Although the place of death of patients with terminal cancer is influenced by multiple factors, few studies have systematically investigated its determinants. The purpose of this study was to examine the influence of the patients' sociodemographic, clinical and support network variables on the place of death of terminally ill cancer patients under the care of home care agencies in Japan. Among 528 patients from 259 home care agencies, 342 (65%) died at home and 186 (35%) died at a hospital. From the multivariate logistic regression model, patients who expressed the desire for receiving home care at referral [odds ratio (OR), 95% confidence interval (CI): 2.19, 1.09-4.40] in addition to the family caregiver's desire for the same (OR, 95%CI: 3.19, 1.75-5.81), who had more than one family caregiver (OR, 95%CI: 2.28, 1.05-4.94), who had the support of their family physician (OR, 95%CI: 2.23, 1.21-4.08), who were never rehospitalized (OR, 95%CI: 0.04, 0.02-0.07), who received more home visits by the home hospice nurse during the stable phase under home hospice care (OR, 95%CI: 1.25, 1.02-1.53), and who were in the greatest functionally dependent status during the last week prior to death (OR, 95%CI: 8.60, 4.97-14.89) were more likely to die at home. Overall, this model could accurately classify 95% of the places of death, which is higher than other published studies. A clearer understanding of factors that might influence the place of death of terminally ill cancer patients would allow healthcare professionals to modify healthcare systems and tailor effective interventions to help patients die at their place of preference.

To investigate the relationships among the amount of job stressors, self-reported sleep quality, and daytime autonomic activities, a questionnaire survey was conducted for 223 healthy male white-collar workers, and their short-term heart rate variability (HRV) was also examined. Half of the subjects complained of nightly poor sleep quality. Self reported poor sleep quality was associated with a qualitative aspect of job stressors characterized by high amounts of "job difficulty", less amounts of "achievement in job", and less amounts of "support by colleagues", and also with high amounts of personal distress and difficulty in changing their mood. Those who complained of poor sleep quality exhibited sympathetic predominance and reduced heartbeat intervals at standing rest, although job stressors was not correlated to HRV. These results suggest that their job stress disrupts nightly sleep, and also that their insufficient sleep at night causes daytime sympathetic predominance.However, the amount of job stressors was not directly associated with HRV. Further studies should focus on the relationships among chronic job stress, the satisfaction of sleep demands, and the daily and long-term variation in cardiac autonomic activities.

To investigate the possible effects of long commuting time and extensive overtime on daytime cardiac autonomic activity, the short-term heart rate variability (HRV) both at supine rest and at standing rest of 223 male white-collar workers in the Tokyo Megalopolis was examined. Workers with a one-way commute of 90 min or more exhibited decreased vagal activity at supine rest and increased sympathetic activity regardless of posture, and those doing overtime of 60 h/ month or more exhibited decreased vagal activity and increased sympathetic activity at standing rest. These findings suggest that chronic stress or fatigue resulting from long commuting time or extensive overtime caused these individuals to be in a sympathodominant state. Although these shifts in autonomic activities are not direct indicators of disease, it can be hypothesized that they can induce cardiovascular abnormalities or dysfunctions related to the onset of heart disease.Assessment of the daily and weekly variations in HRV as a function of daily life activities (such as working, commuting, sleeping, and exercising) among workers in Asia-Pacific urban areas might be one way of studying the possible effects of long commuting time, and extensive overtime, on health.

A cross-sectional survey of regularly employed information technology (IT) engineers with preschool children in Japan was conducted to examine the gender difference in WFC, relationship of WFC with outcomes, and predictors of WFC by gender. Data from 78 male and 102 female respondents were analyzed. There was no significant gender difference in total level of WFC. However, the level of work interference with family (WIF) was significantly higher in males than in females and the level of family interference with work (FIW) was significantly higher in females. Regarding outcomes, WIF was significantly related to depression and fatigue in both genders. Moreover, different predictors were related to WIF and FIW by gender. A family-friendly culture in the company was related to WIF only in males. To prevent depression and cumulative fatigue in employees with young children, occupational practitioners have to pay attention to not only employees' work stress but also their family stress or amount of family role in both genders. (J Occup Health 2008; 50: 317-327)

Although the relationship between job stress and depressive symptoms has been well documented among workers in large scale enterprises, the situation in small-and medium-scale enterprises (SMEs) is not fully understood. Objectives: To clarify the factors associated with depressive symptoms in SMEs in Japan. Methods: 1,516 male and 738 female Japanese workers at SMEs were surveyed using a self-administered questionnaire. We applied hierarchical multiple linear regression with depressive symptoms (Center for Epidemiologic Studies Depressive Symptoms Scale) as the dependent variable, and (1) Individual, (2) Lifestyle, (3) Job stressors, and (4) SME unique factors as independent variables entered in 4 steps. Analyses were stratified by sex due to large differences in stress scores and demographic variables. Results: Perceived lack of understanding from others with regard to health was the strongest factor associated with increased depressive symptoms (BETA=0.29 in males and 0.28 in females). Higher intragroup conflict (BETA=0.15 in males and 0.09 in females), perceived job future ambiguity (BETA=0.09 in males and 0.11 in females), higher quantitative workload (BETA=0.06 in males and 0.10 in females), and being an employer or a member of the employer's family (BETA=0.06 in males and 0.10 in females) were additional factors associated with high depressive symptoms. Economic concern, being single, cigarette smoking, shorter sleep duration, and skill underutilization were male specific, while younger age and lower social support at work were female specific factors significantly associated with increased depressive symptoms. Conclusions: These data suggest that poor mental health may be prevented by creating a workplace climate which focuses on the high value of the health of fellow workers. (J Occup Health 2009; 51: 26-37)

Sleep debt on weekdays in Japanese white-collar workers, estimated using a questionnaire, was associated with age, overtime, and self-rated workload.

For the purpose of examining the relation of sleep problems and other possible correlates with smoking among staff nurses in hospitals, the cross-sectional data of a self-administered questionnaire survey for 522 Japanese female staff nurses were reanalyzed. Registered nurses or licensed practical nurses were 82%, while nursing assistants were 18%. The prevalence of current smoking (PCS) was 29%, being higher than that in the general population of Japanese women. The current smokers exhibited a high tendency toward tobacco dependence. Multivariate analyses revealed that PCS was associated with recent frequent night shifts and a large amount of support from coworkers, while the association of a large amount of job control and a feeling of light overnight sleep with PCS was also suggested. The tobacco-dependent tendency was associated with recent life events and the presence of insomnia. It is possible that smoking is a countermeasure against sleepiness caused by the disadaptation to shift-work, or that tobacco-intake pharmacologically disturbs sleep. For decreasing PCS in staff nurses, further research should focus on the relation of smoking with their sleepiness and shift-working system, and also on the process in which major life events develop smoking behaviors.

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