Journal of Occupational Health

Publisher: Japan Society for Occupational Health

Description

  • Impact factor
    1.63
  • 5-year impact
    1.80
  • Cited half-life
    10.00
  • Immediacy index
    0.14
  • Eigenfactor
    0.00
  • Article influence
    0.53
  • ISSN
    1348-9585
  • OCLC
    66371254
  • Material type
    Periodical
  • Document type
    Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: We evaluated the percutaneous absorption of N,N-dimethylformamide (DMF) in DMF-exposed workers in the summer and winter by assessing their urinary levels of DMF metabolites. Methods: Breathing-zone concentrations of DMF and workers' urinary levels of N-methylformamide (NMF) and N-acetyl-S-(N-methylcarbamoyl)-cysteine (AMCC) were simultaneously measured in the summer and winter in 193 male workers wearing a respirator and chemical protective gloves. Results: The mean breathing-zone concentrations of DMF in both seasons were below the occupational exposure limit of 10 ppm. Although there was no significant seasonal difference in the breathing-zone concentrations of DMF, workers' urinary levels of NMF and AMCC were significantly higher in the summer than in the winter. Log-transformed urinary levels of the metabolites were significantly correlated with log-transformed breathing-zone concentrations of DMF in the summer, whereas no significant correlation between AMCC and DMF was found in the winter. The urinary levels of AMCC were dispersed more widely than those of NMF, suggesting that urinary AMCC reflected the cumulative exposure to DMF over a workweek. Conclusions: Percutaneous absorption was the principal route of exposure to DMF for the respirator-wearing workers. Increased urinary levels of NMF and AMCC in the summer were attributed to increased percutaneous absorption of DMF resulting from the increased amount of water-soluble DMF absorbed by sweaty skin caused by the increased summertime room temperature and humidity.
    Journal of Occupational Health 05/2014;
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    ABSTRACT: Objectives: We previously reported a cluster of cholangiocarcinoma patients among proof-printing workers who were exposed to 1,2-DCP for a long term. The present study was conducted to evaluate blood parameters in these proof-printing workers during and after exposure. Methods: Health examination records during employment and after retirement were obtained for ten cholangiocarcinoma patients to analyze their blood parameters. The patients and/or their relatives were also interviewed about lifestyle and occupational history. Results: All study patients were exposed to 1,2-DCP for 6-17 years. Red blood cells, hemoglobin, hematocrit, total cholesterol, triglycerides, and fasting plasma glucose were within the standard ranges for almost all patients, but the γ-glutamyl transpeptidase (γ-GTP) levels exceeded the standard range during 1,2-DCP exposure for six patients. Two of the six patients were diagnosed with cholangiocarcinoma during 1,2-DCP exposure, and the other four patients were diagnosed 1-9 years after termination of exposure. The remaining four patients had γ-GTP levels within the standard range during 1,2-DCP exposure, but had increased γ-GTP levels thereafter, and were diagnosed with cholangiocarcinoma 4-10 years after termination of exposure. Aspartate aminotransferase and alanine aminotransferase levels started to increase following the increase in γ-GTP levels. Conclusion: Workers exposed to 1,2-DCP should be provided with periodic health examinations during and after exposure. In the examination, even small increases in γ-GTP levels should be considered a signal of early development of cholangiocarcinoma.
    Journal of Occupational Health 05/2014;
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    ABSTRACT: Objectives: There are high levels of global and national underemployment, but limited information is available on the impact of this phenomenon on the quality of employees' working lives. This study examines the relations among perceived employer support for creative work, different forms of underemployment and employee quality of life, including job satisfaction, perceived job security and job satisfaction. Methods: The study was performed using cross-sectional data from the Canadian 2010 Work and Lifelong Learning Survey (WALL), which included 1,042 randomly selected currently employed participants between the ages of 18 and 64 years of age. Results: The study found a significant inverse association between employer support for innovative work and different forms of underemployment. It also suggested a strong relationship between support for such work and participation in work-related informal learning. The results from this study confirmed the hypothesis that employer support for creative work is significantly associated with the quality of employees' working lives, as manifested through increased job security and job satisfaction. Employees experiencing greater support for workplace creativity report less job-related stress. The present study identified relatively low employer support for creative work and significant differences in the perception of support among managers and workers. Conclusions: The results of this study indicate that employer support for innovative work can mitigate significant underutilization of employee knowledge and skills. Such support can contribute to the reduction of job-related stress, increased job satisfaction and perceived job security. This kind of support can also improve the quality of life of employees and facilitate creativity and overall organizational and social development.
