Job stress in employees in hospitals has been recognized as a key issue in the workplace. In this paper, characteristics of job stress in the medical profession, especially in doctors and nurses, and the effectiveness of stress management are overviewed. The important points in stress management in hospitals are summarized as follows: 1) improvement of work environment, 2) assurance of participation and autonomy, 3) education or training to reduce job stress (ex. coping behavior, self-care, relaxation), 4) career development, 5) total support among medical professions. Some reports have demonstrated that the establishment of constant meetings is an effective method of reducing job stress and improving mental health in the medical profession, but few prospective intervention studies have been carried out. Further research is necessary to evaluate the effectiveness of stress reduction and to develop effective intervention programs for medical professions in hospitals.

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The authors conducted a survey in July 2001 to examine the present state and forthcoming problems facing occupational health physicians (OHPs). The establishments investigated were those which employed 1,000 or more workers and had consulted us for the employment of OHPs. The number of establishments chosen was 1,658. A questionnaire was sent to the division chiefs responsible for the health management of the establishments, and those who supervised the OHPs engaged in the establishments were asked to complete the questionnaire. The questionnaire included items about the attributes of the perspective establishments, the work of OHPs and the personnel management system for the OHPs. Four hundred and forty-seven establishments (27.0%) out a total of 1,658 returned eligible responses for further analysis, and the major results were as follows: First, 79.2% of the manufacturing establishments which responded comprised those which employed 1,000 or more workers, even though the percentage of companies which employ 1,000 or more workers throughout Japan is 62.5%. The percentage of the establishments which employed full time OHPs was 64.2% in secondary industries (mining, constructing and manufacturing), and higher than the 40.8% in tertiary industries (other than farming, forestry, fishing and secondary industries). Second, although OHPs properly coped with the obligatory issues regulated by the related laws, the OHPs who routinely consulted with workers about their work-related health problems were few (36.7%). Third, despite the low percentage of the establishments (23.5%) which had recognized OHPs' work to be part of enterprise management, the budget of the health care section was kept unchanged (55.0%). And, in 49.0% of the establishments, the nomination of OHPs was recognized to be necessary irrespective of the presence of the related laws, and OHPs were expected to cope with the work-related health problems of workers (62.9%). On the other hand, the personnel management system for OHPs was insufficient, and the performance rating for OHPs' activity was prepared for only 50.3% of the establishments. In addition, when the subjects were confined to regular OHPs, they were allowed to attend internal training courses for regular employees in only 25.0% of the establishments. Taking the above into account, the activity of OHPs has to be developed more in tertiary industries. OHPs may also be asked to positively cope with workers' work-related health problems. Simultaneously, the personnel management system for OHPs has to be arranged properly.

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Most companies utilize original questionnaires developed by the health-care staff to evaluate their workers' mental health status. To build effective strategies, it is crucial to use proper measures validated psychometrically. We demonstrated the process to evaluate the reliability and validity of the original health questionnaire developed by the health-care team of an industrial company. We used the Beck Depression Inventory-II, and the Job Content Questionnaire as the gold standards for external validation. Out of 21 items in the original health questionnaire, 9 items significantly correlated with depression. From the results of a factor analysis, the 9 items composed 2 independent components out of 5 factors. A subscale which consisted of the 9 items from the original questionnaire was proposed as a screening tool to detect depression, but no items of the original questionnaire correlate with the Support subscale nor the Job Control subscales of the JCQ. Just one item correlated with the Job Demand subscale of the JCQ. Additional information should be added to the original questionnaire to evaluate Job Stress based on the Karsek's Job Demand-Control-Support model.

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The influence of the "shukko" (temporary transfer) work system on health was examined. "Shukko" is a Japanese individual work system. The life-time employment system was general in Japan. "Shukko" work system was devised to reduce the number of personnel in Japan. "Shukko" personnel belong to their present company but they must do the work of another company. Generally, the disadvantages of "shukko" personnel are greater than in former "shukko". The subjects are 483 office workers in a certain industrial company. 143 workers work in a subsidiary of this company (Age: 42.2±5.5) (strategic shukko group), 30 workers work in the other company, having resigned their administrative post in the head office (55.6±2.1) (Demotion by the manager shukko group), and 310 workers work in the head office of this company (41.8±5.2) (head office working group). The medical examination results (degree of obesity, systolic blood pressure (SBP), GPT, GGTP, total cholesterol, triglyceride (TG), fasting blood sugar (FBS), uric acid (UA), electrocardiography (ECG), and gastrography were compared by mean of multiple regression analysis. In the "Demotion by the manager shukko" group, the average age and SBP were higher than in the other groups. (p<0.0001). The "strategic shukko" group was compared with the "head office working" group. There is no significant difference in average age. The average SBP (p<0.001) and EBS (p<0.0001) of the "head office working" group was significantly higher than those of the "strategic shukko" group. ECG findings were more serious in the "Demotion by the manager shukko" group than in the other groups (p<0.0001). There is a significant correlation between SBP and "degree of obesity, FBS and UA" (p<0.0001). There is significant correlation between FBS and "GGTP, SBP, UA, GPT and TG" (p<0.0001). And there is significant correlation between ECG findings and "working form and SBP" (p<0.05). The prevention and early diagnosis of geriatric diseases is important for the "Demotion by the manager shukko" group, and their average age is older than that of the other groups. A problem with the head office working group is obesity. In this group it is important to take into consideration life related diseases. The workers complaint a lot in the "strategic shukko" group, but there are no abnormal findings. We think that their complaints are due to their mental stress. In this group measuring mental stress is important.

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