Objectives: To narratively review the presence and treatments of mental health problems among high-level political leaders. These questions have been noted in few epidemiologically sound studies and in the media. Methods: The literature search was performed and it resulted well-described cases and case series, but lacks properly designed studies focusing on medical issues. Results: High-level political leadership is a high-risk occupation, especially during crises and wartime, but also stressful in modern, democratic society. Leadership positions do not necessary facilitate the early detection of and intervention in mental disorders. In the media, psychiatrists should ensure that leaders with mental disorders are treated in a manner that preserves their dignity. Commonly accepted ethical principles stress that psychiatrists should not make announcements to the media about presumed psychopathology and diagnosis of any individuals. Conclusions: Current top leaders are mostly in midlife and rarely seriously mentally ill, but many are prone to anxiety, depression, addictions or stress-related disorders. The care of these eminent persons presents a clinical challenge that requires experience, clinical skills and multidisciplinary team work, usually within the occupational health system which is familiar with the working conditions and state of health of each patient.

Objectives: In the event of a disaster, both victims and first responders are exposed to health risks. The purpose of this study was to investigate the health effects of workers responding to disasters following the Great East Japan Earthquake (GEJE). Methods: We reviewed the literature on the health effects of workers responding to disasters at GEJE. PubMed and Ichu-Shi Web (an online search database for Japanese medical literature) were utilized. After the screening, we excluded papers that did not meet our inclusion criteria. Results: We identified 25 papers matching our criteria. Papers on the health of workers who responded to disasters was primarily focused on medical professionals, public servants, and emergency professionals. Although many papers focused on the mental effects of health effects of health consequences, suggesting that many occupations increase the risk of depression and PTSD, some also reported on positive factors, such as improving work engagement by overcoming difficulties. Emergency professionals were also at risk for PTSD and depression, however, some reported that the risk was relatively low compared to other occupations. Conclusions: In the event of a disaster such as GEJE, many first responders were traumatized. Attention should be paid to the support of survivors during a disaster, but the health effects of workers involved in disaster response should also be addressed. In the future, it is necessary to establish a system to monitor and support the health of first responders.

Objectives: To examine the association between metabolic syndrome or its components, including central obesity, and domestic migration in the radiation decontamination workers. Methods: This study was conducted on male workers who engaged in decontamination work at Iitate Village, Fukushima Prefecture, Japan. Of 125 workers, 91 answered a question about their domestic migration. Metabolic syndrome was assessed based on the criteria of the Japanese Committee for the Diagnostic Criteria of Metabolic Syndrome, using their health checkup data from February through June 2017. We used logistic regression analysis to examine the associations of metabolic syndrome and its components with migration status. Results: Of the 91 workers, 32 (35.1%) were migrant workers. The age-adjusted odds ratios of domestic migrant workers for metabolic syndrome, central obesity, hypertension, glucose intolerance, and dyslipidemia were 1.75 (95% confidence interval (CI): 0.60–5.10), 2.45 (95% CI: 1.01–5.94), 1.07 (95% CI: 0.39–2.94), 0.40 (95% CI: 0.13–1.25), and 0.87 (95% CI: 0.34–2.20), respectively, compared to non-migrant workers. Conclusions: Domestic migrant radiation decontamination workers have a high prevalence of central obesity compared with non-migrant workers. Further longitudinal investigation is necessary for health promotion in domestic migrant workers.

The Japan Society for Occupational Health (JSOH) recommends the Occupational Exposure Limits (OELs) as reference values for preventing adverse health effects on workers caused by occupational exposure to chemical substances, continuous or intermittent noise, impulsive or impact noise, heat stress, cold stress, whole-body vibration, hand-arm vibration and time-varying electric, magnetic and electromagnetic fields and ultraviolet and ionizing radiation.

Objective: While the workplace wellness program (WWP) has been widely provided around the world, there was little discussion of ethical issues around WWP. This article describes the overview of how ethical issues arise in WWP, and how practitioners, as well as employers, can mitigate these problems. Methods: The author reviewed the literature addressing the ethical issues around WWP and ethical analytic tools, potentially useful for practitioners to improve WWP from ethical perspectives. Results: The ethical issues in WWP were categorized based on the three principles in bioethics: the principle of autonomy, the principle of beneficence/non-maleficence, and the principle of justice. For each category, various ethical concerns have been discussed in previous research, such as autonomous decision-making under financial incentives, the importance of evidence-based intervention, unexpected consequences of health promotion programs, and disparities among workers under WWP. The author also identified several useful tools and approaches, which practitioners can utilize for improving WWP from ethical perspectives. Conclusion: The employers and practitioners are recommended to conduct ethical analysis with multiple stakeholders to improve their WWPs from ethical perspective during the process of program development and implementation.