    Journal of Occupational Health 05/2014;
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    ABSTRACT: Objectives: To clarify effort-reward imbalance among eldercare workers in nursing homes and to examine the association between the effort-reward imbalance (ERI) and low back pain (LBP) among them. Methods: A total of 549 questionnaires were distributed to a random sample comprising 23% of the 79 special elderly nursing homes in Kagawa in 2013. A total of 467 eldercare workers (response rate 85%) participated in this study. Of the 467 eligible respondents, 372 (80%) completed all items of the ERI questionnaire. Complete data were available for 342 (73%) eldercare workers. Results: Of the 342 respondents, 215 (63%) had LBP at the time of the study, and 291 (85%) showed a critical "high cost/low gain" condition as determined by an effort-reward ratio >1. Multiple logistic regression analyses adjusted for age, gender, previous LBP experience, high-risk work and K6 score showed that eldercare workers with a high ERI had a higher risk for LBP than workers with a low ERI (OR, 1.96; 95% CI, 1.02-3.77). Conclusion: Most eldercare workers have a high ERI, and their LBP is associated with their ERI. Balancing effort and reward may be an important factor for improving LBP among eldercare workers in nursing homes.
    Journal of Occupational Health 04/2014;
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    ABSTRACT: Objectives: The aim of the present study was to develop standardized cost estimation tools that provide information to employers about occupational safety and health (OSH) activities for effective and efficient decision making in Japanese companies. Methods: We interviewed OSH staff members including full-time professional occupational physicians to list all OSH activities. Using activity-based costing, cost data were obtained from retrospective analyses of occupational safety and health costs over a 1-year period in three manufacturing workplaces and were obtained from retrospective analyses of occupational health services costs in four manufacturing workplaces. We verified the tools additionally in four workplaces including service businesses. Results: We created the OSH and occupational health standardized cost estimation tools. OSH costs consisted of personnel costs, expenses, outsourcing costs and investments for 15 OSH activities. The tools provided accurate, relevant information on OSH activities and occupational health services. Conclusions: The standardized information obtained from our OSH and occupational health cost estimation tools can be used to manage OSH costs, make comparisons of OSH costs between companies and organizations and help occupational health physicians and employers to determine the best course of action.
    Journal of Occupational Health 04/2014;
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    ABSTRACT: Objective: In order to safely manage nuclear power plants, their workforce should be mentally healthy. This study clarifies the coping strategies of radiation control personnel and nondestructive inspectors engaged in the periodic inspection of nuclear power plants, the effect of the coping strategies on their mental health, as well as any effect based on whether or not they had worked after the nuclear disaster caused by the Great East Japan Earthquake and tsunami in March 2011. Methods: A questionnaire survey was administered to 133 technicians attending a certification course, and among them, our subjects of analysis were 104 people with work experience in radiation control and/or nondestructive inspection. Results: The results indicated that even among workers of the same company who were assigned to similar duties in the periodic inspections of nuclear power plants, the group that had worked at a nuclear plant after the disaster had a tendency to use coping strategies, such as giving up and avoidance-like thinking, which was dissimilar to the group that had not worked at a nuclear plant after the disaster. Further, the former group had higher levels of distress than those who tended to use other coping strategies. In addition, the results suggested that the plan-drafting strategy adopted by the group that had not worked after the disaster did not result in stress reduction. Discussion: Based on these results, we propose a stress management program specifically for radiation workers.
    Journal of Occupational Health 04/2014;
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    ABSTRACT: Backgrounds: Two-component acrylic resin used in nail art and dentistry can cause allergic contact dermatitis (ACD), but only a few reports from Japan have been published. Cases: A 35-year-old female manicurist (case 1) and 30-year-old female dental hygienist (case 2) were diagnosed with ACD caused by ethyl methacrylate and methyl methacrylate in a liquid monomer of two-component acrylic resin respectively. Case 1 was sensitized from direct skin contact with nail art acrylic products, which could have been avoided, and gave up both being a manicurist and a user. Onset in case 2 occurred when she started to work as an apprentice. She had believed that the cause of her symptoms was use of disposable natural rubber gloves, not a liquid monomer penetrating through her gloves, until she was patch tested positive to (meth)acrylates and liquid monomer. Conclusions: To prevent sensitization, it should be emphasized in occupational training in both specialties that there should be no direct contact with acrylic products and that disposable gloves do not have sufficient protecting properties.
