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1.  The possible absence of a healthy-worker effect: a cross-sectional survey among educated Japanese women 
BMJ Open  2012;2(5):e000958.
Objectives
Despite being highly educated in comparison with women in other member countries of the Organisation for Economic Cooperation and Development, Japanese women are expected to assume traditional gender roles, and many dedicate themselves to full-time housewifery. Women working outside the home do so under poor conditions, and their health may not be better than that of housewives. This study compared the self-rated health status and health behaviours of housewives and working women in Japan.
Design
Cross-sectional survey.
Setting
A national university in Tokyo with 9864 alumnae.
Participants
A total 1344 women who graduated since 1985 and completed questionnaires in an anonymous mail-based survey.
Primary and secondary outcome measures
Health anxiety and satisfaction, receipt of health check-ups, eating breakfast, smoking, and sleep problems according to job status and family demands: housewives (n=247) and working women with (n=624) and without (n=436) family demands. ORs were used for risk assessment, with housewives as a reference.
Results
After adjustment for satisfaction with present employment status and other confounding factors, working women were more likely than housewives to feel health anxiety (with family demands, OR: 1.68, 95% CI1.10 to 2.57; without family demands, OR: 3.57, 95% CI 2.19 to 4.50) and health dissatisfaction (without family demands, OR: 3.50, 95% CI 2.35 to 5.21); they were also more likely than housewives to eat an insufficient breakfast (with family demands, OR: 1.91, 95% CI 1.22 to 3.00; without family demands, OR: 4.02, 95% CI 2.47 to 6.57) and to have sleep problems (ORs: 2.08 to 4.03).
Conclusions
No healthy-worker effect was found among Japanese women. Housewives, at least those who are well educated, appear to have better health status and health-related behaviours than do working women with the same level of education.
doi:10.1136/bmjopen-2012-000958
PMCID: PMC3467618  PMID: 22964114
2.  Effort-reward imbalance and its association with health among permanent and fixed-term workers 
Background
In the past decade, the changing labor market seems to have rejected the traditional standards employment and has begun to support a variety of non-standard forms of work in their place. The purpose of our study was to compare the degree of job stress, sources of job stress, and association of high job stress with health among permanent and fixed-term workers.
Methods
Our study subjects were 709 male workers aged 30 to 49 years in a suburb of Tokyo, Japan. In 2008, we conducted a cross-sectional study to compare job stress using an effort-reward imbalance (ERI) model questionnaire. Lifestyles, subjective symptoms, and body mass index were also observed from the 2008 health check-up data.
Results
The rate of job stress of the high-risk group measured by ERI questionnaire was not different between permanent and fixed-term workers. However, the content of the ERI components differed. Permanent workers were distressed more by effort, overwork, or job demand, while fixed-term workers were distressed more by their job insecurity. Moreover, higher ERI was associated with existence of subjective symptoms (OR = 2.07, 95% CI: 1.42-3.03) and obesity (OR = 2.84, 95% CI:1.78-4.53) in fixed-term workers while this tendency was not found in permanent workers.
Conclusions
Our study showed that workers with different employment types, permanent and fixed-term, have dissimilar sources of job stress even though their degree of job stress seems to be the same. High ERI was associated with existing subjective symptoms and obesity in fixed-term workers. Therefore, understanding different sources of job stress and their association with health among permanent and fixed-term workers should be considered to prevent further health problems.
doi:10.1186/1751-0759-4-16
PMCID: PMC2990722  PMID: 21054838
3.  Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan 
BMC Palliative Care  2010;9:13.
Background
Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs) among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs.
Methods
This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155). We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs.
Results
We found that the physicians who were aware of the World Health Organization (WHO) analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79) more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness.
Conclusion
Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.
doi:10.1186/1472-684X-9-13
PMCID: PMC2901325  PMID: 20546626
4.  Competition or complement: relationship between judo therapists and physicians for elderly patients with musculoskeletal disease 
Objectives
Among the complementary and alternative medical services available in Japan, only judo therapists are covered under the national health-insurance program without a referral from a physician. Many orthopedists claim that judo therapists deprive them of potential patients. If such competition exists, fewer patients would be expected to visit orthopedists in areas where many patients visit judo therapists. Therefore, we examined the correlation between the number of patients visiting judo therapists and those visiting physicians for musculoskeletal diseases.
Methods
In a cross-sectional study covering each prefecture in Japan (n = 47), we obtained figures for the numbers of judo therapist facilities and elderly patients (over 70 years old) who visited them and the numbers of orthopedists and patients who visited physicians for musculoskeletal diseases. Correlations between the numbers of practitioners per 100,000 population and the numbers of their patients per 100,000 population were examined by prefecture.
Results
There were positive correlations between the numbers of judo therapist facilities and elderly patients who visited them (r = 0.72, P < 0.01, n = 47), and between the numbers of orthopedists and elderly patients who visited physicians for musculoskeletal diseases (r = 0.32, P = 0.03). However, there was no significant correlation between the numbers of elderly patients who visited judo therapist facilities and those who visited physicians (r = 0.06, P = 0.68) for musculoskeletal diseases.
Conclusions
This study did not find a negative correlation between the numbers of patients visiting judo therapists and patients visiting physicians for musculoskeletal diseases. Thus, these results do not support the orthopedists’ claim that the two services compete for patients.
doi:10.1007/s12199-007-0021-x
PMCID: PMC2698256  PMID: 19568896
Distribution; Health-care service; Judo therapist; Elderly patient; Orthopedist

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