Objectives: Eucalyptus trees are used in the particleboard wood industry in Ethiopia. Dust and chemicals from this production may cause respiratory health problems, but the exposure levels have not been studied previously. The aim of this study was to assess workers’ exposure to inhalable dust, endotoxin, and formaldehyde in the two largest particleboard factories in Ethiopia, and compare the results with occupational exposure limits. Methods: A total of 152 inhalable dust and endotoxin samples were collected using a conductive plastic inhalable conical sampler (CIS), in addition to 45 formaldehyde samples using Dräger tubes for collection in two particleboard factories in Ethiopia. Linear mixed models were used to identify exposure determinants. Results: The geometric mean (GM) of inhalable dust exposure was 4.66 mg/m³ and 93% of the samples were above the threshold limit value of 1 mg/m³. For endotoxin exposure GM was 62.2 EU/m³, and 41% of samples were above the recommended occupational limit value of 90 EU/m³. Formaldehyde was added in a blending section of the production line, and the formaldehyde level was highest here (3.5 ppm). The level decreased at the workstations following blending, and 13% of the formaldehyde samples were above the peak exposure limit value of 1.0 ppm. Conclusions: The findings revealed exposure levels higher than recommended for inhalable dust, endotoxin, and formaldehyde in the particleboard factories. A reduction in dust, endotoxin, and formaldehyde exposure levels in these workplaces is recommended. We also recommend provision of proper personal protective equipment.

Objectives: Depression is pervasive among farmers. In the present study, we tried to clarify the effects of programs aimed at preventing chemical intoxication or improving communication skills on ameliorating depression in rice farmers with mild-to-moderate depression symptoms. Methods: Ninety-two rice farmers (mean age, 49.0 years old) with mild-to-moderate depression symptoms, as measured by the Center for Epidemiologic Studies Depression Scale (CES-D), were randomly assigned to either a program for preventing chemical intoxication or one for improving communication skills in the family for 6 weeks. The participants were then crossed over to the alternate program for an additional 6-week period. Both programs consisted of a lecture and small group discussion on the starting day and a home visit by village health volunteers 4 weeks from the starting day. Results: After participation in the program, the CES-D scores showed a significant decrease in both groups. No interaction was obtained between the two programs. The decreased CES-D scores in the program for improving family communication skills were significantly related to the changes in the total scores of scales for attitude and practice on improving communication skills, even after adjusting for personal and communication factors. The decreased CES-D scores in the program for preventing chemical intoxication were significantly related to the change in the total score of scale for practice on preventing chemical intoxication. Conclusion: The findings in this study suggest that programs for prevention of chemical intoxication or for improving family communication skills may be effective at improving the depressive state of rice farmers with mild-to-moderate depression symptoms.

Objectives: The aim of the study was to investigate the number of workplace measures implemented to respond to the COVID-19 epidemic reported by employees and their association with company size and industry among employees in Japan. Methods: A cross-sectional online questionnaire survey was conducted of full-time employees in Japan from March 19–22, 2020. Questions were about announcements by the company of measures taken and 23 items of workplace measures. Associations of company size and industry with the announcements and the number of workplace measures were analyzed. Results: The final sample consisted of 1,379 respondents. The mean number of implemented preventive measures for COVID-19 among 23 items was 11.2 (standard deviation, 5.9). Proportions of respondents who reported receiving announcement of measures taken was high (79.9%), as were proportions of respondents reporting implementation of some of the workplace measures, while the less than half reported implementation of most of the workplace measures. The announcement of measures and the number of workplace measures that were implemented in the workplace were generally lower/smaller among respondents in smaller companies and in retail, wholesale, and transportation industries. Conclusions: While most respondents reported receiving information about measures by their companies/organizations, it may be a further challenge to implement workplace measures in smaller companies and companies in retail, wholesale, and transportation industries.

Workstyle reform for Japanese doctors is a priority of Japanese labor policy. Factors influencing this include the low birthrate and longevity of the population and the long working hours experienced by Japanese workers. Long working hours imperil the health of doctors and create discord between their work and other life roles. The Japanese government enacted measures to promote workstyle reform for doctors, including a provision that capped legal overtime work. The limit was set to sustain healthcare services in the community. However, the allowed level of overtime is substantially higher than the so-called “line of karoshi” at which point worker compensation for work-related medical disorders is approved. Despite limited research, several measures can be considered to reduce health risks of overworked doctors, such as recommending psychological detachment from clinical work and maintaining work-life balance. Doctors should realize that self-care is a professional imperative. Organizational efforts from public administration entities or hospitals are required to secure the health of doctors. The number of surgeons and obstetricians has not recently increased. Gender role stereotyping has encouraged male Japanese doctors to work long hours and makes it difficult for female doctors to continue their professional life after childbirth. Without reforming the workstyle and protecting the health of doctors, younger workers, particularly women, are liable to avoid entering medical professions. To ensure the provision of good healthcare, it is necessary to change traditional values and improve the work environment. Academics in occupational fields should produce evidence that will help improve Japanese labor policies.

