Hot Topic : The Tokyo Declaration on Prevention and Management of Work- Related Cardiovascular Disorders...

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Adopted by the Plenary of the Sixth ICOH International Conference on Work Environment and Cardiovascular Diseases under the auspices of the ICOH Scientific Committee on Cardiology in Occupational Health in Tokyo, Japan on March 30th 2013.

Cardiovascular disorders (CVDs) constitute a major burden for health of working populations throughout the world with as much as 50% of all causes of death and at least 25% of work disability. According to research data about 10 to 20% of all causes of CVD deaths among the working age populations can be attributed to work, i.e. are work-related. The loss of work days and work ability is likely to be substantially greater.

While CVD mortality is declining in developed countries, trends in incidence and prevalence are not parallel across age- and gender-groups, geographical areas, sectors of the economy or among certain occupational groups. In industrialized countries, while CVD mortality and myocardial infarction incidence are decreasing, some data indicate that if the acute coronary syndrome are included in the endpoint, the trends get flat, having as a net effect the increase in prevalence of the chronic forms of the disease, with its consequences in terms of returns to work.

Also there are some changes in CVD incidence among occupational classes. This is mainly due to the new types of work-related causes of morbidity associated with the recent developments in global work life; particularly in the industrialized countries, which give rise to psychosocial and physical risk factors in the work environment such as growing competition and time pressures, productivity pressures, continuous organisational changes, re-engineering and downsizing, lean production, job insecurity and threat of unemployment, introduction of new technologies and increase of sedentary work, changing patterns of working hours and partially extensive working hours. Meanwhile, in the developing countries or those in transition (e.g., Eastern Europe), CVD mortality is increasing due to major socioeconomic changes, the demographic transition and rapid industrialisation and urbanisation all leading to growing challenges to cardiovascular health.

Ageing of working populations and life style risk factors such as low-level physical activity during leisure time enhance the risk of CVDs and are often in complex interaction with the work-related factors. For example, certain working conditions may be important determinants of obesity, due to sedentary labour and promotion of unhealthy behaviours at work (e.g., stress-related eating) and through them, determinants of workers’ cardiovascular health as well.

Available research data suggest that about 80% of CVD mortality is preventable if the existing knowledge could be effectively used for system-wide implementation of prevention and health promotion programmes. Some countries have shown convincing examples of such system- wide impact.

The obstacles of achieving such wide-scale impact are less due to lack of knowledge or standardised methods than to lack of awareness, lack of policies and their implementation into practice and shortage of infrastructures and human resources needed for wide-scale and long-term programme implementation.

6th ICOH International Conference Panel on Kivimaki Article...

6th ICOH International Conference on Work Environment and Cardiovascular Diseases panel on the Kivimaki article, which recently appeared in Lancet in 2012, demonstrating a statistically significant relationship between Job Strain and Cardiovascular Disease in a meta analysis of 116,000 European working people.

Repeated Job Strain and the Risk of Depression: Longitudinal Analyses From the Whitehall II Study...

A new article has been published by the APHA on the powerful impact of job strain on mental health outcomes such as depression (see Abstract below).
Stephen A. Stansfeld, PhD, Martin J. Shipley, MSc, Jenny Head, MSc, and Rebecca Fuhrer, PhD

Stephen A. Stansfeld is with the Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, UK. Martin J. Shipley and Jenny Head are with the Department of Epidemiology and Public Health, University College London Medical School, London. Rebecca Fuhrer is with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
S. A. Stansfeld conceptualized and designed the study, interpreted the data, and wrote the first draft of the article. M. J. Shipley carried out the analyses and contributed to their interpretation. Jenny Head contributed to the analyses and to their interpretation. Rebecca Fuhrer codesigned the study and contributed to the analyses and the interpretation of the data. All authors contributed to writing the article.


Objectives. We addressed whether repeated job strain and low work social support increase the risk of major depressive disorder (MDD).
Methods. We used work characteristics from Karasek’s Job Strain model, measured on 3 occasions over 10 years in a cohort of 7732 British civil servants, to predict subsequent onset of MDD with the Composite International Diagnostic Interview.
Results. Repeated job strain was associated with increased risk of MDD (odds ratio [OR] = 2.19; 95% confidence interval [CI] = 1.48, 3.26; high job strain on 2 of 3 occasions vs none) in a fully adjusted model. Repeated low work social support was associated with MDD (OR = 1.61; 95% CI = 1.10, 2.37; low work social support on 2 of 3 occasions vs none). Repeated job strain remained associated with MDD after adjustment for earlier psychological distress.
Conclusions. Demonstration of an increased association for repeated job strain adds to the evidence that job strain is a risk factor for depression. Recognition and alleviation of job strain through work reorganization and staff training could reduce depression in employees.


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