatment strategies (meditation, yoga, physical activity, psychological assistance, β-blockers) to prevent or relieve ongoing cardiac damage.

Nonlinear associations between working hours and overwork-related cerebrovascular and cardiovascular diseases (CCVD)

Long working hours are recognized as a risk factor for cerebrovascular and cardiovascular diseases (CCVD). We investigated the relationship between working hours and different CCVD severity outcomes—death, disability, and illness—across industries in Taiwan from 2006 to 2016. We applied a generalized additive mixed model to estimate the association between working hours and the rate of each severity outcome, adjusted for salary, unemployment rate, time, and a random intercept. Industry-average working hours were significantly associated with each outcome level of overwork-related CCVD, especially when monthly working hours increased from 169 (relative risk [RR] = 1.46, 95% confidence interval [CI] 1.002–2.12) to 187 (RR = 5.73, 95% CI 3.61–9.08). Although RR trends declined after monthly working hours exceeded 187, excess risks remained statistically significant. Each 1-hour increase in working hours had a stronger effect on the RR increase in death and disability than on illness. Variations in CCVD risks existed across industries, with the highest risk in transportation and information. Reducing working hours is essential to preventing overwork-related CCVD, especially the more severe outcomes. We recommend further research to address possible underreporting of less severe cases, and to explore actions to narrow the gaps in risk across industries.

Relationship between stress-related psychosocial work factors and suboptimal health among Chinese medical staff: a cross-sectional study

OBJECTIVES

The study aimed to develop and validate a model to measure psychosocial factors at work among medical staff in China based on confirmatory factor analysis (CFA). The second aim of the current study was to clarify the association between stress-related psychosocial work factors and suboptimal health status.

DESIGN

The cross-sectional study was conducted using clustered sampling method.

SETTING

Xuanwu Hospital, a 3A grade hospital in Beijing.

PARTICIPANTS

Nine hundred and fourteen medical staff aged over 40 years were sampled. Seven hundred and ninety-seven valid questionnaires were collected and used for further analyses. The sample included 94% of the Han population.

MAIN OUTCOME MEASURES

The Copenhagen Psychosocial Questionnaire (COPSOQ) and the Suboptimal Health Status Questionnaires-25 were used to assess the psychosocial factors at work and suboptimal health status, respectively. CFA was conducted to establish the evaluating method of COPSOQ. A multivariate logistic regression model was used to estimate the relationship between suboptimal health status and stress-related psychosocial work factors among Chinese medical staff.

RESULTS

There was a strong correlation among the five dimensions of COPSOQ based on the first-order factor model. Then, we established two second-order factors including negative and positive psychosocial work stress factors to evaluate psychosocial factors at work, and the second-order factor model fit well. The high score in negative (OR (95% CI)=1.47 (1.34 to 1.62), P<0.001) and positive (OR (95% CI)=0.96 (0.94 to 0.98), P<0.001) psychosocial work factors increased and decreased the risk of suboptimal health, respectively. This relationship remained statistically significant after adjusting for confounders and when using different cut-offs of suboptimal health status.

CONCLUSIONS

Among medical staff, the second-order factor model was a suitable method to evaluate the COPSOQ. The negative and positive psychosocial work stress factors might be the risk and protective factors of suboptimal health, respectively. Moreover, negative psychosocial work stress was the most associated factor to predict suboptimal health.

Cardiovascular diseases, metabolic syndrome and health behaviours of postmenopausal women working in agriculture

INTRODUCTION

The objective of the study was to examine the impact of occurrence of cardiovascular diseases (CVDs) and metabolic syndrome (MS) diagnoses on the frequency of health behaviours in postmenopausal women working in agriculture.

MATERIAL AND METHODS

Eight hundred and ten postmenopausal women living in rural areas and working in agriculture, aged 46-70 and at least 12 months from the last menstrual period, were examined. Analysis of variance with multiple comparison tests was used to compare the Inventory of Health Behaviours among the women with and without CVDs and MS.

RESULTS

The frequency of some health behaviours, mainly health practices, is higher in postmenopausal women working in agriculture with CVDs or MS than in those without CVDs or MS (p = 0.045). Women with such disorders more often limit their physical effort (p = 0.029), try to be less overworked (p < 0.001) and to take more rest (p = 0.027), more often limit consumption of animal fat and sugar (p = 0.024), more regularly visit physicians (p = 0.003) and more often take seriously recommendations concerning their health. However, an insufficient frequency of health behaviours was observed among both the healthy women and those with metabolic disorders and CVDs. One third of all the examined women had a high frequency of health behaviours, one third had an average frequency and one third had a low frequency; hence actions should be taken to improve the situation.