    Journal of Occupational Health 04/2014;
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    ABSTRACT: Objective: Occurrence of cholangiocarcinoma was recently reported at a high incidence rate among the employees working for an offset printing company in Osaka, Japan. 1,2-Dichloropropane (1,2-DCP) and dichloromethane (DCM) are suspected to be the causes of the cancer, as they had been used as ink cleaners in large amounts. However, it is not clear whether these chlorinated organic solvents played a role in the occurrence of cholangiocarcinoma or why the incidence rate is so high among the workers in this industry. To provide possible evidence for this severe occupational problem, we investigated the genotoxic effects of 1,2-DCP and DCM. Methods: Male B6C3F1 and gpt Delta C57BL/6J mice were exposed by inhalation to the individual solvents or both solvents at multiple concentrations including the levels that were possibly present in the workplaces. The genotoxicity was analyzed by Pig-a gene mutation and micronuclei assays in peripheral blood and gpt mutation and comet assays in the livers of mice after repeated inhalation of 1,2-DCP or/and DCM. Results: The Pig-a mutant frequencies and micronuclei incidences were not significantly increased by exposure of either 1,2-DCP or/and DCM at any concentration, suggesting there was no genotoxic potential in bone marrow for both solvents. In the liver, DNA damage, as measured by the comet assay, was dose dependently increased by 1,2-DCP but not by DCM. The gpt mutant frequency was 2.6-fold that of the controls in the co-exposure group. Conclusions: These results indicate that 1,2-DCP showed stronger genotoxicity in the liver and that the genotoxic effects were greatly enhanced by simultaneous exposure to DCM.
    Journal of Occupational Health 04/2014;
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    ABSTRACT: Objectives: The aim of this study was to investigate the association between skill underutilization, a psychological job stressor proposed in the NIOSH (National Institute for Occupational Safety and Health) job stress model, and the prevalence of hypertension. Methods: We studied sitting blood pressure and fasting blood laboratory parameters in 3,429 inhabitants of the town of Watari during annual health check-ups in 2010. A questionnaire was administered to examine job status, weekly working hours and degree of skill utilization. We divided subjects into tertiles according to skill utilization score. Multivariate logistic regression analysis was performed using prevalent hypertension as the dependent variable. Results: Questionnaires were collected from 2,550 individuals. After excluding those who were not in paid employment and those with missing data, 1,075 permanent or part-time workers were included in the final analysis. The odds ratio for the presence of hypertension was significantly higher in the lowest tertile of skill utilization score compared with the highest tertile (1.776; 95% confidence interval, 1.137-2.796) after adjusting for age, sex, body mass index, low-density lipoprotein cholesterol level, triglyceride level, current smoking status and daily alcohol intake. Conclusion: Skill underutilization was associated with a higher prevalence of hypertension in a working population including various kinds of occupations.
    Journal of Occupational Health 03/2014;
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    ABSTRACT: Objectives: This study evaluated the levels of exposure to polycyclic aromatic hydrocarbons (PAHs) and their relationship with oxidative DNA damage among Vietnamese coke-oven workers. Methods: We collected urine from 36 coke-oven workers (exposed group) at the beginning and end of the shift on 2 consecutive days. We also collected urine from 78 medical staff (control group). Information was collected by questionnaire about smoking status, drinking habit, and working position. Urinary 1-hydroxypyrene (1-OHP) and 8-hydroxydeoxyguanosine (8-OH-dG) were measured using HPLC. All statistical analyses were performed with SPSS version 19. Results: Urinary 1-OHP was significantly higher in the coke-oven workers than in the control group (p<0.05). Top-oven workers had the highest levels of internal exposure to PAHs, followed by side-oven and then bottom-oven workers (5.41, 4.41 and 1.35 ng/mg creatinine, respectively, at the end of the shift on day 2). Urinary 8-OH-dG was significantly higher in top- and side-oven workers at the end of the shift on day 2 (4.63 and 5.88 ng/mg creatinine, respectively) than in the control group (3.85 ng/mg creatinine). Based on a multi-regression analysis, smoking status had a significant effect on urinary 8-OH-dG (p=0.049). Urinary 1-OHP tended to have a positive correlation with urinary 8-OH-dG (p=0.070). Conclusions: Vietnamese coke-oven workers were exposed to PAHs during their work shift. Urinary 1-OHP exceeded the recommended limit, and elevated oxidative DNA damage occurred in top- and side-oven workers on the second day of work. A tendency for positive correlation was found between urinary 1-OHP and urinary 8-OH-dG.