Objective: To examine the hypotheses that the depression prevalence would be lower in working cancer survivors compared to non-working cancer survivors and that the depression prevalence of working cancer survivors could be as low as that of the cancer-free general population. Methods: We used the PubMed database to search for relevant literature. Out of 299 matches to the used terms, 17 cross-sectional, quantitative studies that compared depression statuses of working cancer survivors with non-working cancer survivors or cancer-free general samples were considered. Results: In some studies, survivors of breast cancer, Hodgkin lymphoma, and hepatocellular carcinoma indicated a significantly lower depression prevalence compared to non-working survivors with the same cancer types. On the other hand, some studies did not demonstrate a significant difference in the association between depression prevalence and working status among breast cancer and head and neck cancer survivors. Working survivors of breast cancer and malignant brain tumor demonstrated significantly worse scores on the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) compared to the cancer-free general population. However, the depression prevalence was not compared. Conclusions: The existing literature did not consistently support our hypotheses. Working does not function as an absolute prevention method for depression in cancer survivors. Preventive measures against depression are necessary even after cancer survivors return to work. Further research is necessary to determine whether working is effective for preventing depression in cancer survivors.

Objectives: We prospectively examined the combined effect of high stress (i.e., being under great work-related stress), as defined in the Japanese Stress Check Program manual using the Brief Job Stress Questionnaire (BJSQ), and job dissatisfaction on long-term sickness absence lasting 1 month or more. Methods: Participants were 7,343 male and 7,344 female financial service company employees who completed the BJSQ. We obtained personnel records covering a 1-year period to identify employees with long-term sickness absence, which was treated as a dichotomous variable. Participants were classified into four groups (high-stress+dissatisfied, high-stress+satisfied, not high-stress+dissatisfied, and not high-stress+satisfied groups) to calculate the hazard ratios (HRs) of long-term sickness absence for these groups using Cox’s proportional hazard regression analysis. Furthermore, to examine whether the combined effect of high stress and job dissatisfaction is synergistic or additive, we calculated relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), synergy index (SI), and their 95% confidence intervals (CIs). Results: After adjustment for covariates, the HR of long-term sickness absence was highest among the high-stress+dissatisfied group (HR 6.49; 95% CI, 3.42–12.3) followed by the high-stress+satisfied group (HR 5.01; 95% CI, 1.91–13.1). The combined effect of high stress and job dissatisfaction was additive (95% CIs of RERI and AP included 0 and that of SI included 1). Conclusions: Our findings suggest incorporating high stress with job dissatisfaction improves the predictability of long-term sickness absence. However, employees reporting high stress but satisfaction with their jobs may still at increased risk of developing long-term sickness absence.

Objectives: To preliminarily determine the effects of an Internet-based cognitive behavioral therapy program for the stress management of new graduate nurses on improving depressive symptoms and other psychological outcomes using a pre-post experimental design. Methods: A 6-week, six-lesson Internet-based cognitive behavioral therapy program was developed through an extensive interviewing of nurses. The program utilized major cognitive behavioral therapy skills (self-monitoring, cognitive restructuring, assertiveness, problem-solving, and relaxation). We administered the Internet-based cognitive behavioral therapy program to participants who were at 5 months after starting their job. At baseline and post-intervention, we measured the primary outcome of depressive symptoms along with the secondary outcomes of psychological distress, dysfunctional attitude, and knowledge of and self-efficacy for the components of cognitive behavioral therapy. Results: Twenty-three new graduate nurses were recruited, although only 21 actually took part in the program. Twelve (57%) participants completed all six lessons, and about one-third of participants completed less than three lessons. At post-intervention, only 12 of the 21 participants had completed the post-intervention survey. The program failed to show significant intervention effects on depressive symptoms, psychological distress, and dysfunctional attitude, but it did show significant or marginally significant improvements in knowledge of and self-efficacy for most cognitive behavioral therapy components. Conclusions: The relatively low intensity of the program may explain the null findings. This suggests a need for further improvement of the content and mode of delivery. Nevertheless, the program was able to improve knowledge of and self-efficacy for most cognitive behavioral therapy components.