CONCLUSIONS

Postmenopausal women working in agriculture more often perform beneficial health behaviours if they have MS and CVDs diagnosed in comparison to healthy women.

The impact of the introduction of new recognition criteria for overwork-related cardiovascular and cerebrovascular diseases: a cross-country comparison

Cardiovascular and cerebrovascular diseases (CVDs) related to overwork are common in Asia, as is death from overwork, known as karoshi. Japan was the first country in the world to introduce criteria for recognizing overwork-related CVDs in 1961. Taiwan followed Japan in putting in place new policies and then updating these in 2010. We aimed to investigate the effect of introducing the new criteria for recognizing overwork-related CVDs in both countries. We defined the baseline period as the 5 years before launch of the new criteria, then collected data to 5 years after the new criteria. We applied a Poisson regression model to analyze the longitudinal change in rates of overwork-related CVDs before and after, adjusting for indicators of working conditions. Implementation of the new criteria was associated with a 2.58-fold increase in the rate of overwork-related CVDs (p-value < 0.05). However, the examined policy framework in Taiwan still appears to miss a substantial number of cases compared to that are captured by a similar policy framework used to capture overwork-related CVD rates in Japan by a factor of 0.42 (p-value < 0.05). Accordingly, we make a case for enhancements of Taiwan’s system for reporting and recognizing overwork-related diseases and deaths.

Association of Psychosocial Work Hazards With Depression and Suboptimal Health in Executive Employees

OBJECTIVES

This study aims to investigate whether psychosocial work-related hazards, measured by workplace justice and employment insecurity, are associated with depression and suboptimal health status in Taiwan's executive-level employees.

METHODS

There were 365 executives who have received a series of cardiovascular health examinations, blood sampling, and self-reported questionnaires, which included the psychosocial work-related hazards and the CES-D scale. Suboptimal health status was defined as the presence of dyslipidemia or prediabetes.

RESULTS

Executive-level employees perceived lower workplace justice and higher employment insecurity and had a significantly higher risk of depression (CES-D scores ≥16 or ≥23). However, workplace justice was identified as a significant determinant factor that was negative for dyslipidemia but protective for prediabetes.

CONCLUSION

This study supports the fact that psychosocial work-related hazards can independently contribute to the risk of developing depression, prediabetes, and dyslipemia in executives.

Casual dock work: profile of diseases and injuries and perception of influence on health

The present study aimed to identify the profile of diseases and injuries that affect casual dock workers and identify casual dock workers’ perceptions of positive and negative work influences on their health. This study consisted of two phases. The first phase was a quantitative study composed of a retrospective analysis, conducted with 953 medical records. The second phase of the research is a non-random sample with 51 casual dock workers. Data analysis was performed with SPSS 19.0. The average age of the casual dock workers was 48.7. Concerning working time, the majority had more than 19.6 years of dock work experience. In the first phase, 527 pathologic diagnoses were identified. The diagnoses that affected the musculoskeletal system (15.8%, N = 152; p < 0.01) were highlighted. Consequences to physical health produced by accidents stood out, with fracture registration predominating (12.8%, N = 122; p < 0.05). Significant differences were found for positive work influence on the cardiovascular system and family health. It was concluded that the diagnoses obtained are related to the influence of dock work perception and have motivated an introduction of preventive measures.

Working hours, sleep duration and the risk of acute coronary heart disease: a case-control study of middle-aged men in Taiwan

BACKGROUND

This study aimed to examine whether long working hours and short sleep duration were associated with an increased risk of acute myocardial infarction (AMI) or severe coronary heart diseases (SCHD), independent of established psychosocial work-related factors.

METHODS

A case-control study was conducted. Cases were 322 men, aged <60 years and economically active, who were admitted to hospital with a first diagnosed AMI or SCHD during 2008-2011, of whom 134 were confirmed AMI and the other 188 were angiography-confirmed SCHD. Controls were 644 men who were drawn from a national survey and were matched to the cases on age, education and area of residence. Odds ratios of total CHD and confirmed AMI in relation to average weekly working hours and daily hours of sleep were calculated.

RESULTS

Men with average working hours longer than 60 h/week were found to have significantly increased risks for total CHD (OR=2.2) as compared to those with weekly working hours in 40-48 h, and those with daily hours of sleep fewer than 6 h were found to have increased risks for CHD (OR=3.0) as compared to those with sleeping hours in 6-9 h. Restriction to confirmed AMI yielded a greater risk and these associations remained consistent with adjustment of smoking status, body mass index and psychosocial work factors including job demands, job control, workplace justice, job insecurity and shift work.

CONCLUSION

The results support the hypothesis that long working hours and short sleep duration contribute independently to the risk of cardiovascular diseases in men.