    Journal of Occupational Health 03/2014;
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    ABSTRACT: Objectives: Asbestos causes lung cancer and malignant mesothelioma, and chronic inflammation is considered to participate in carcinogenesis. However, biomarkers to evaluate its carcinogenic risk have not been established. Reactive oxygen/nitrogen species are generated in biological systems under inflammatory conditions and may contribute to carcinogenesis by causing DNA damage. In this study, we examined the relationship between the formation of 8-nitroguanine (8-nitroG), a mutagenic DNA lesion formed during inflammation, and asbestos contents in human lung tissues. Methods: We obtained non-tumor lung tissues from patients with (n=15) and without mesothelioma (n=21). The expression of 8-nitroG and related molecules was examined by immunohistochemistry, and their staining intensities were semiquantitatively evaluated. Asbestos contents in lung tissues were analyzed by analytical transmission electron microscopy. Results: In subjects without mesothelioma, staining intensities of 8-nitroG and apurinic/apyrimidinic endonuclease 1 (APE1) were significantly correlated with total asbestos and amphibole contents (p<0.05), but not with chrysotile content. In mesothelioma patients, their staining intensities were not correlated with asbestos contents. The double immunofluorescence technique revealed that APE1 was expressed in 8-nitroG-positive cells, suggesting that abasic sites were formed possibly due to the removal of 8-nitroG. The staining intensities of 8-oxo-7,8-dihydro-2'-deoxyguanosine, an oxidative DNA lesion, and its repair enzyme 8-oxoguanine DNA-glycosylase were correlated with age (p<0.05), but not with asbestos contents in subjects without mesothelioma. Conclusions: This is the first study to demonstrate that 8-nitroG formation is associated with asbestos contents in human lung tissues. This finding raises a possibility that 8-nitroG serves as a biomarker that can be used to evaluate asbestos exposure and carcinogenic risk.
    Journal of Occupational Health 03/2014;
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    ABSTRACT: Objective: Hairdressers have a high incidence of occupational diseases, owing to excessive wet work and exposure to chemical substances. The objective of this study was to assess the prevalence of occupational diseases in a population of self-employed hairdressers, matched for age and sex with a control group of wage-earning hairdressers. Method: A health questionnaire was administered to both groups by an occupational health practitioner. Results: Irritative skin diseases were reported by 1.5% of the self-employed hairdressers versus 9.1% of the wage earners. Conversely, the rates of respiratory diseases and cumulative musculoskeletal injuries were much higher among self-employed hairdressers. Conclusions: This study shows that the overall health of self-employed hairdressers is lower than that of their wage-earning counterparts. This can be attributed to several aspects of work exposure, organization, including longer working hours, fewer protective measures and the absence of preventive medicine in the workplace.
    Journal of Occupational Health 03/2014;
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    ABSTRACT: Background: The Work Limitations Questionnaire (WLQ) was recently developed to measure health-related decrements in ability to perform job roles among employed individuals. The purpose of this study was to develop and test a Japanese version of the WLQ. Methods: Developing the Japanese version of the WLQ involved translations, back-translations, and a pilot study. Using data obtained from a nationwide survey, 4,600 people aged ≥ 20 years were selected from the entire population of Japan by stratified random sampling. We ultimately used data from a total of 1,358 workers out of 2,266 subjects who filled out the self-administered questionnaire. We computed the proportion of missing data, measured internal consistency reliability, and tested for convergent and discriminant validity, concurrent validity, known-groups validity, and the factor structure of this instrument. Results: For the Japanese version of the WLQ, the percentages of missing values for each scale ranged from 3.6% to 7.8%. Internal consistency reliability was high, and Cronbach's α was ≥ 0.7 for all subscales. Subjects with headache and orthopedic pain had significantly higher WLQ subscale scores than subjects without. Higher WLQ subscale scores were associated with depressive symptoms as measured with the Hospital Anxiety and Depression Scale (p<0.001). Conclusions: The Japanese WLQ provides reliable and valid information on at-work disability for group-level comparisons and tracking therapeutic outcomes.
    Journal of Occupational Health 02/2014;
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    ABSTRACT: Objectives: This study examined the changes in neck and back pain visual analog scale (VAS) scores, cervical range of motion (CROM), cervical flexion?relaxation ratio (FRR) and lumbar FRR after below-knee assembly work. Methods: Fifteen young male workers were recruited. Neck and back pain VAS scores, active CROM and cervical and lumbar FRRs were measured in all subjects once before and once after 10 minutes of below-knee assembly work. Results: The VAS scores for both neck and back pain increased significantly with below-knee assembly work. The CROM for all measures decreased significantly with below-knee assembly work. Both the cervical and lumbar FRRs on the left and right sides decreased significantly with below-knee assembly work. Conclusion: We postulate that 10 minutes of below-knee assembly work can increase neck and back pain and cause changes in the active CROM and cervical and lumbar FRRs.
    Journal of Occupational Health 02/2014;
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    ABSTRACT: The aim of the study was to assess both personal and occupational risk factors for non-specific neck disorder (ND) in a representative working population characterized by various levels of exposure to work-related constraints. ND during the preceding 7 days was assessed in 3,710 workers surveyed by 83 occupational physicians between 2002 and 2005. Personal risk factors and work exposure were assessed by a standardized examination and a self-administered questionnaire. Associations between ND and personal and occupational factors were analyzed using logistic regression modeling separately in men and in women. Results: The personal risk factors for ND were age (OR for 1-year increment 1.02, 95% CI 1.01 to 1.03 in men and 1.03 [1.01-1.04] in women) and previous history of arthritis disease (OR 2.39 [1.17-4.91] in men and 3.95 [1.92-8.12] in women). The risk of ND increased with previous history or upper limb musculoskeletal disorders in men (OR 1.58 [1.17-2.13]) and decreased with BMI in women (OR for 1-kg/m2 increment 0.96, [0.93-0.99]). The work-related risk factors of ND were sustained or repeated arm abduction (OR 2.08 [1.35-3.21] in men and 2.22 [1.27-3.86] in women) and neck flexion (OR 1.64 [1.26-2.12] in women). Work pace dependent on customers (OR 1.42 [1.10-1.83]) and psychological demand of the task (OR 1.49 [1.15-1.92]) increased the risk of ND in men. Work pace dependent on quantified targets (OR 1.37 [1.05-1.79]) and low supervisor support (OR 1.68 [1.30-2.17]) increased the risk of ND in women. This study highlighted the multifactorial nature of ND.
    Journal of Occupational Health 02/2014;
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    ABSTRACT: Objectives: Previously, the author reported a cluster of 11 cholangiocarcinoma cases exposed to 1,2-dichloropropane (1,2-DCP) and/or dichloromethane (DCM) in an offset proof-printing company. Before that report, the association between the two chemicals and cholangiocarcinoma had not been known. The current study describes two cholangiocarcinoma patients exposed to 1,2-DCP or DCM in different offset printing companies. Methods: The author obtained medical records for the patients, and interviewed the surviving patient and a relative of the deceased patient about their occupational history. Results: Case 1 was a man born in 1950. He worked in the printing section in a proof-printing company for 26 years. He was diagnosed as cholangiocarcinoma in 1998 and died in 2000. In proof-printing operations, he used gasoline for 14 years and 1,2-DCP for 11 years to remove ink from a rubber transcription roller (blanket). The exposure concentration of 1,2-DCP was estimated to be between 72 and 5,200 ppm. Case 2 was a man born in 1963. He worked in the printing section in a general offset printing company for 11 years. He was diagnosed with cholangiocarcinoma in 2007. In printing operations, he used both kerosene and a mixture of 50% DCM and 50% 1,1,1-trichloroethane (1,1,1-TCE) for 11 years to remove ink from a blanket. The exposure concentration of DCM was estimated to be between 240 and 6,100 ppm. He was simultaneously exposed to similar levels of 1,1,1-TCE. Conclusion: Because the offset printing process may cause cholangiocarcinoma, occupational history should be examined for patients with this cancer.
    Journal of Occupational Health 02/2014;
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    ABSTRACT: Aims: The aim of this study was to investigate age-related differences in the relationship between work-related factors and heavy drinking. Methods: This study in 3398 male workers at a factory in Japan examined data on heavy drinking, defined as an alcohol consumption >40 g/day, and work-related factors including occupation, shift work, and job stress evaluated using the Japanese version of the Karasek's Job Content Questionnaire (JCQ). In the present cross-sectional study, alcohol consumption was assessed using a self-administered diet history questionnaire (DHQ). Results: The prevalence of heavy drinkers in the study population was 15.5% and rose with increasing age. An increase in the odds ratio (OR) for heavy drinking was observed consistently in blue-collar workers compared with white-collar workers in all age groups. In subjects aged 20-29 years, shift work had also increased the OR for heavy drinking. In subjects aged 40-49 years, the two groups with a lower decision latitude had an increased OR compared with the highest group. The adjusted OR for individuals who received the lowest level of social support in the workplace was increased significantly compared with the highest group (4.22 [95%CI, 1.07-16.62]). On the other hand, social support showed a positive association with heavy drinking in subjects aged 40-49 and 50-59 yr. Job demand was not related to heavy drinking in any of the age groups. Conclusion: Our findings suggest that occupation and work schedule are related to alcohol use more apparently in a younger age group and that psychosocial factors are related to enhancement or prevention of alcohol use.
    Journal of Occupational Health 02/2014;
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    ABSTRACT: Objectives: Breast cancer (BC) is a cancer that affects working age women in Japan. The aim of this study was to examine the impact that BC has on the work-related life of Japanese women and identify factors that correlate with job resignation. Methods: A cross-sectional Internet survey of cancer survivors in Japan was conducted from December 2011 to February 2012. The questionnaire included questions regarding demographic characteristics, impact of cancer diagnosis and treatment on job resignation and consultation behavior of respondents regarding work-related issues. This study reports results obtained from 105 respondents with BC. Results: The mean age of respondents at diagnosis was 42.5 ± 6.4 years, and the median time since diagnosis was 40 months. Thirty-one respondents (29.5%) lost their jobs, and 12 could not find another job after BC diagnosis. Nearly half of the respondents (47.6%) reported a decrease in personal income after diagnosis. Multiple logistic regression analysis revealed that contract or part time workers were significantly more likely to lose their jobs compared with regular, full time workers (odds ratio, 2.52; 95% confidence interval, 1.39 to 4.55; P < 0.001). Seventy-nine respondents (75.2%) consulted someone regarding work-related issues. The most frequently consulted person was the boss at the workplace. Conclusions: Our findings suggest that women with BC experience various job-related problems. In order to create a supportive work environment for BC survivors, focus should be placed on facilitating communication and coordination between BC survivors, health-care providers and coworkers.
    Journal of Occupational Health 01/2014;
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    ABSTRACT: Objectives: Several previous studies showed that the lack of organizational justice was associated with poor mental health. However, no study examined the effect modification by internal factor, such as coping strategies, on the association of organizational justice with mental health. The purpose of the present study was to investigate the effect modification by coping strategies on the association of organizational justice with psychological distress. Methods: A total of 471 men and 764 women from a manufacturing company in Japan completed self-administered questionnaires, including the Organizational Justice Questionnaire, K6 scale (i.e., psychological distress scale), Brief Scales for Coping Profile, and demographic characteristics. Multiple logistic regression analyses were conducted for each coping strategy. Results: After adjusting for demographic characteristics, the association of the lack of procedural justice with psychological distress was greater among the low changing a point of view group than among their counterparts. Furthermore, the interaction term of procedural justice with changing a point of view was significant. The association of the lack of procedural justice and interactional justice with psychological distress was also greater among the high emotional expression involving others group than among their counterparts, while the interaction terms of procedural justice and interactional justice with emotional expression involving others were marginally significant. Conclusions: Positive emotion-focused coping strategies, such as changing a point of view, may effectively prevent psychological distress when there is a lack of organizational justice, while problem-focused coping strategies may have no effects, and negative emotion-focused coping strategies, such as emotional expression involving others, may have harmful effects on the association.
    Journal of Occupational Health 01/2014;